PMT16-03132 City of Menifee Permit No.: PMT16-03132
29714 HAUN RD.
<A-CCELA> MENIFEE, CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued: 09/22/2016
P E R M I T
Site Address: 25986 PROSPECTOR CT, MENIFEE,CA Parcel Number: 358-522-029
92584 Construction Cost: $15,000.00
Existing Use: Proposed Use:
Description of I NGROUND SPA ONLY,48 SF
Work:
Owner Contractor
NATASHA BRENNAN QUALITY CUSTOM POOLS INC
25986 PROSPECTOR COURT 30138 MARNE WAY
MEN]FEE, CA 92584 MENIFEE,CA 92584
Applicant Phone: 9516799732
JIM BARRETT License Number.,795820
QUALITY CUSTOM POOLS INC
30138 MARNE WAY
MENIFEE, CA 925B4
Fee Description City Amount
Swimming Pool/in-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Electrical 1 23.35
$520.35
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.
Ak8k1g_Perm1t-Templat9.rpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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).
Chapter!)(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—(2,51_? License No. By mysignature below I acknowledge that,exceptformy personal residence
Expires 1-7 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
WORKER'S COMPENSATION DECLA4;16�'45�' 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.leeinfoxa.emdcala�htnni.
this permit is issued.
Policy# 1,4 2— :�/4' ) Date
P607'ry OW
I have and will maintain worker's compensation insurance,as required by #6ALFIFfORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which &Sly 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
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# IQW—Expires �714/ 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 zf�
(/PROP9RTY OW*ER—OR AUTHORIZED AGENT
a I certify 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
'\.e provisions.
Code,I shall forthwith y with�po Will the applicant or future building occupant handle hazardous material or a
�t:� mixture containing a hazardous material equal to or greater that the
Applicant '7�5�_ amounts specified an the Hazardous Materials Information Guide?
,�Ilca nt D.te
a
0
6
W RN�I E T� T11
ARN FAILL _UIRE KERS COMPEN A COVE�AG� oYes cNo
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 occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDb FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY uYes oNc,
I hereby affirm that under the penalty of perjury them is a construction Will the proposed building or modified facility be within 1000 feet of the
lend ing agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) oYes oNo
OWNER BUILDER DECLARATIONS I have mad 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 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its IU��IZEO AGENT
issuance,also requires the applicant for the permit to file a signed statement C!�R�r_A�
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 recilving compensation for most work that disturbs paint in a pre-19711
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 sole employees.For more information about EPA's Renovation Program visit:
compensation,will do I )all of or( )portion of the work,and the structure is www.epa.goyllead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(S323).
Code,The Contractoes State License Law does not apply to an owner of a o 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. o No EPA Lead-Safe Certified Firm is required for this project because:
u 1,as owner of the property a m 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 a,)- PERMIT/PLAN CHECK NUMBER
TYPE: COMMERCIAL EIRESIDENTIAL [:]MULTI-FAMILY [IMOBILEHOME [RPOOL/SPA [-]SIGN
SUBTYPE: []ADDITION DALTERATION E]DEMOUTIONE]ELECTRICAL 0 MECHANICAICity Of MenI ee
[:]NEW EIPLUMBINGEIRE-ROOF-NUMBER OF SQUARES_ Building & Salet, Dept.
DESCRIPTION OF WORK SFP 7 7 21
16
PROJECTADDRESS
5,Ztpecelved
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ASSESSOR'S PARCEL NUMBER LOT TRACT
PROPERTY OWNER'S NAME
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME.A ---,>,rV, "- -
I OWNER BUIL ER?
E]YESPNO
BUSI
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT L SO FT
APPLICANT'S SIGNATURE DATE Z,
DEPARTMENFI"DIMIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMB
BUILDING PLANNING ENGI FIRE GREEN SMIP
INVOICE
AMOUNT PAIDAMOUNT OCASH --CHECK# 0 CREDIT CARD VISA/MC
D AMOUNT
PLAN CHECK FEES PAI i H 0 CHECK# OCREDITCARD VISA/MC
L
OWNER BUILDER VERIFIED
770 YES 0 NO DL NUMBER NOTARIZED LE17ER C YES -- NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA-92586 951-672-5777
www.cityofmenifee.us inspection Request Line 951-246-6213
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