PMT17-00910 City of Menifee Permit No.: PMT17-00910
29714 HAUN RD.
�CCELA�. MENIFEE, CA 92586 Type: Pool/Spa -Residential
MENIFEE Date Issued:
03127/2017
PERMIT
Site Address: 28771 ARGO DR, MENIFEE, CA 92584 Parcel Number: 339484-004
Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 582 SO FT
Work:
Owner Contractor
MIKE LEE INFINIUM CONSTRUCTION
28771 ARGO DR 42801 LARRY LEE LANE
MENIFEE,CA 92584 TEMECULA, CA 92592
Applicant Phone:9517979476
KAREN MCROBERS License Number: 976676
42801 LARRY LEE LANE
TEMECULA, CA 92592
Fee Description Qtv Amount(S)
Swimming Pool/in-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Electrical 1 23.35
$522.35
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_Bldg_Permil_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 contmctor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 am exempt from Ilcensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class -,'11Q3-k-Z License No. tte Vr By my signature below I acknowledge that,except for my personal residence
Expires 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 DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
01 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 Cade,for the performance of work for which ,�„�„�,I i (o.ca. ov calaw.html.
'this permit is issued.
Policy ff Date
JPRY OWNER OR AUTHORIZED AGENT
D I have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ignature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insuran a carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: ems. al. r`e application and the information I have provided is correct.I agree to comply
Carrier - with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Polity p �✓>R�� Explres — � 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
❑1 certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker compensation provisions of Section 3700 of the Labor
Code,Ishall fo �'t o y i ose�:/�P�I�ro��v,is,,'�/�1�o/�' J) Will the applicant or future building occupant handle hazardous material or
Applic 1/�"!i"�Date_!. � mixture containing a hazardous material equal to or greater that the
amoun f 'fied on the Hazardous Materials Information Guide?
WARNING:F LURETO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes Flo
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 TO ONE 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 for guide)'
CONSTRUCTION LENDING AGENCY ❑Yes j9Wo
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) oYes o
OWNER BUILDER DECLARATIONS I have r. ad 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 underthe State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(5ection 7031.5 h zardau�j mate' r I2orttng.
Business and Professions Code).Any city or county that requires a permitto Ye jJJo y Y�T�
construct,alter,improve,demolish or repair any structure,prior to its .rw v
Issuance,also requires the applicant for the permit to file a signed statement "--p /9 NER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION.REPAIR AND PAINTING(ARP)
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 properly owners and property
than($SOD). managers who do the paint-disturbing work themselves or through their
❑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.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-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:
o 1,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 project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
1
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE "2'I'1 -I PERMIT/PLAN CHECK NUMBER I�/ I O
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME m'POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
C NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK D L) 'SPA
PROIECTADDRESS ATM I P1.,2 6-1 ,
ASSESSOR'S PARCEL NUMBER � 4SL Obf LOT 2 TRACT
OWNER NAME�p jIU.-'ADDRESS 1i611 I
PHONE ,/ n _EMAIL
APPLICANT NAME (2Z-VQ C. 13�'2-TS
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME "e y' P-e1&1?�� OWNER BUILDER? O YES "0
BUSINESS NAME "AA �v7S�-rl..l.c..r-i�
ADDRESS 4 2� I -V LJ/
PHONE —q`4-1(10 EMAIL D c�
CONTRACTOR'S STATE LIC NUMBER `T'� S/ 7LIC�E CLASSIFICATION
VALUATION$ J J O SQ FT 5$,2- L SO FT
APPLICANT'S SIGNATU DATE
DEPARTMENT DISTRIBU CITY OF ME E L$ ICJ:ySE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP /V.�(o(
INVOICE PAIDAMOUNT O O
AMOUNT q• CASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Deportment29714 Houn Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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