PMT16-02765 City of Menifee Permit No.: PMT16-02765
29714 HAUN RD. Type: Pool/Spa-Residential
`tXCCEL:A—> MENIFEE, CA 92586
MENIFEE Date Issued: 08123/2016
P E R M I T
Site Address: 28892 EVENING PASSAGE DR, Parcel Number: 372-351-017
MENIFEE, CA 92584 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL AND SPA,430 SF,WITH 30'U/G GAS LINE FOR FIRE PIT
Work:
Omer Contractor
ROXANA CARPENTER PACIFIC COAST POOLS INCORPORATED
28892 EVENING PASSAGE DRIVE 43020 BLACKDEER LOOP#106
MENIFEE, CA 92584 TEMECULA,CA 92590
Applicant Phone:9512960199
BRANDY CORAL License Number!852237
PACIFIC COAST POOLS ING DBA PREMIER POOLS&SPA,'
43020 BLACKDEER LOOP#106
TEMECULA, CA 92590
Fee Description Oty Amount
Swimming Pool/in-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Electrical 1 23.35
$638.35
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errom in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA.BidgPermil—Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contnictur(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of.Division 3 ofthe Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license Is In full force and effec L the following reason:
License Class cs :�6 License No. FG-2'-Z.�57 By my signature below I acknowledge that,except for my personal residence
Expires L 95: Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKEWS COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
ci I hereby affirm under pena Ity of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is ava liable upon request when
compensation,issued by the Director of Industrial Relatilons as provided for this application is submitted or at the followling website:
by Section 3700 of the Labor Code,for the performance of work for which www.Ieainfo.ca.Rov/caIaw.htmL
this permit is issued.
Policy# —Date -6 (Z-21
ci I have and will maintain worker's compensation insurance,as required by PROP TY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following;I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's beha If.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires entep boveldentifie property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROP EIJTYbWNER OR AUTHORIZED AGENT
a I certify that in the performance of the work for which this permit is issued,
Ishallitotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the w"ker's compensation provisions of Section 3700 of the Labor
Code,I hall th those provisions. Will the applicant or future building occupant handle hazardous material or a
Dat W mixture containing a hazardous material equal to or greater that the
Applicant e amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0yes
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of tile building by the applicant or future building
AN D CIVIL FINES UP TO ON E HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR CoastAirQuali Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LA13OR CODE,INTEREST�AND ATTORNEYS FEES forguldeli
CONSTRUCr[ON LENDING AGENCY a Yes a No
I hereby affirm that under the penalty of perjury there Is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer bound of a school?
(Section 3097 Civil Code) ci Yes ci or
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 2550S and 25534 concerning
Contractor's License Law for the reason(s)Indicated below by the hazardous ma eri.al r Ing.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ciYes a ff.� !��--Z-:�— I
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish o r repair any structure,prior to its PROPERTY OWN ER OA AUTHORIZED AGENT
issuance,also requires the appl!ca nt for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
a 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA!s Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.Roy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a a An EPA Lead-Safe Cerrified Renovator will be responsible for this project
property who,through employeae or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or Improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ci No EPA Lead-Safe Certified Firm Is required for this project because:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION City of menifee
AUG 2 3 2016
Wentee
DATE ftq�, a3t ZC)t(,6 PERMIT/IPLAN CHECK NUMBER Received
I �
TYPE: OCOMMERCIAL ORESIDENTIAL CIVULTI-FAMILY OMOBILEHOME 40-0�0L/SPA OSIGN _
SUBTYPE: OADDITION 0ALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORKRia 12
PROJECTAIDDRESS )0v `t9e0H
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS
PHONE %T� EMAIL
JAPPLICANTINAME
ADDRESS
PHONE EMAIL
CONTRACTOWS NAME OWNER BUILDER? 0 YES
BUSINESS NAME
ADDRESS
PHONE 63/ Sl EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALLIATION$ SQ FT 613D L SO,FT
APPLICANT'S SIGNATURE DATE
CJTY STAFF USE ONLY
DEPARTMENT DISTRIBUTION WEE BUSINESS ULI,Nbl,NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT 0 CAS
AMOUNT 10� H OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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