PMT17-01711 City of Menifee Permit No.: PMT17-01711
29714 HAUN RD. Type: Pool/Spa-Residential
�XCCELAI7. MENIFEE,CA 92586
MENIFEE Date Issued: 05/31/2017
PERMIT
Site Address: 26163 SIERRA SKY ST, MENIFEE, CA Parcel Number: 360-531-004
925B4 Construction Cost: $45,000.00
Existing Use: Proposed Use:
Description of INSTALL IN-GROUND POOL WITH SPA W 3 LIGHTS
Work:
Owner Contractor
TYSEN QUTANTANCE PRESTIGE POOL 8.SPA
26163 SIERRA SKY ST 29492 MCVICKER CANYON PARK RD
MENIFEE,CA 92584 LAKE ELSINORE,CA.92530
Applicant Phone:9518363002
MARK MCULLOUGH License Number:905724
PRESTIGE POOL&SPA
29492 MCVICKER CANYON PARK RD
LAKE ELSINORE, CA 92530
Fee Description (Cl t Amount ISI
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_BIdg_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 ❑I am exemptfrom licensure under the Contractor's State License Law for
Professions Code
/nand my license is in full force and a ct. ,/ the following reason:
License Class L 63 License No. G•�7 UI' By my signature below I acknowledge that,except for my personal residence
Expires/0— 3 1_n Signature .CPI 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
Qjhereby 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 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,forthe performance of work for which this permit is issued. www.leeinfo.ca.eovhalaw.html.
LJ f c�
Policy It / l ! f �J o l)[, Date
m,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
numberare: application and the information I have provided is correct.I agree to comply
S,fJ-,�e I-V�� with all applicable city and county ordinances and state laws relating to
Carrier /T;u-� building construction.I authorize representatives of this city or county to
Policy if -!-7 L— RW�a Expires O t7-Ii 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
RJ,eerl(fythat 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 p
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensati.onprovisions of Section 3700 of the Labor
Code,I shall forthwith c mply will' s oovvisiionnys� Will the applicant or future building occupant handle hazardous material or a
Applicant �"^L Date mixture containing a hazardous material equal to or greater that the
/// amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes &Wo
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 I occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR r Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes M-Wo
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) ❑Yes "o
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 I am exempt from the California Health&Safety Cod Sect an 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reportin
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 No
Business and Professions Code).Any city or county that requires a permit to �/,yL7< Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER O 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 IRRP)
License Law(Chapter9(commencing with Section 7000)of Division 3 of t XWE' ®p%. The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from tic sw@R p
and the basis for the alleged exemption.Any violation of Sectowip �y receiving ng compensation for most work that disturbs paint in a ply with
.01{ residence ra childcare facility a he RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil �}O�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 the! fmployees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is . w.e a. av lead or contactthe National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professior�s p ,®`a 1-,00-024-LEAD(5323).
Code,The Contractors State License Law does not apply to an o ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees or personal effort,builds or im roves 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:
01,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 70",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 plena fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE J—3 f— Zc)1 ( PERMIT/PLAN CHECK NUMBER w Il—D I '
ll
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O-PIbOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NErW O PLUM/RING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK I K-f r60AJ 0,zil Gv 4A 5.,aet
PROJECTADDRESS V,& (235erraS-yK- S�• lti'��e►u � �i Sr -8`
ASSESSOR'S PARCEL NUMBER LOT �Z TRACT 500104
OWNER NAME
ADDRESS �b l /�rGa. (�L p
PHONE U P'//�Tb M/AIIII . Se- .1 e• C�
APPLICANT NAME rk C_ l f U I�'� ''
P-
ADDRESS 9 MC ICI-e (JAB� L-LG6 P- 'CC L� ��1 Sr drC O
PHONE 7 5/ O�j 36—.3UO 1 EMAIL 5CO �PK L'J7 fta&j
CONTRACTOR'S NAME M cz r I'C C c OWNER BUILDER? O YES Z-Nb
BUSINESS NAME /"M(-? t, f P001 I i J A-
ADDRESS j/rr� MC1f 1 r-P� (-tJL.A OLD I• PLA, La I`,e 6151 u.6rt' -
PHONE ? 6I— $36-300c�— EMAIL qle J'n&k( . C
CONTRACTOR'S STATE LIC NUMBER 9C)5 7,LL I LICENSEC�ENSE CLASSIFICATION 1,63
VALUATION$ qS , UUUJ�J SQ FT ` 'a L SO FT -7
APPLICANT'S SIGNATURE // L DATE
DEPARTMENT DISTRIBUTION �/) 1 /1 CITY OF MENIFEE BUSINESS LICENSE NUMBER
�/'BUILDING PLANNING ENGINEERING FIRE GREEN Z' , SMIP ' /
INVOICE f_ r �j PAIDAMOUNT
AMOUNT •I a"J 0CASH 0CHECK# CCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 9516tyc�Wnifee
www.cityofinenifee.us Inspection Request Line 951-246-6213 Elullding &Safety Dept.
MAY 31 2017
Received
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