PMT16-03196 City of Menifee Permit No.: PMT16-03196
29714 HAUN RD. Type: Pool/Spa-Residential
<A-CCEL:A—> MENIFEE, CA 92586
MENIFEE Date Issued: 09/28/2016
P E R M I T
Site Address: 25337 HIGH NOON CT, MENIFEE, CA Parcel Number: 3513460-004
92584 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 370 SO FT
Work:
Owner Contractor
RANDY&LINDA PHILLIPS PACIFIC COAST POOLS INCORPORATED
25337 HIGH NOON CT 43020 BLACKDEER LOOP#106
MENIFEE, CA 92584 TEMECULA, CA 92590
Applicant Phone:9512960199
BRANDY CORAL License Number.852237
PACIFIC COAST POOLS INCORPORATED
43020 BLACKIDEER LOOP#106
TEMECULA, CA 92590
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
$622.35
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.
Ao�_Bldg_Permit Templatesirt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the project-s
with a licensed contractor(s)pursuant to the contractors State License Law)
I hereby affirm under penalty of perjury that I am under provisions of n I am exempt from licensure under the Contractor's State License Law for
Chapter9(commencing with section 7000)of Division 3 of the Business and
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
in which I must have resided for at least one year priorto completion of
Expires aE Signature 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
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-insu re 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 La bor Code,for the performance of work for which w. -info.ca. ov calaw.litml. —)V
this permit is issued. Date 41
?ollcy# PRbPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensation Insurance,as required by n By my signature below I certify to each of the following:I am the property
section 3700 of the Labor Code,for the performance of the work for which owner or authorized to act on the property ownees behalf.I have read this
this permit is issued.My worker's compensation insurance carrier and policy application and the information I have provided is correct.I agree to comply
number are: with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
enter the above Identified property for inspection purposes.
Policy# Expires
(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 the performance of the work for which this permit is issued, e_
I shall not em ploy any persons in any me nner so as to become subject to the CITY BUSINESS LICENSE#
worke s compen artion laws o HAZARDOUS MATERIAL DECLARATIO
subject to the r er's compensation provisions of Section 3700 of the Labor Will the applicant or future building occupant handle hazardous material or a
Code,I shall f h ith com with those provisions. mixture containing a hazardous material equal to or greater that the
Applicant Date amounts s Wed on the Hazardous Materials Information Guide?
W_ARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes FN.
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FIN ES UP TO ONE 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,INTEREST,AND ATpORNEYS FEES for guldeler
CONSTRUCTION LENDING AGENCY n Yes 0 0
1 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 0'�LQ_
OWNER BUILDER DECLARATIONS I have read 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 t porting
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ciYes 0 7. Lq—?J,.A —I
Businiess and Professions Code).Any city or county that requir'es a permit to Date
construct,alter,improve,demolish or repair any structure,prior to Its PROPERTY OWI&k OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement EPA�RENOVATIONREPAIR AND PAINTING IRRPJ
that he or she is licensed pursuant to the provisions of the Contractoes State
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 exem ption.Any Violation of Section 7031.5 by residence or childca re facility to be RAP-certified firms and com ply with
a n Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners a nd property
than($500). managers who do the paint-disturbing work themselves or through their
a 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( I portion of the work,and the structure is www.epa.govIlead 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 respDns'ible for this project
property who,through employees'or personal effort,builds or improves the Certified Firm Name:
property provided that the improvements are not intended or offered for
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 o No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
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
r
MeniTee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: CCOMMERCIAL CRESIDENTIAL OMULTI-FAMILY OMOBILEHOME CWP`O0L/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOUTION OELECTRICAL OMECHANICAL
CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK
PROJECTADDRESS (-V '
.517
ASSESSOR'S PARCEL NUMBER !MeD04LOT SFS TRACT
OWNER NAME ILA V\aw (Kv-ix, 01 f N I Pj
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? CYES04e---�
BLISINESSNAME 4)kL4-j41'P_j, 01 &0ff
ADDRESS
PHONE qS-1 EMAIL
CONTRACTOR'S STATE LIC NUMBER 00-512�37 LICENSE CLASSIFICATION
VALUATION$ L-2 L 66-b - SQ FT 376 - L SO FT
APPLICANT'S SIGNATURE DATE
.CITYSTAFF USE ONLY
DEPARTMENT 05TRIBUTIUN U I y UE MLNIFEE.BUSINESS LICENSE NUMBER
C)55(
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE
AMOUNT PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
P�
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-677 7
www.cityofmemfee.us Inspection Request Line 951-246-6213
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