PMT16-03638 City of Menifee Permit No.: PMT16-03638
29714 HAUN RD. Type: Pool/Spa-Residential
'5A—CCIELA> MENIFEE, CA 92586
MENIFEE Date Issued: 11/0912016
P E R M I T
Site Address: 31232 RAWHIDE CT, MENIFEE, CA Parcel Number: 360-140-001
92584 Construction Cost: $30,000.00
Existing Use: Proposed Use:
Description of INGROUND GUNITE POOL&SPA 535 SQ FT, 14 L FT GAS LINE FOR FIRE PIT
Work:
Owner Contractor
DESIREE DUPLESSIS PHOENIX POOLS AND SPAS INC
31232 RAWHIDE CT 40940 VIA LOS ALTOS
MENIFEE, CA 92584 TEMECULA, CA 92591
Applicant Phone:9516950225
ERIC PHOENIX License Number: 559593
PHOENIX POOLS AND SPAS INC
40940 VIA LOS ALTOS
TEMECULA, CA 92591
Fee Description Qtv Amount($1
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 2.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 23.35
$645.16
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of enurs 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.
AAL131dg_Permrt Template.rpt 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
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 form and effect the following mason:
License Class Z77 4-:tl Ucense;No. By my signature below I acknowledge that�except for my personal residence
Expires Signature in which I must have resided for at least one yeai prior to completion of
-7;;� improvements covered by this permit.I cannot legally sell a structure that I
WORKEWS COMPENSATION DECIA AT N have built as an omer-builder if It has not been constructed in its entirety by
ci I hereby affmin 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 Pmfmions Code,Is ava ilable 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.lexinfo.ca.Rov/calaw.htmL
this permit Is Issued.
Policy If PROPERTY OWNER OR AUTHORIZED AGENT Date
ci I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work forwhich o 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 am: 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 ;!kp� — building construction.I authorize representatives of this city or county to
policy# Expires enter the above identified property for inspection purposes.
Mis section need not to be completed Is the permit Is for one-hundred Date
dollars($10D)Or IM PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not employ a ny persons in any manner so as to become subject to the CITY BUSINESS LICENSE N
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's c pensation provisions of Section 37. 0 of the Labor
Code,I shall With those pronrisions- Will the applicant or future building occupant handle hazardous material or a
Applicant Date TZ )-
mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNIZAILURAU/SECURE WORKEWS COMPENSATION COVERAGE 15 ciYes nNo
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 PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECFION 3706 OF THE LABOR CODE,INTEREST,AND ATTORN EYS FEES forguldelines
CONSTRUCTION LENDING AGENCY a Yes o 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 th e performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) uYes allo
OWNER BUILDER DECLARATIONS I have read the Hazardous Materiial Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm u cider penalty of perjury that I am exempt from the California Hea Ith&Safety Code,Section ZSSOS and 25534 concerning
contractor's License Law for the reason(s)indicated below by the hazardous mater al re o i.ng.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 0yes a No
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 _pROPERW_()Z EprOR AUTHORIZED AGENT
Issuance,also requires the applicant for the permit to file a signed statement IRRPI
that he or she is licensed pursue nt to the provisions of the Contractoes State EPA RENOVATION,REPAIR AND PAINTIN
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-cerfifled firms and comp"th
a n 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 themselvesor through their
cr 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.goy/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAO(S323).
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 emploms'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-Safe Certified Firm Is required for this pmject because:
not built Or Improved for the purpose of sole.
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 RAP
Acknowledgement.
& SAFETY PERMIT/PLAN CHECK APPLICATION
11 9S,
.."Menifee
DATE S,!;, PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL AESIDENTIAL 0MULTI-FAMILY OMOBILEHOME ChOOL/SPA 0-SIGN
SUBTYPE: OADDITION c'ALTERATION ODEMOUTION OELECTRICAL (DMECHANICAL
ONEW VPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK 7crMea—
PROJEcTADDRESS I
ASSESSOR'S PARCEL NUMBER �3(pb� '5t( �0409LOT TRACT ")00(d+
OWNER NAME
ADDRESS Ch.f C-�B7-
PHONE
44Li EMAIL
APPLICANT NAME �E:Ve 7Xe-- -V?o E:�> C-4 X41:!�
ADDRESS Lj 2n <i z-543
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES OAO
BUSINESS NAME
ADDRESS
PHONE EMAIL 4:1
CONTRACTOR'S STATE LIC NUMBER 99 -:5;,9j LICENSE CLASSIFICATION
VALUATION SO FT L SO FT
APPLICANT'S SIGNATURE
DATE
CITY STAFF USE ONL Y 0 1 CITY OF MENIFEE BU51NE55 UCLN5L NUMBER
BUILDING PLANNING ENGINEERIN
DEPARTMENT DISTRIBUTION 6 FIRE I GREEN
INVO=ICE (o
AMOUNT al PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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