PMT16-02834 City of Menifee Permit No.: PMT16-02834
29714 HAUN RD. Type: Pool/Spa -Residential
<ACCIELA�' MENIFEE, CA 92586
MENIFEE Date Issued: 08/29/2016
P E R M I T
Site Address: 28183 CIDER ST, MENIFEE, CA 92585 Parcel Number: 329-370-021
Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INSTALL INGROUND POOL 450 SOFT NO GAS
Work:
Owner Contractor
DANIEL SPICER VACATION POOLS INC
28183 CIDER ST P 0 BOX 10940
MENIFEE,CA 92585 INDIO, CA 92202
Applicant Phone:7607750468
JOHN PAOMIERI License Number: 856835
VACATION POOLS INC
44907 GOLF CENTER PARKWAY STE#9
INDIO, CA 92202
Fee Description Qtv Amount
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Electrical 1 23.35
$522.35
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 buillding 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 Bldg_Pemit—Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perju ry that I am under provisions of
Chapter9(commencing with section 7000)of Diviision 3 of the Business and u I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect 'k the following reason:
License Clam 10__5�3 By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
2 improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COlyl-DECLAIZION have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty 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 available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca.goy/calaw.html.
this permit is issued.
Date
Policy# PROPERTY OWNER OR AUTHORIZED AGENT
ci I have and will maintain workees compensation insurance,as required by
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 insuraince carrier and policy owner or authorized to act on the property ownees behalf.I have read this
number ' I application and the information I have provided is correct.I agree to comply
a:, with all applicable city and county ordinances and state laws relating to
Carrier _Q building construction.I authorize representatives of this city or county to
Policy#-C_/Qu-XM6q-7 C4YExpilres —AI enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in performance of the work for which this permit is issued,
I shall not emplov y 11 . ny manner so as to become subject to the CITY BUSINESS LICENSE#
any ers sma
t_ 1, f California,and agree that if I should became
. a;,..sn'
worker's comp n I AZARDOUS MATERIAL DECLARATION
subject to th;t�: s coppensation provisions of Section ROO of the Labor
Cade,ishall,ortz thA mply with thosAprovisions. Will the applicant or future building occupant handle hazardous material are
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts spVfied on the Hazardous Materials Information Guide?
/7/c/ —
WARNING:�FAILURETO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes '�No
UNLAW L,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES
Will the intended use of the building by the applicant or future building
ANDCI IL FINES UP TOONE 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 Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTERM,AND ATTORNEYS FEES forguldelin �
,las
CONSTRUCTION LENDING AGENCY a Yes ro
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 Iso cl of a school?
(Section 3097 Civil Code) 0 Yes 070
OWNER BUILDER DECLARATIONS I have rea e Haza dous Material Information Guide and the SCAQMD
I ',st
Pe__ tt e CiSt. understand my requirements under the State of
S e VC cle,
f t T
T, ePmrti'g.
Y A L::�:
ten'
P UT 0 IZ
rm
I hereby affirm under penalty of perjury that I am exempt from the Califor a S fety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the haze, teria eporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Ely
Business and Professions Code).Any city or county that requires a permit to Dat
construct,alter,Improve,demolish or repair any structure,prior to its W
/�RO/P OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signedstatement TIO P N PA
thatheorsheis licensed pursuant to the provisions of the Contractor's State E��ARENOVATION REPAIR AND�PAINI ING�RRP
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($500). managers who do the paint-disturbing work themselves or through their
ci 1,as owner of the property,or my employee with wages as their sale employees.For more information about EPA's Renovation Program visit:
compensation,will do( I all of or( )pardon of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or hin proves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. a No EPA Lead-Safe Certified Firm is required for this project bemuse;
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"Menifee
DATE (e PERMIT/PLAN CHECK NUMBER (4 - 0 v)3,4
TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME (IPOOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION CDEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS
�? zu cllk�
ASSESSOR'S PARCEL NUMBER 05-?c) - 0 2-1 LOT Sb TRACT
C'NA
OWNER NAME
ADDRESS �W4,3 CV9r
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES �IeO
BUSINESS NAME
ADDRESS
PHONE 7CO- 7 25� -U&1,� EMAI
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 257
'0 oc�,� -Sq FT L SO FT
APPLICANrsSIGNZRE 7 DATE
rc;WSTAFF USE ONLY
DEPARTMENT DISTRIBUTION
BUILDING PLANNING ENGINEERWG F18E GAEN SMI MENIFEE BUSINESS LICENSE NUMBER
INVOICE PAIDAMOUNT
AMOUNT 1 0 CASH 0 CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLEITER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-572-5777
www.cityof,menifee.us Inspection Request Line 951-246-6213