PMT17-00035 City of Menifee Permit No.: PMT17-00035
29714 HAUN RD. Type: Pool/Spa-Residential
'KXCCEL/-> MENIFEE, CA 92586
MENIFEE Date Issued: 01/05/2017
PERMIT
Site Address: 31564 NORTHFIELD LN, MENIFEE, CA Parcel Number: 358-234-024
92584 Construction Cost: $70,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL AND SPA, 1200 SF,WITH 70'U/G GAS LINE FOR 2 FIRE BOWLS
Work:
Owner Contractor
RANDY ALTMAN MH POOL CONSTRUCTION
31564 NORTHFIELD LANE 16078 PORTER AVENUE
MENIFEE, CA 92584 RIVERSIDE,CA 92504
Applicant Phone:9514152329
MATT HYLTON License Number: 1011457
MH POOL CONSTRUCTION
16078 PORTER AVENUE
RIVERSIDE, CA 92504
Fee Description Oft Amount
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 3.00
SMIP RESIDENTIAL 1 10.00
General Plan Maintenance Fee-Electrical 1 23.35
$646.35
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 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.
Page 1 of 1
AA_Bldg_Permit_Template.rpt
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CITY OF MENIFEE
property who builds or improves thereon,and who contracts for the projects II
ntractors)pursuant to the Contractors State License Law).
LICENSED DECLARATION with a licensed co
I hereby affirm under penalty of perjury that I am under provisions of ❑1 am exempt from licensure under the Contractors State License Law for i
Chapter9(commencing with section 7000)of Division 3 of the Business and the following reason:
Professions Code and my license is in full force and effect. personal residence
License No. /� S By my signature below I acknowledge that,except far my
License Class if `5> in which 1 must have resided for at least one year prior to completion of
Expires 7/7 Q ZZ R Signature improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built n ra owntors.I understand
if d has not been constructed ble law,section In its entirety
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand thatssions o copy of the applicable
have and will maintain a certificate of consent of self-insure for worker's thiapplication 44 of the pis subm submitted oness and r at the foldlow ng website:e,is available pon request when
compensation,issued by the Director of Industrial Relations as provided forl t cis submitted or .
by Section 3700 of the Labor Code,for the performance of work for which
this p permit is issued. Date�
is PROPERTY OWNER OR AUTHORIZED AGENT
# am,h-fhave and will maintain worker's compensation insurance,as required by o By my signature below I certify to each of the following:owners behalf.I have read a sy
section 3700 of the Labor code,for the performance of the work for which owner or authorized to act on the property
application and the information I have provided is correct.I agree to comply
this permit is issued.My workers compensation insurance carrier and policy with all applicable city and county ordinances and state laws relating to
number are:
i [P building construction.I authorize representatives of this city or coon o
Carrier /22� qC r+ /��'A y enter the above identified property for inspection purposes.
,. r5 9 W 5) Expires A9/7 �/�'
Polity# Oates
(This section need not to be completed is the permit is for one-hundred PROPERTY OWNER OR AUTHORIZED AGENT
dollars($300)or less
o I certify that in the performance of the work for which this permit is issued, CITY BUSINESS LICENSE#
1 shall not emolov any persons in any manner so as to become subject to the fiAZAR0005 MATERIAL DECLARATION
worker's compensation laws of California,and agree that if I should become Ikant or future building occupant handle hazardous material or a
subject to the worker's compensation provisions of Section 3700 of the Labor Will the app
Code,I shall forthw'h comply a provisions. mixture containing a hazardous material equal to or greater that the
Date — amounts specified on the Hazardous Materials Information Guide?
Applicant Dyes ONO
WARNING:FAILURE T SECUREWORKER'S COMPENSATION COVERAGE IS Will the intended use of the building by the applicant or future building
UNLAWFUL,AND SHALL SUBJECT AN EMPLO SAND CRIMINAL PENALTIES occupant require a permit for the construction or modification from South
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARSROVIDED F IN Coast Air Quality Management District(SCAQMD)7 See permitting checklist
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR
for guidelines
IN SECTION 3706 OF THE TABOR FADE,INTEREST,AND ATTORNEYS FEES m yes ❑No
CONSTRUCTION LENDING AGENCY Will the proposed building or modified facility be within 1000 feet of the
I hereby affirm that under the penalty of perjury there is a construction outer boundary of a school?
lending agency for the performance of the work which this permit Is issued D Yes a No
(Section 3097 Civil Code) 1 have read the Hazardous Material Information Guide and the SCAQMD
OWNER BUILDER DECLARATIONS 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
hazardous material reporting.
Contractor's License Law for the reason(s)Indicated below
by the
checkmark(s)I have placed next to the applicable items)(Section 7031.5 oyes ❑No Date
Business and Professions Code).Any city or county that requires a permit to PROPERTY OWNER OR AUTHORIZED AGENT
construct,alter,Improve,demolish or repair any structure,prior to its
issuance,also requires the applicant for the permit to file a signed statement EPA RENOVATION REPAIR AND PAINTING IRRPI
that he or she is licensed pursuant to the provisions of the Contractor's State The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
License Law(Chapter 9(commencing Section 7000)of Division 3 of the receiving compensation fort most work that disturbs paint in a pre-1`9'h
Business and Professions Code)or that he or she is exempt from licensure
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to 6e RRP-certified firms and comply
an Applicant for a permit subjects the applicant to a civil penalty of not more
required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
than($500). employees.For more information about EPAN Renovation Program visit:
o I,as owner of the property,or my employee with wages as their sole ezd or contact the National Lead Information Center at
compensation,will do( )all of or( )portion of the work,and the structure is 1-B00-474-LEAD(5323).
not intended or offered for sale.(Section 7044,Business f a
Code;The Contractors State License Law does not apply ❑An EPA Lead-Safe Certified Renovator will 6e responsible far this project
to an owner o
property who,through employees'or personal effort,builds or improves the certified Firm Name:
property provided that the improvements are not intended or offered for
sale.If,however,the building or improvement is sold within one year°f Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was D No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale. .
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Code:The Contractor's State License Law Acknowledgement
APPLICATION � ..
SAFETY PERMIT/PLAN CHECK
BUILDING &
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL 'RESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 4pPa 00 S �[
PROJECTADDRESS ! c lj&,,7411 fPI / 1A
ASSESSOR'S PARCEL NUMBER � ' ',� +( L( LOT TRACT
OWNER NAME 2-ig b, >•+? R
ADDRESS ,- h �eI'/cI
PHONE 9y°! ZI Z - Z 3 SQ> EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES "0
BUSINESS NAME
ADDRESS 1,607 0,,zc
PHONE g S/ G//S - Z 3 2 I EMAIL
CONTRACTOR'S STATE LIC NUMBER C-53 loll yS -4 LICENSE CLASSIFICATION z -53
VALUATION$ 19000 SO,FT LSQFT
APPLICANT'S SIGNATURE DATE
_ . ..
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP (�
INVOICE PAID AMOUNT �;
AMOUNT OCASH CHECKN OCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 925S6 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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