PMT16-03541 City of Menifee Permit No.: PMT16-03541
29714 HAUN RD.
't��CCIEU� MENIFEE,CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued 11/01/2016
P E R M I T
Site Address: 29322 FINVACK CIR, MENIFEE, CA Parcel Number: 364-320-007
92584 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INSTALL POOL/SPA
Work:
Omer Contractor
VENETTA NIKOLOVA PACIFIC COAST POOLS INCORPORATED
29322 FENWICK CIR 26499 JEFFERSON AVE UNIT E
MENIFEE, CA 92584 MURRIETA, CA 92562
Applicant Phone:9512960199
BRANDY CORAL License Number:852237
PACIFIC COAST POOLS INCORPORATED
26499 JEFFERSON AVE UNIT E
MURRIETA,CA 92562
Fee Description Qtv Amount($1
Swimming Pooltin-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
$622.36
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 builicling operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as othervvise 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_Bldg_Pemjt-Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION propertywho builds or Improves thereon,and who contractsforthe 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).
Chapterfl(commencing with section 7000)of Division 3 of the Business and ci I a rn exempt from licensure under the Contractor's State License Law for
Professions CoCa�dsllcense is in full force and effect. - the following reason:
License Clan License No. P57-73 7 By my signature below I acknowledge that,except for my personal residence
Expires oal 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 DECLARATION 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 understand that a copy of the applicable law,Section
have and Will maintain a certificate of consent of self-insure for worker's 70"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. www4wInfu.ca.gov/calaw.htmI.
Policy# Date
ci I have and will maintain worker's compensation Insurance,as required by FkCiPERTY OWNER OR AUTHOR17ED AGENT
section 3700 of the Labor Code,forthe performance of the work forwhich 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 carder and policy owner or authorized to act on the property owner's behalf.I have read this
num ber 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 c7sqction.I authorize representatives of this city or county to
Policy#\AtA) Expires enter tir'abgWe'identified property for inspection purposes.
(This section need not to be completed is the permit is far onehundred /1 Date
dollars($100)or less PROFVERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any me nner so as to become subject to the CITY BUSINESS LICENSE It
worker's compensation laws of California,a nd agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workees compensation provisions of Section 3700 of the Labor
Code,I shall with omply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applion gnc -Date P—t-11,41 mixture containing a hazardous material equal to or greater that the
amounts specified an the Hazardous Materials Information Guide?
WARNING:AILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes OY-
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVI L FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO TH E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require 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(SCAQMD)?See permitting checklist
forguideli
CONSTRUCTION LENDING AGENCY a Yes ;z
I hereby affirm that under the penalty of perjury there is a construction Will th e 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) 0yes apd'",
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 Heth&Safety Code,Section 25505 and 25534 concerning
hazardou at eporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 us'. T, I
Business and Professions Code).Any city or county that requires a permit to 0yes 4No[1 7
construct,alter,improve,demolish or repair any structure,prior to its K=_c —Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she Is licensed pursua nt to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING 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 residencia or childca re facility to be RRP-certlfled 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( )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 1-80D-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,th rough employees'or personal effort,builds or improves the
property provided that the improvements am 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 sa le. a No EPA Lezid-Safe Certified Firm is required for this project because:
a 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
& SAFETY PERMIT/PLAN CHECK APPLICATION
NOV 0 1 2016
4"Menifee
QQr,CQ4x^,4
DATE PERMIT/PLAN CHECK NUMBER Vff- Vio b3'Sq
TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME <UeCQSPA O_SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION 0ELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK _f001 ,F 5PI
PROJECTADDRESS Z3�;L;t F-e I,vu,or- L-e
ASSESSOR'S PARCEL NUMBER LOT TRACT �OLJ ?2-2-
OWNER NAME 11IKC>1L)v4
ADDRESS
PHONE '10-17 L-1,�-j EMAIL
APPIL CANT NAME r.-
ADDRESS
PHONE 70 EMAIL
CONTRACTOR'S NAME 6��
OWNER BUILDER? 0 YES *_N'O
BUSINESS NAME
j d�
ADDRESS Z% /�jt��Iel;65kl 2/ vue�
PHONE EMAIL j h)�tjl- PP0"_1-S
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 02_<�= SQ FT 527te eDZ)) L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GIEEN 5 q IP
INVOICE - PAIDAMOUNT I
AMOUNT 15LI 0% P, OCASH OCHECKJI OCREDITCARD VISA/MC
PLAN CHECK FEES AIDAMOUNT
kP OCASH OCHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER 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
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