PMT17-00708 City of Menifee Permit No.: PMT17-00708
29714 HAUN RD.
�l-�CCEI-A— MENIFEE,CA 92586 Type: Pool/Spa -Residential
MENIFEE Date Issued:
03108/2017
PERMIT
Site Address: 26490 MILENA DR,MENIFEE, CA 92584 Parcel Number: 360-610-007
Construction Cost: $30,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 360 SQ FT
Work:
Owner Contractor
BRIAN MILLER PARADISE POOLS AND DESIGNS INC
26490 MILENA DR 43064 BLACKDEER LOOP#E
MENIFEE,CA 92584 TEMECULA, CA 92590
Applicant Phone:9512961961
MIKE STEPHENSON License Number 943481
PARADISE POOLS AND DESIGNS INC
43064 BLACKDEER LOOP#E
TEMECULA,CA 92590
Fee Description Qtv Amount ISI
Swimming Pool/In-Ground Spa _ 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Electrical 1 23.35
$523.35
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.
AA_aldg_Pemiit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors State Umnse Law for
Professions Code and my license is in full force and effect. the following reason:
License Class-(:::! -9-3 License do. By my signature below I acknowledge that,except for my personal residence
Expires�- IS Signat in which I must have resided for at least one year prior to completion of
r� 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
❑I hereby affirm under penalty of perjury one o e 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 workers 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 ,A,ww.leeinfo.ca.eov/calaw.html.
this permit is issued. y�
Policy# oi� �� /7 r)14 Date
o I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My workers pensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
/�_[r_ I� with all applicable city and county ordinances and state laws relating to
Carrier r Q.r� ✓taC / building construction.I authorize representatives of this city or county to
Policy If Expires � f 7 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
❑I certify that in the performance of the work for which this permit is issued, �/�
1 shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE k 0 ,15 1^81
workers compensation lax f California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers co en ion provisions of Section 3700 of the Labor
Code,I shall forthwith:o wit those provisions. m Will the applicant or future building occupant handle hazardous material or a
Applicant z Date a mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE 70 SECUR WORKER'S COMPENSATION COVERAGE 15 o Yes
UNLAWFUL,AND SHALL UBf AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ON UNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 37060F THE HE LABOR
ABOR CODE,INTEREST,AND ATTORNEYS FEES forguide�Jlines W'
CONSTRUCTION LENDING AGENCY ❑Yes D
1 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) ❑Yes g�aoda
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors license Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 feria)re
Business and Professions Code).Any city or county that requires a permit to oyes
construct,alter,improve,demolish or repair any structure,prior to its Date d
issuance,also requires the applicant for the permit to file a signed statement PROPER OR UTHORRED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATI N RE IR AND PAINTING IRRPj
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renov.\tjbWepair 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 Contractors 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 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 proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State license Law does not apply to an owner of a If your pmject does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
Menifee
DATE PERMIT/PLAN CHECK NUMBER n-0070'9
TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION twLTECTRICAL 0-MECHANICAL
ir-N'EW V-KUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 'X SjQe,
PROJECT ADDRESS 2 y y 0/ f-e b e.. /'j e,
•LA
ASSESSOR'S PARCEL NUMBER 616 6,e�7 LOT / TRACT
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OWNER NAME y'Lev.. a �¢IY"
ADDRESS (pg/ 0 p , � 04C,
PHONE �f'2.S• ,�/(O aJ�. `� EMAIL
APPLICANT NAME�/
ADDRESS 3c�°'I �I� �"� C�-1 - C� ( <-•
PHONE q-j- EMAIL 1
CONTRACTOR'S NAME Alxxd,Sz. krvl;- i ot r1S OWNER BUILDER? O YES O-N@-
C 'BUSINESS NAME
1 w�/ 'o _.� / -5
ADDRESS �Y //� Kam✓ w ,0 �� ��--• Z
PHONE 2?1( sb( EMAIL
CONTRACTOR'S STATE LIC NUMBER 9v 3 / )l LICENSE CLASSIFICATION
VALUATION$ 3 8 It 36 L SQ FFTT �f /
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION (p CITY OF{MEftEWWSINES LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP V//II'']]�•��JJ 91
INVOICE
G)l�j,'J PAIDAMOUNT O
LII'' CASH OGHECKk OCREDITCARD VISA/MC
N CHECK FEES PAID AMOUNT OCASH r-'CHECK# OCREDITCARD VISA/MC
UILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of PAegifee Building& Safety Department 29714 Hour) Rd. IV/enifee, CA 92536.951-672-6777
www.Ciryofinenif ee.us Inspection Reques Iwe 951-246-6213
Gas & electric stubs for
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