PMT16-03200 City of Menifee Permit No., PMT16-03200
29714 HAUN RD. Type: Pool/Spa-Residential
-5A—CCELA—> MENIFEE,CA 92586
MENIFEE Date Issued: 09128/2016
P E R M I T
Site Address: 26269 ALEPPO PINE CIR, MENIFEE, CA Parcel Number: 360-671-022
925B4 Construction Cost: $65,000.00
Existing Use: Proposed Use:
Description of 1420 SQ FT SHOTCRETE POOL&SPA, 160 L FT GAS LINE FOR FIRE PIT&PRE-FAB BBQ
Work:
Owner Contractor
MATTSTACK S C POOLS&LANDSCAPES INC
26269 ALEPPO PINE CIR 33975 SIDNEY CIRCLE
MENIFEE, CA 925a4 WINCHESTER, CA 92595
Applicant Phone:9517572644
STEVE CURRIE License Number:758701
S C POOLS&LANDSCAPES INC
33975 SIDNEY CIRCLE
WINCHESTER, CA 92596
Fee Description ON Amount is
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 9.00
General Plan Maintenance Fee-Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 23,35
$651.15
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.
AA._B1dg_Penn1t-TeMplate.rpt Page I of 1
CITY OF IVIENIFEE
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 contiactor(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 underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason;
License Cl N —IS
!, 6ipense o. 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
Wol CLARATION have built as an owner-builder if it has not been constructed in its entirety by
a I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I under�tand 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
this permit is issued. www.leginfo.ca.goy/calaw.litmi.
Policy# Date
ci I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ci By my signature below I certify to each of the following:I am the property
this permit is issued.My workees compensation insurance carrier and policy owner or authorized to act an 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:F�1�T—F— 4-(1-J r-3 F building construction.I authorize representatives of this city or county to
Policy# tt� 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
o I certify that in the performance of the work for which this permit is issued,
Ishallnotempi 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 cc pensation provisions of Section 3700 of the Labor
hwith com,
Code, rthwith comlAyWith those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to orgreater thatthe
.an%
t
Ap :ant Date amouk
is specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIC119 COVERAGE IS a Yes �4 No
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 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 CoaskAir Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for gu Ines
CONSTRUCTION LENDING AGENCY a Yes%-1 No
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 bkul clary of a school?
(Section 3097 Civil Code) o Yes 1 0
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACIMD
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 Lawforthe reason(s)indicated belowbythe \�ardous material rep
checkmark(s)I have placed nextto the applicable item(s)(Section 7031.5 ous P
Business and Professions Code).Any city or county that requires a permit to at
PROP 0
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY 0 A I ' GENT
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 PAINTINGIRRP
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 exemption.Any violation of Section 7031.S by residence or childcare facility to be RRP-certifled firms and comply with
an Applica nt for a permit subjects the a pplIca nt to a civil pace Ity 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
o 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.govAead 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 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:
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
'Wenifee
DATE 9 PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL RESIDENTIAL OMULTI-FAMILY OMOBILEHOME 0 POOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK RL
�A_
PROJECTADDRESS tababj ALC�t_��P IfIkC16—
ASSESSOR'S PARCEL NUMBER 'Y40 - (Inj b;0' LOT TRACT
OWNERNAME [V)IQ7—r 5_j_jQ0K
ADDRESS '5 AM 6-
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME 01CJ)Pr,3r OWNERBUILDER? 0jYESeN0
BUSINESS NAME '3T0VV_ CAJ e-f
ADDRESS 3307--15 3io8LES� C)'R- W )1JC9&S_rgx_ CA '3a'51(V
PHONE(9,51) -7 97 - �7_& 44 EMAIL57eVL-
CONTRACTOR'S STATE LIC NUMBER _7521D I LICENSE CLASSIFICATION 53
VALUATION$ 61� / SO FT /vzo L SO FT
e9a
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
L)LIPARTMENT UlbTRIBUTIUN 59 SMIP CITY OF MENIFEE BUSI 5 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN
INVOICE It, PAID AMOUNT
AMOUNT I I OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I 1 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 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
xe