PMT16-04004 City of Menifee Permit No.: PMT16-04004
29714 HAUN RD. Type: Pool/Spa-Residential
<A-CC1E-Cj-Q.' MENIFEE,CA 92586
MENIFEE Date Issued: 12107/2016
P E R M I T
Site Address: 25728 BUFFALO CIR, MENIFEE, CA Parcel Number: 358-502-017
92584 Construction Cost: $50,000.00
Existing Use: Proposed Use:
Description of INGROUND SPOOL 264 SO FT, 130 L FT GAS LINE FOR BBC &FIREPIT&50 L FT ELECTRICAL
Work: LINE FOR BBC
Owner Contractor
LEONARD GREENLEE PATRON LANDSCAPE CONSTRUCTION
25728 BUFFALO CIR 632 E SHAVER STREET
MENIFEE, CA 92584 SAN JACINTO, CA 92583
Applicant Phone:9514908226
DA License Number.917722
PATRON LANDSCAPE CONSTRUCTION
632 E SHAVER STREET
SAN JACINTO, CA 92583
Fee Description QtV Amount
Receptacle, Switch,Outlet&Fixture 1 116.00
Swimming Pool/In-Ground Spa 1 467.00
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
GREENFEE 1 2.00
SMIP RESIDENTIAL 1 7.00
General Plan Maintenance Fee-Electrical 1 29.15
$764.15
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 carded 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.
AA Bidg_Permt-Ternplate.rpt Page I 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).
Chapterg(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 force and effect. the following reason:
License Class bm' ense By my signature below I acknowledge that,except for my personal residence
Expires C'130 4�k Signature Inwhich 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
ci 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 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.leginfo.ca.goy/calaw.htmi.
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
numberare- application and the Information I have provided is correct.I agree to comply
C 6?Xc—/ '—Z'_4f "/Z 4-&4� with all applicable city and county ordinances and state laws relating to
I El :2 building construction.I authorize representatives of this city or county to
7 enter the above identified property for inspection purposes.
Policy# Pvivc �-��'?5 pirias A�l f,
(Thissection need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHOR17ED AGENT
a I certify that in the performance of the work for which this permit is issued, CITY BUSINE 3
1 shall not employ any persons in any manner so as to become subject to the SS UCENSE# 0
worker's compensation laws of California,and agree that if I should become H.AZARDOUS MATERIAL DECLARATION
subject to*worker's comperysation provisions of Section 3700 of the Labor
Code,I shall 110 th ply"those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicamt� P Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
E VJ91R
WARNING:FAILURE TO SEC KER'S COMPENSATION COVERAGE IS oYes oNo
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 TOONE 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 forguidelines
CONSTRUCTION LENDING AGENCY ci Yes a 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 th e
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACLMD
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 hazardous materl I re ing.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 o N9,"
Business and Professions Code).Any city or county that requires a permit to- 91's's A-f Date /)-7
construct,alter,improve,demolish or repair any structure,pricurto its ��DPERTY 0 ERIOR AUTHORIZED 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 Continictor's State EPA REM ZN,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 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-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 workthemselves cirthrough their
o 1,as ownerof the property,ormy employee With wages astheirsole 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.epa.goy/lead or contact the National Lead Information center at
not intended or offered for sale.(Section 7044,Business and Professions 1-SOG-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through em ployeee or persona I effort,builds or im proves 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 FIRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
lddk�...Menifee
hb�—
DATE PERMIT/PLAN CHECK NUMBER O%p q-
TYPE: OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJEcrADDRESS c2S7.)8 13j�1�6qlo eacle
ASSESSOR'S PARCEL NUMBER �559 -fjbq�-bQ LOT TRACT
OWNERNIAME Z eolvl9le) 2/9E CA/k�(F
ADDRESS -),57�kg ;:?L�fF41b (!�tCl?
