PMT16-03709 City of Menifee Permit No.: PMT16-03709
29714 HAUN RD. Type: Pool/Spa -Residential
<A—CCIEU� MENIFEE, CA 92586
MENIFEE Date Issued: 1111712016
P E R M I T
Site Address: 31896 ARIEL CT, MENIFEE, CA 92586 Parcel Number: 339-362-004
Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL ONLY,360 SF, NO GAS
Work:
Owner Contractor
GENERAL GORDON TEMECULA VALLEY CUSTOM POOLS INC
31896 ARIEL COURT 27315 JEFFERSON AVE#J 100
MENIFEE, CA 92586 TEMECULA,CA 92590
Applicant Phone:9512022393
DAVID THOMPSON License Number:818695
TEMECULA VALLEY CUSTOM POOLS INC
27315 JEFFERSON AVE#J 100
TEMECULA, CA 92590
Fee Description Qtv Amount t$)
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
$522.35
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 othervAse 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 BidgPermit Template.rpt Page I of I
CITY OF MENIFEE
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 contractor(s)pursuant to the Contractor;State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Businesyand o I am exempt from ficensure under the Contractor's State License Law for
Professions Code and my license is in full for e e the following reason;
License Class (--,K:�� icense N By mysignature below I acknowledge that,except for my personal residence
Expires 000,I)'V Sign.t... inwhich I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legallysella structurethat I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder If It has not been constructed in its entirety by
o I hereby affirm under penalty of perjury one of the folio Zng 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 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.Iegmfio.ca.gov/caIaw.htmL
Policy# Date
o 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 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 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 building construction.I authorize representatives of this city or county to
Policy# 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
.XI"oertify that in the performance of the work for which this permit is issued,
Mail not employ any persons in any manner so as to become subject to the CITY BUSINESS UCENSE#
worker's compensation laws of Calffow'a,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the r e sco ensati �rpvisions of Section 3700 of the Labor
Code,I sha orthwi mp t s provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amountssp ified on the Hazardous Materials Information Guide?
WARNING-'FAILURETOSECUR WORKER'S COMPENSATION COVERAGE IS o Yes Zc
UNLAWFUL,AND SHALL SU82cr AN EMPLOYER TO CRIMINAL PENALTIES Wilitheintended usecifthe building by the applicant or future building
ANDOVILFINESUPTOONE HUNDREDTHOUSAND 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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidefirips
CONSTRUCTION LENDING AGENCY a Yes crNo
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 boun ary of a school?
(Section 3097 Civil Code) o Yes 12,
OWNER BUILDER DECLARATIONS I have mad 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 Cafifornj�'"th&Safiety C
Contractor's License Law for the reason(s)Indicated below by the hapr6l.1 rijif .9de,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable ftem(s)(Section 7031.5 reS2 09.
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 PROPERTY OWNER;0'1UTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
Ept
that he or she is licensed pursuant to the provisions of the Contractor's State EPA BEN EPAIR AND PAINTING RRP)
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 RAP-certified 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.eva.aovllead 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,th rough ern ployees'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 RAP rule please fill out the RRP
Acknowledgement
BUILDIN & SAFETY PERM IT/PLAN CHECK APPLICATION
"I.Wenifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL e/RESIDENTIAL CMULTI-FAMILY OMOBILEHOME W,-POOL/SPA SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION e-fLECTRICAL OMECHANICAL
"EW O-PLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME gjj�f nj Menlflo
ADDRESS lq'eg�C'L I k. & sa"'Y oupt.
1-1 17
PHONE j as'� 27 y2V EMAIL NOV
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES *<O
BUSINESS NAME Temecula Valley Custom Pools. Inc-
David Thompson
ADDRESS 27315 Teffermn Ave., JT100
Temecula, CA 92590
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 2 A� /-� Z--Sq FT L SO FT
APPLICANT'S SIGNATURE DATE 11-14=--le-
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN smip a,�7A(�I
INVOICE PAIDAMOUNT
AMOUNT 3�S I �. 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES AIDAMOUNT
Pl 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& Sofety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6177
www.cityafmenifee.us Inspection Request Line 9Sl-246-6213
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