PMT16-03050 City of Menifee Permit No.: PMT16-03050
29714 HAUN RD. Type: Pool/Spa-Residential
<A-CCIEU� MENIFEE, CA 92586
MENIFEE Date Issued: 09/14/2016
P E R M I T
Site Address: 31436 GAVINO CT, MENIFEE,CA 92584 Parcel Number: 360-611-042
Construction Cost: $32,000.00
Existing Use: Proposed Use:
Description of INGROUND SWIMMING POOL ONLY 380 SQ FT
Work:
Owner Contractor
JOHN&SARA RACINE DUSTIN PHILLIPS POOLS
31436 GANANO CT 39705 CALLE AZUCAR
MENIFEE, CA 92584 MURRIETA, CA 92562
Applicant Phone:9517646607
DUSTIN PHILLIPS License Number: 958517
DUSTIN PHILLIPS POOLS
39705 CALLE AZUCAR
MURRIETA, CA 92562
Fee Description P!Y. Amount
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 5.00
General Plan Maintenance Fee-Electrical 1 23.35
$524.35
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 bulliding 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 Bidg_Peanit-Ternplate.ript 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 o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason;
License Class 3 icen ..CW By my signature below I acknowledge that,except for my personal residence
Expires *-311-IT Sig ature Inwhich I must have resided for at least one year prior to completion of
4W& 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 constructed in its entirety by
it 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 forworker's 7044 of the Business and Professions Code,is available upon requestwhen
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,forthe performance of work forwhich
this permit is issued. www.leginfo.ca.goy1caIaw.htmI.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
o 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 folloVing: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 behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires 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
)d4certify that In the performance of the work for which this permit is issued,
I shall a,em any pesonsm any manner so as'o bec CITY BUSINESS LICENSE# 075001
or 0
law ak
w lie s nra,and agree�a, HAZARDOUS MATERIAL DECLARATION
s u I cl
b e t t co mvrsums-FS ctio
Code,is provision,. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Appil.nt Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS 0yes /No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the Intended use of the building by the applicant or future building
AND CIVI L FINES UP TO ONE H UNDRED THOUSAND DOLLARS($11)(1,000),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,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ciYes yNo
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 boundary of a school?
(Section 3097 Civil Code) a Yes lb No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting chh�.�t erstand in requirements under the State of
]ff rnl:Ce:t
I hereby affirm under penalty of perjury that I am exempt from the 0 th 8, e, n 25505 and 25534 concerning
C:, . in g.
Contractoes License Law for the reason(s)indicated below by the h ,d eri
checkmarks)I haveplaced next to the applicable item(s)(SectIon7031.5
Businessand Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repair any structure,prior to its
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWAER OkUfHORIZED AGENT
that he or she Is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING JRRPJ
License Law(Chapter 9(commeneing 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 RAP-certifled 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-ifisturbing work themselves or through their
u 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( I portion of the work,and the structure is www.epa.gov/fead 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
propertywho,through employees!or personal effoM 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. a No EPA Lead-Safe Certified Firm is required for this project bemuse:
u 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.
III I IN]ILI 02-411421�I
A "..'Menifee
.&W
DATE q_1 PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME Y�POOL/SPA OSIGN
SUBTYPE: OADDITION 0ALTERATION ODEMOLITION � ELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK _-60Imw%l(jfi_PC6(_
PROJECTAIDDRESS
ASSESSOR'S PARCEL NUMBER (0 0'10 11-0 L12)r LOT V5 TRACT P_X)66
OWNER NAME A CJ A)f
ADDRESS �31436 (:,�Avjlvo C-- r
PHONE I] (, CLio it 9cf EMAIL
APPLICANT NAME V%JZTI)\j ?qltutr
ADDRESS CALCe- Az_oc-A A-
PHONE J!!21 74Y "67 EMAIL P05-D t-1 7 V4 I L-L I FS 73 e L(ve,com
CONTRACTOR'S NAME _DJWlA) f)PICLIP5 A=t;6 OWNERBUILDER? OYESO'NO
BUSINESS NAME P35T-1k) -PPILLie-5 fcocc;
ADDRESS �q-7D5- aL-Lg Az-ocAR- maDr_r4 c-4 -
PHONE Yf'l -76 q 4�0 7 - EMAI[
CONTRACTOR'S STATE LIC NUMBER fr5l 51-7 LICENSE CLASSIFICATION
VALUATION$ coo,aQ LSQFT
APPIL —DATE L/
IrITYSTA4 USE ONLY
DEPARTMENT DISTRIBUTION LIIYU�Mtffll, tbu�INESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP M&(0-7
INVOICE __�4 Pll�_ PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISIVIVIC
AMOUNT j5a 1
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISIVNIC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLEITER 0 YES 0 NO
City of Alenifee Building&Scfety Department 29714 HOUn Rd. Menifee, CA 92586 95 1-672-6777
wL4jw.cityofmenifee.us Inspection Request Line 951-246-6213
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