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PMT17-01260 City of Menifee Permit No.: PMT17-01260 29714 HAUN RD. <A—CCEL/4? MENIFEE,CA 92586 Type: Pool/Spa-Residential MENIFEE Date Issued: 04/24/2017 PERMIT Site Address: 28752 PARK TRAIL WAY, MENIFEE, CA Parcel Number: 333-680-036 92584 Construction Cost: $30,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA 480 SO FT Work: Owner Contractor TAMARA DYER BLUERIDGE POOLS 28752 PARK TRAIL WAY 30097 SWAN POINT DRIVE MENIFEE, CA 92584 CANYON LAKE, CA 92587 Applicant Phone: 9517600152 ROBERT BEECH License Number:825370 BLUERIDGE POOLS 30097 SWAN POINT DRIVE CANYON LAKE, CA 92587 Fee Description QQrl Amount fSl 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_Bldg_Permit 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 perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and D 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 ^Jtr/R C�L� Uce No. �zL �7l/ By my signature below I acknowledge that,except for my personal residence Expires /� 3j / /� Signature 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 1 WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by o 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 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 this permit is issued. www.leginfo.ca.gov/calaw.html. Policy It Date ❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which o 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 with all applicable city and county ordinances and state laws relating to Carrier building construction.I authorize representatives of this city or county to Policy p Expires enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGE rjT��p certify that in the performance of the work for which this permit is issued, f6l /](.[1.5e hall not emolov any persons in any manner so as to became subject to the CITY BUSINESS LICENSE It ✓�J workers compensation laws of California,and agree that if 1 should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall fort rr'th comply with th seprovisions. Will the applicant or future building occupant handle hazardous material or h Z�) I mixture containing a hazardous material equal to or greater that the Applicant Date `� / / - amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURETO SECURE WORKER'S COMPENSATIO6 COVERAGE IS Dyes M11N0 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 r o ion occupant require a permit for the construct modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC ion or See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines - CONSTRUCTION LENDING AGENCY Dyes I Qhlo 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 rkNo 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 checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hhaazzzaardous mat ri I reporting. Business and Professions Code).Any city or county that requires a permit to - o N% Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNERFOR 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(RRPI 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 ❑I,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 wsvw.eoa.Rov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800424-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. a No EPA Lead-Safe Certified Firm is required for this project because: ❑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. APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK Meniree DATE 17 PERMIT/PLAN CHECK NUMBER T TYPE: O COMMERCIAL O RESIDENTIAL C MULTI-FAMILY G MOBILE HOME )f POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION A ELEcFRICAL C MECHANICAL O NEW MPLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS a97Z / �j,,I� �, ASSESSOR'S PARCEL NUMBER 3 -O V�COT �� TRACT OWNER NAME )�qmxrAer ADDRESS n 7 75 2 Al LJ A PHONE EMAIL APPLICANT NAME ADDRESS 60 n/ 5 tjA.N PHONE 9- / 760 016 7. EMAIL CONTRACTOR'S NAME A / !C OWNER BUILDER? O YES O NO I BUSINESS NAME Pr/ (i ADDRESS )06 Ijr PHONE _ %rj 7.�`[j d yCj EMAIL CONTRACTOR'S STATE LIC NUMBER 3 70 LICENSE CLASSIFICATION [I ,- VALUATION$ �d/ d'd1j" SQQ FT L SQ FFT� r� APPLICANT'S SIGNATURE �� �1 ) 7 �✓ S DATE s mw e DEPARTMENT DISTRIBUTION � CITY OF MENxIFEE`fBU INESS LIC NSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN' SMIP INVOICE �j PAIDAMOUNT AMOUNT `� OCASH GCHECK# GCREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH G CHECK# GCREDITCARD VISA/MC [OWNER BUILDER VERIFIED OYES G NO DL NUMBER NOTARIZED LETTER G YES G NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-572-6777 www.cityo/Inenifee.us Inspection Request Line 951-245-6213 S. 13 1 MENT ]XIt4k IYO1j 8 f)CM ri 1 ATE a, , ;