PMT16-03882 City of Menifee Permit No. PMT1 6-03882
29714 HAUN RD. Type: Pool/Spa-Residential
<A—CCIEO� MENIFEE, CA 92586
MENIFEE Date Issued: 12/01/2016
PERMIT
Site Address: 28600 LANTERN PARK LN, MENIFEE, CA Parcel Number: 372-270-019
92584 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA,420 SF,WITH 55'U/G GAS LINE FOR FUTURE FIRE PIT
Work:
Owner Contractor
MARK&SHERRIE BALADY PACIFIC COAST POOLS INCORPORATED
2860 LANTERN PARK LANE 26499 JEFFERSON AVE UNIT E
M ENIFEE, 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
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 4.150
General Plan Maintenance Fee-Electrical 1 23.35
$638.35
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of en-ors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violatilon of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a pernift 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__Perrnt-TempIate.rpt Page 1 of 1
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 Contractors State License Law).
Chapter9(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
Professi C d n!j_rBy license Is in full force and effect. the following reason:
License By my signature below I acknowledge that except for my personal residence
License Ons, Signet .. in which I must have resided for at least one year prior to completion of
Expires
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
o 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 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this
by Section 3700 of the Labor Code,for the performance of work for which wwalication is submitted or at the following website:
this permit is issued. lnfo.ca.gov/calaw.htmL
Policy# Date
PROPIE RTY OWN ER OR AUTHORIZE D AGENT
ci I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,forthe 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 workerrs 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 buildiqg construction.I authorize representatives of this city or county to
enter above Identified property for inspection purposes.
Policy I VJ I, Expires C6 -1 V 1 - —
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less IL�
PROPERW OWNER OR AUTHORIZED AGENT
ci I certify that In the performance of the work for which this permit is issued,
I shall not employ 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 wo�er's compensation provisions of Section 3700 of the Labor
Codeo I shall forth th comply with those provisions. Will the applicant or future building occupant handle hazardous material ora
Applicant Date rL-�—Pl mixture containing a hazardous material equal to or greater that the
amounts sp!-Cft-1 on the Hazardous Materials Information Guide?
WARNING:FAILLIME TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes oNo
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UPTO 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 Coast Air Quality Management District[SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelbyes—
CONSTRUCFION LENDING AGENCY o 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 the performance of the work which this permit is issued outer boundaWof a school?
(Section 3097 Civil Code) o Yes ci No
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 California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)Indicated below by the hazarrions-rP,erial reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dyes a No
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,Improve,demolish or repair any structure,prior to Its �&
issuance,also requires the applicant for the permit to file a signed statement PROPERTY 041NER-OTrAUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR 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 a nd Professions Code)or that he or she Is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
a nd the basis for the a lleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certffied 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 theirsole employees.For more information about EPA's Renovation Program visit:
compensation,will do I )all of or I I portion of the work,and the structure is www.epagov/iead 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 improvesthe
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 a m 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.
2xU==_MUNEWT-11,1119101,
A wenifee
DATE k-a�llkv PERMIT/PLAN CHECK NUMBER 0
TYPE: OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME \/POOL/SPA OSIGN
SUBTYPE: OADDITION CALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS t) �eu,�—z qa�oA
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME ff\DAjk(_ A- SVQI/VU— OA OLJ Ily 01 Menifee
Varuly Uept.
ADDRESS VCkkA�= I_A ,±�
6-5-1 - 3z"�F�6 _22�� DF_U U 1 2016
PHONE EMAIL
APPLICANT NAME Recewyed
ADDRESS �Yxp
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES ONO
BUSINESSNAME 1�_
ADDRESS V�0'�
PHONE at�j EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C"�
VALUATION$ �n SQ FT L SQ FT
APPLICANT'S SIGNATURE' DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION L11Y UF WNIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAN40UNT
AMOUNT I( OAS. 1 OCASH OCHECK# OCREDITCARD V1SA/MC
PLAN CHECK FEES PAIDAMOUNT I I OCASH OCHECK# OCREDITCARD VIWMC-
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LE17ER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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