PMT16-02935 City of Menifee Permit No.: PMT16-02935
29714 HALIN RD. Type: Pool/Spa -Residential
<,—'\CCIEU� MENIFEE, CA 92586
MENIFEE Date Issued: 09/02/2016
P E R M I T
Site Address: 27756 POINT BREEZE DR, MENIFEE,CA Parcel Number: 333-352-003
92586 Construction Cost: $60,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 420 SO FT 8 L FT GAS LINE FOR FIRE PIT
Work:
Owner Contractor
TIM&SWAN TIEKEN TAYLOR MADE POOLS INC
27756 POINT BREEZE DR 18795 OAK VIEW WAY
MENIFEE,CA 92586 LAKE ELSINORE,CA 92530
Applicant Phone:9518166444
GEORGE License Number.795053
18795OAKVIEWWAY
LAKE ELSINORE,CA 92530
Fee Description QtV Amount(1)
Swimming Pool/In-Ground Spa 1 467.00
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 3.00
SMIP RESIDENTIAL 1 8.00
General Plan Maintenance Fee-Electrical 1 23.35
$644.35
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors 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.
AkBldg_Pennit-TeMp1ate.rpt Page 1 of I
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 contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force anyeffect. the follo"drig reason:
License Class 4�:—.tg Ucen 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 priorto completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constnicted In its entirety by
ci 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 workees 7044 of the Business and Professions Code,is ava'a upon request when
fiofiav�h
compensation,issued by the Director of Industrial Relations as provided for this applicat' I bmitted or at the te.
by Section 3700 of the Labor Code,for the performance of work for which www.l .
this permit is issued. gov/calaw.htm4r
Policy# A��
PROPERTY OWNER OR AUTHORIZED AGENT
ci I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which u By my signature below I certify to each of the following:I a in the property
this permit is issued.My workerrs com pensation insurance ca rrier and policy owner or authorized to act an the property owner's beha If.I have read this
numberare: application and th Information I have!provided is correct.I agree to comply
fi
ic.
with all app and county ordinances.4xite laws relating to
Carrier
building can n.I authorize represent of this city a�r c/ounc
r
Policy# Expires eVnterth.: ;rldentif�edp�r�for' tion purposes.
(This section need not to be completed Is the permit is for one-hundred
dollars($100)or less t��eZ�Date
--KO'PERTYOWNER Cfk AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
Ishallnotempl any persahsinnymanne, ar toXc3rle subject to the CITY BUSINESS LICENSE#
W.10K fic HAZARDOUS MATERIAL DECLARATION
am
worker's compensatio s C; .ta, c1sag e if should become
subject to the work persation provision ion 3700,of the or
Code,I shall forth J ompl wit epr Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
0 Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes "a
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUN DRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO TH E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY 0 Yes /_No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified faicifitV be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) 0yes X—No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide anphe SCAQMD
permitting checklist. ad and my requiremen n rt,e State of
I hereby affirm under penalty of perjury that I am exempt from the California He.h:V e,Wct'on 25505 534 c ncernin
al h ad
'at Part
Contractor's License Law for the reason(s)indicated below by the hazardous mat( portin
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 &es a No
Business and Professions Code).Any city or county that requires a permit to Z�,,-'�,Agf--Dte
construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant 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 IRRP)
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
a nd the basis for the alleged exem ption.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 Pena Ity of not more required practices.This includes renta I property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
a 1,as owner of the propeft or my employee with wages as their sale employees.For more information about EPA�s Renovation Program visit:
compensation,will do I )all of or I )portion of the work,and the structure Is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ci An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or Improved for the purpose of sale. ci No EPA Lead-Safe Certified Firm Is required for this project because:
ci 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
MINIMUM I I Wa a 4 11 IVA I I Mal W-11 I,KI 11
Men if ee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL WQRESIDENTIAIL CMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION O-DEMOLITION CELECTRICAL OMECHANICAL
^NEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER TRACT
OWNER NAME
ADDRESS
PHONE E MA
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME 1"Zle
OWNERBUILDER! OYESkNO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT L SO FT
APPLICANT'S SIGNATURE DATE fizZ1,51,41,
DEPARTMENT DISTRIBUTION CITY OF MENIFEL ICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I C
AMOUNT PAIDAIMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER 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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