PMT17-00721 City of Menifee Permit No.: PMT17-00721
29714 HAUN RD.
<ACCELA— MENIFEE,CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued:
03/1012017
PERMIT
Site Address: 29918 SALMON ST, MENIFEE,CA 92584 Parcel Number: 340-500-064
Construction Cost: $45,000.00
Existing Use: Proposed Use:
Description of INGROUND SHOTCRETE POOL&SPA 328 SQ FT
Work:
Owner Contractor
TARA&BRIAN THORP QUALITY CUSTOM POOLS INC
29918 SALMON ST 30138 MARNE WAY
MENIFEE,CA 92584 MENIFEE,CA 92584
Applicant Phone: 9516799732
JIM BARRETT License Number:795820
QUALITY CUSTOM POOLS INC
30138 MARNE WAY
MENIFEE,CA 92584
Fee Description Oyt Amount I$
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 6.00
General Plan Maintenance Fee-Electrical 1 23.35
$525.35
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_B1d9_Permil_Template.rpl 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 D I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effect, the following reason:
Ltcense Class (..5'6 • License No.—Mg q-)-o)/� By my signature below l acknowledge that,except for my personal residence
Expires ll•.�D •17 5�gnature b �� /l"7 in which l 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
a I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a ropy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7041 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 www.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
C7,—#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 compensation 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
Carrier•�V(Lv'Q-�4 ✓�0.ct1'u'r1Gl�� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Cal l 000-1% CL-1 Expires —7 en r the above identifi dprgparty for inspection purposes.
(This section need not to be completed is the permit is fo one-hundred I 'Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZEDA NT
Certify that in the performance of the work for which this permit is Issued, i
I shall not emplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 00CK 7 8 Y
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Cade,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to orgreater that the
amounts s ecifred on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes
UNLAWFUL,AND SHALL SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,00D),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 a Yes d3'No
I hereby affirm that under the penalty ofperjury 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 C•rv0 Code) a Yes t?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 l am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors 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 es• o No r7
Business and Professions Code).Any city or county that requires a permit to r] � Date 1' I'1 •1'7
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN ER 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 Iicensure receiving compensation for most work that disturbs paint In a pre-1978
and the basis for the alleged exemption.Any violation of Section 70313 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($SOD). managers who do the paint-disturbing work themselves or through their
oI,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.eov/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7041,Business and Professions 1-000-424-LEAD(5323).
Code,The Contactors State License Law does not apply to an owner of a ❑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 ofsale. O No EPA Lead-Safe Certified Firm is required for this project because:
g)l,as owner of the property am exclusively contracting with licensed
contactors to construct the project(Section 7044,Business and Professions
Code:The Contactors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please Rll out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 7 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL C MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL C MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS G' y,
ASSESSOR'S PARCEL NUMBER �j`}0'r,�(�- { LOT ��O ✓ TRACT AN 5-7
OWNER NAME f ,
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME n .�d -+ OWNER BUILDER? OYES "0
BUSINESS NAME
ADDRESS
PHONE (�� aj �J�� EMAIL
CONTRACTOR'S STATE LIC NUMBER �-� y LICENSE CLASSIFICATION
VALUATION $ SO.FT L SQ FT
1
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION P CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN a, SMIP Loo S l 5'
INVOICE �/ PAID AMOUNT
AMOUNT S-3 CLASH OCHECKB CCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED CO YES C NO DL NUMBER NOTARIZED LETTER C YES 0 NO
City of Menifee 6uildinp& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-5777
www.Citvofinenifee US Inspection Request One 951-246-6213
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