PHONE E M A I L f�14PZe4 A 4�&Ll 1-14
APPLICANT NAME �WL18 el IUq,�7(f rJ
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME A27,-?a1v ��7�vc7-iwv OWNERBUILDER? OYES,4�1\10
BUSINESS NAME
ADDRESS 63D (�c '04 (f�'j
PHONE Cj�-f- L/IjO - (� EMAIL
CONTRACTOR'SSTATE LIC NUMBER q)'IT3 '�- LICENSE CLASSIFICATION
VALUATION$ 501 oaz,e� �Q FT LSQFT
APPLICANT'SSIGNAT'UREAO�lf Z4" DATE
DEPARTMENT DISTRIBUTION SMIP CITYOFMENI MBER
BUILDING PLANNING ENGINEERING FIRE GREEN MgMI
INVOICE 11(.Cf.145 PAIDAMOUNT
LAOU NT OCASH 0CHEOK# OCREDITCARD VISA/MC
M
PLAN CHECK FEES PAID AMOUNT 0 CASH OCHECK# 0 CREDIT CARD VISAIMC
OW BU
NEERILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofimenifee.LIS Inspection Request Line 951-246-6213
------N DATE(MMMONM)
I�MJCP' CERTIFICATE OF LIABILITY INSURANCE 1012412016
THIS CERTIFFcATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the poticy(les),nast be cl. If S ATION IS WAIVED,subject to
the terms and conditions of the policy,certain POIiCiO5 may require an ando Ent. A stc("ro"ni-onthIscerti e does not confer rights to the
certificate holder in lieu of such enclorsement(l). r --
PRODUCER CONT T Pay hex Insurance Agency Inc
NAME- 7EUlf� .
PAYCHEX INSURANCE AGENCY,INC. PHO FAX
150 SAWGRASS DRIVE fAICNqEn\lg� 877-266-6850 %q7Pt/)o/ I(Alc Nct, 585-389-7426
ROCHESTER,NY 14620 E-MAIL '---Qerts@paycheX
ADDRESS.
INSURER(S)AFFORDING COVERAGE NAIC S
INSURED INSURER A.' Wesco Insurance Company 25011
PATRON GROUP INC(A CORP) INSURER 8:
PATRON LANDSCAPE CONSTRUCTION
632 E SHAVER STREET INSURER C:
SAN JACINTO.CA 92583 INSURER 0.'
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INSURER I-'
INSURER F.-
COVERAGES CERTIFiCA NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE ISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.N OTMTHSTANOING ANY REQUIREMENT,TE OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INS RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMIT SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL EIR OLICY NUMBER POLICY EFF POLICYEXP LIMITS
LTR INSR�WUID IP JMMMDNYYY) IMMUNYYY)
GENERAL LIABILITY 10� I - EAC-IOCCURRENCE 3
COMMERCIAL GENERAL LIABILITY 0 OL"U a'4 14%� R s
E::1tAs!S-MADEE�CUR NED Sale(An'orm Perso.) s
PFRSO MAL 9 MV WURY
GENERALAGGREGME $
GEITL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COLIPAOPAGG
�D I'MIC' =PROJEM=I-OC 0 r-
AUTOMOBILE LIABILITY COM
MY AUTO (E..=INGLE LINT
BODILY INJURY
4LOWI� SCHEOULEO (Per pwaon)
AMOS AMOS
SODILYINJURY
(Per accident)
FROPEffTYOAIAAGE
(Pwuddedt)
—a.—L-11 —R EACH OCCURRENCE
EXCESS LIAB C�ms-;mrE AGGREGATE S
DED I I RETENTION 5 $
WORKERS COMPEMATIONAND WWC3235957 1011512016 1011512017 X1 10'.'
A JIMPLOTRAW URINUFFY 1.000.000.00
MYPROPR1ETOR?PMTNG�9CU7IVE
EL DISEASE EA EMPLOYEe S 1,000,000.00
��y NIA E.L.DISEASE POLICY UNIT 3 1.000.000.00
9,as.des.l...
OFAQRIPTI,OF QPWRAIMIN,
RECEIVED
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Mach ACORD 401.Additional Remarks Schedule,It more space 1.required) OCT 2 4 2016
State License Number. 917722 WORK COMP UNIT
CERTIFICATE HOLDER CANCELLATION
Contractors State License Board SHOULD ANY OF THE MOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
PO Box 26000 DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY
Sacramento,CA 95626 PROVISIONS,Burr FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR
UMILIV OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25(2010105) 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AB-Incorr bus name and entity
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