PMT16-03086 City of Menifee Permit No.: PMT16-03086
29714 HAUN RD. Pool/Spa -Residential
<A-CCF-L;�> MENIFEE, CA 92586 Type:
1;-1-11 Nod,— MENIFEE Date Issued: 09/2012016
P E R M I T
Site Address: 30691 BUCKBOARD LN,MENIFEE, CA Parcel Number: 358-450-017
92584 Construction Cost: $35,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL AND SPA, 390 SF
Work:
Owner Contractor
DEAN&SUZETTE HANSEN MAJESTIC POOL CONSTRUCTION
30591 BUCKBOARD LANE 31566 RAILROAD CANYON ROAD
MENIFEE,CA 92584 STE 2#106
Applicant Phone: 9514456384
ERIC ROSENKRANTZ License Number.889638
MAJESTIC POOL CONSTRUCTION
31566 RAILROAD CANYON ROAD
STE 2#106
CANYON LAKE, CA 92587
Fee Description ON Amount($
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 enors 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 othervrise 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.
AABIdgPermit-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 contractar(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 underthe Contractor's State License Law for
Professions Code and my license is in full farce and effect the following reason:
License Clam—/11�5 9 License No. By my signature below I acknowledge that,except for my personal residence
Expires Li�_ a Anature In which I must have resided for at least one year priorto completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
a 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 a nd 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
this permit Is issued. www.leginfa.ca.gov/cal@w.htmI.
Policy# Date
a I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 37GO of the Labor Code,for the performance of the work for which a 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 behalf.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 enter the above identified property for inspection purposes.
(Mis section need not to be completed is the permit is for one-hundred
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT Date
CbI ertify that in the performance of the work for which this permit is issued,
Ishallnotemplo 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 worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply witl�those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
Its Red on the Hazardous Materials Information Guide?
M _RNI amoun
A NG:FAILURE TO SECURE WC1RKER_ Zii
L 'S r MPENSATION COVERAGE IS a Yes
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 ON E HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant req uire a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQM D)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY 0 Yes \.,:No
I hereby affirm that under the pena Ity 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 "a
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 azarclaus aterial reporting.
Business and Professions Code).Any city or county that requires a permit to 't -7)
Date -Z 62-2-e-.214
construct,alter,improve,demolish or repair any structure,prior to Its
issuance,also requires the applicant for the permitto file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractoes State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting RAP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint In a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childca re facility to be RRP-certified firms and comply with
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
u 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.Royllead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-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 farthis 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 wrlithin 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. o No EPA Lead-Safe Certified Firm is required for this pmject because:
in 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business a nd 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 PERMIT/PLAN CHECK NUMBERemy n wav
TYPE: OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME �2001./SPA "SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION CELECTRICAL OMECHANICAL
*EW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK fPr2!� :j 1�?A
crADDRESS Buildmg 061=�lee6t-
PROJE QA-ew
ASSESSOR'S PARCEL NUMBER LOT TRAWP 2 0 Z616
r;OWNER NAME
ADDRESS
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PHONE EMAIL
APPL CANT NAME
ADDRESS
PHONE
EMAIL
CONTRAcrOR'S NAME - >�
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BUSINESSNAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 99�0139 LICENSE CLASSIFICATION
VALUATION$ fa e,,w e) SO FT I/LIQ FT
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I APPLICANVSSIGNATURE9!f DATE VngQ
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITYQFMENIFEEB
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE PAIDAMOUNT
AMOUNT �5C;ILi.3CS I I OCASH QCHKK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT I OCASH OCHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. illlenifee, CA 92586 9SI-672-6777
www.cityoftnenifee-us Inspection Request Line 951-246-6213
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