PMT17-01502 City of Menifee Permit No.: PMT17-01502
29714 HAUN RD.
<-�CCELAI' MENIFEE, CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued: 0511512017
PERMIT
Site Address: 30684 CARRIAGE HILL DR, MENIFEE, Parcel Number: 364-300-026
CA 92584 Construction Cost: $45,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 410 SQ FT
Work:
Owner Contractor
NANCY MOLKA BLUERIDGE POOLS
30684 CARRIAGE HILL DR 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 ON Amount f$1
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_Bldg Permit_Templalarpt 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
Chapter!)(commencing with section 7000)of Division 3 of the Business and ❑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:
License Class Uce .No. ,- L ,7r2/ By my signature below I acknowledge that,except for my personal residence
Expires /6 31 /gnattuure AC/C,n( h N/ l . In which I must have resided for at least one year odor to completion of
Improvements covered by this permit.I cannot legallysell 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 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 Cade,is available upon request when
compensation,Issued by the Director of Industrial Relations as provided for this application is submitted or at the fallowing 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 p Date
o l 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
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 he completed is the permit Is for one-hundred
dollars($100)or less Date
PROPERTYOWNER OR AUTHORIZED AGEPjT
I certify that in the performance of the work for which this permit Is issued,
NEhall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE K ✓�J �J
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
Code,I shall fo/rtlpinift comply with th a provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant .%LF�7l {�� h> 4 4`� �/ mixture containing a hazardous material equal to orgreater that the
Date / amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS Dyes 1�{N0
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($100,0001,IN occupant requires permit for the construction or modification from South
IN SECTIONON
3 THE COST LABOR CODE,INTERSDAMAGES
r, A D ATTORNEYS
PROVIDED S Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECDON 37060FTNE LABOR CODE,INTERESi,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oyes �No
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) ayes bo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythat 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 Cade,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 In dour mat ri I reporting.
Business and Professions Cade).Any city or county that requires a permit to a to r o Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNE KORAUTHORIZED AGENT
issuance,also requires the applicant for the permit to rile 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 Cade)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 70315 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant fora permit subjects the applicant to a civil penalty of not more than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
o L 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.eoa.gpv/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a oAn 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. o 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 project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING
Menifee
DATE (7 PERMIT/PLAN CHECK NUMBER ' 9 '
TYPE: O COMMERCIAL 4ESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA 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 �p lly
PROJECTADDRESS r
ASSESSOR'S PARCEL NUMBER ��[/�'�" 'QA(aOT c2 TRACT (� �� -
OWNER NAME 1,
ADDRESS (` IOq 4,11 dr
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE �''/S 7tlo 0t67 EMAIL rI r 1 14_1
CONTRACTOR'S NAME 4e f Akk gae WNER BUILDER? O YES O NO
BUSINESS NAME Jj J C
ADDRESS -j 5 u 1 ! AJ /A1'1. Q J� �)
PHONE �S / 7-6� ���7_ EMAIL Pl P14 Q/
CONTRACTOR'S STATE LIC NUnMBER 2�'Cj 3�(}J /1\ LICENSE CLASSIFICATION C S J- GrrU
VALUATION$ C�V SO FT L SO FT
APPLICANT'S SIGNATURE A Ilk DATE
DEPARTMENT DISTRIBUTION tf 00 CITY OOFF�MEENNIFpEE�BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN IV SMIP
INVOICE " S PAIDAMOUNT
AMOUNT 1/� Y' OCASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0!0::YE!Sj0::N:0:Mj_
EDIT D VISA/
[DOWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER
City of Menifee Building &Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
*Approval these plans shaA not be cocsn,fed to be90 etmit I or an
approval of,arty violation of any provisions of the federal,state or cdy
regulations and-ordinances.This set of approved pian`smust6e kept on the
jobsite until completlon.
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