PMT16-03333 City of Menifee Permit No. PMT16-03333
29714 HAUN RD. Type: Pool/Spa-Residential
<A—CC1E1:A—> MENIFEE,CA 92586
MENIFEE Date Issued: 10/1112016
P E R M I T
Site Address: 24131 DEPUTY WAY,MENIFEE, CA Parcel Number: 358-550-009
92584 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL AND SPA, 370 SF. U/G GAS AND ELECTRIC FOR BBQ ISLAND VVITH 2 GFI
Work: OUTLETS
Owner Contractor
SAMANTHASEAMAN PACIFIC COAST POOLS INCORPORATED
24131 DEPUTY WAY 43020 BLACKDEER LOOP#106
MENIFEE, CA 92584 TEMECULA, CA 92590
Applicant Phone:9512960199
BRANDY CORAL License Number:852237
PACIFIC COAST POOLS INC DBA PREMIER POOLS&SPA'
43020 BLACKDEER LOOP#106
TEMECULA, CA 92590
Fee Description Qtv Amount($1
Receptacle, Switch, Outlet&Fixture 2 121.00
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Building 1 5.80
General Plan Maintenance Fee-Electrical 1 29.40
$771.20
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 mmmenced 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�13ldgPerniii—Ternplatierpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
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
Chapter9(commencing with section 7000)of Division 3 of the Business and cz 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 By my signature below I acknowledge that,except for my personal residence
Expires 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 DECLARATION 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 ava flable upo n request when
com pensation,Issued by the Director of Industrila I Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the perlormance of work for which wwwI@B1qfo.ca.gov0Iaw.htmI.
this permit is issued. U
Policy# Date
ci I have and will maintain worker's compensation Insurance,as required by PROPE�TY,"NER dR 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 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 MkM I I tkw I N i IF)Vt building-ccristructimi.I authorize representatives of this city or county to
Policy# %Jqbu�—Iujq4�1 _Exliir� m-E, — enter ntified property for inspection purp
(This section need not to be completed is the permit is for one-hundred — Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
ci I certify that in the performance of the work for which this permit is issued,
I shall not am Ploy 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 wor compe tion provisions of Section 3700 of the Labor
comply
Code,I shall fic I comply h those provisions. Will the applicant or future building occupant handle hazardous mate ral or a
Applicant Date W-1d V mixture containing a hamrdous material equaltz,or greater that the
_. I amounts sp 'fled on the Hazardous Materials Information Guide?
MPENSATION COVERAGE IS cz Yes 4 rN,
WARNING:FAILURE TO SECURE WORKERS CO
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 req uire a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED F Coast Air QuaWManagement District(SCAQMD)?See pamitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTO.RNEYS FEES forguidel�P6
CONSTRUCTION LENDING AGENCY ci Yes d 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 bound f a school?
(Section 3097 Civil Code) o Yes
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
Contractor's License Law for the reason(s)indicated below by the California Heal!YA Safety Code,Section 25505 and 25534 concerning
hazardous pPale§19t)eporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 crYes ci lio I
Business and Professions Code).Any city or county that requires a permit to I V P —Date
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWN�R 6KAbTHORIZED AGENT
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 PAINTI G IRRP)
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 7031.5 by residence or childcare facility to be RRP-cerrified 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
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.goy/lead 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
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 a No EPA Lead-Safie Certified Firm is required for this project because:
not built or improved for the purpose of sale.
ci 1,as owner of the property a m exclusively contracting with licensed
contra ctors;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.
& SAFETY PERMIT/PLAN CHECK APPLICATION
..."Menifee
DATE lo 1010 PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME _��OL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
City of Menif m
G4,,c, 0
OWNER NAME Sa" Dept.
ADDRESS OCT 116
PHONE
EMAIL
APPLICANT NAME ),)Dr_0�4 c e i V
ADDRESS C:��(kmg oto
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? OYESdNO
BUSINESS NAMEP)IMW 02_M(,
ADDRESS
PHONE EMAIL
CONTRACTOWS STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ C�s I C) SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I L4-
- T_
INVOICE
AMOUNT PAIDAMOUNT '6Z) 0 CASH 0 CHECK# OCREDITCARD VISAJMC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER ON YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityof,meoifee.us Inspection Request Line 951-246-6213
ROPERTY LINE +25* PROPE LINE +25'
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