PMT16-04249 City of Menifee Permit No.: PMT1 6-04249
29714 HAUN RD. Type: Pool/Spa-Residential
<A-CCELA. MENIFEE, CA 92586
MENIFEE Date Issued: 12/2012016
P E R M I T
Site Address: 30380 SHENANDOAH CT, MENIFEE, CA Parcel Number: 358-441-001
92584 Construction Cost: $23,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA.400 SF,V\ATH UIG GAS LINE FOR 2 FIRE PITS AND BBQ
Work:
Owner Contractor
MIKE&CHRISTINA SHORES CHAMPAGNE POOLS
30380 SHENANDOAH COURT 955 ROBERTS RD
MENIFEE, CA 92584 CALIMESA,CA 92320
Applicant Phone:9097957035
JEFF HEWITT License Number:495207
CHAMPAGNE POOLS
955 ROBERTS RD
CALIMESA, CA 92320
Fee Description ON Amount
Swimming PooYIn-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 3.00
General Plan Maintenance Fee-Building 1 5.80
$619.80
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.Bldg_Penit-Template.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 a 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 6— License No. flq Byrnysignature belowl acknowledge that,exceptlior arypersonal residence
Expires '7 /1///4 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 DECLARATIOV 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 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. www.IegInf0.Cargov/caIaw_htmI.
Policy# Date
ct(l have and will maintain WOTkees compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ci 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 AA 4. F5�,nz — building construction.I authorize representatives of this city or county to
Policy#---- Expires 1/7 enter the above identified property for inspection purposes.
(This section need not to be completed is the perr4t is for/one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
ci I certify that in the performance of the work for which this permit is issued,
I shall not empi 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 worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply wrh thoseenovi.sions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date 1:2 mixture containing a hazardous material equal to or greaterthatthe
_4-A�ld 4�=� f amounts specified on the Hazardous Materials Information Guide?
WARNING:FAIL4RE I�GCURE WORKER'S COMPENSATION COVE4GE IS o Yes o No
UNLAWFUL,AND SHALLSUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE 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)?See permitting checklist
IN SECnON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes ci 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 boundary of a school?
(Section 3097 Civil Code) o Yes o No
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 California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ciYes o 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 PROPERTY OWNER OR 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 Contractoes 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 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 work themselves or through their
a 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.gov/lead 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 ci An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'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 provingthat itwas
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm Is required forthis 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 Contmctor'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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
1,111�.k. Me n i f e e
DATE PERMIT/PLAN CHECK NUMBER
TYPE: /�CO14MERCIAL VRESIDENTIAL omurn-FAMILY - MOBILEHOME 0 POOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION � ELECTRICAL � MECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK _J117 15.&A)ee� 5�1�Ynll"� Z wr- Irlom\ ads
&Yw 0 fige P/ktf2 !k 960 y I If
PROJECTADDRESS 3rpua� 15:&41"idlob C4
ASSESSOR'S PARCEL NUMBER LOT TRACT
BuudllnZy 8, M f"
OWNER NAME m1ke IIs 1104 y Dept,
ADDRESS DEC 2 0 2W,
PHONE EMAIL
HE)Ceived,
APPLICANT NAME
ADDRESS CW1k7;0[4 09
PHONE -761 5-96-7 EMAIL
CON JOR'S NAME OWNER BUILDER? 0 YES MO
BUSINESS NAME
ADDRESS
PHONE '�loq EMAIL
CONTRACTOR'S STATE LIC NUMBER 2,6 7 LICENSE CLASSIFICATION
VALUATION$ -2-11 /,)/)o SO FT . �eoen LSQFT
APPLICANT'S SIGNATURE--/2.,,C��/ --,r-�L�— DATE 12-hzA
,bTYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION OF MEN]Ftl,BUSI Nt:��U�tNSE N UMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE
AMOUNT I Le 1q. %p PAID AMOUNT 9 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD "ISA/MC_
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
wwwxityofmenifee�us Inspection Request Line 951-246-6213