PMT17-01740 City of Menifee Permit No.: PMT17-01740
29714 HAUN RD.
�A-CCELA7-. MENIFEE,CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued: 0 6/0 212 01 7
PERMIT
Site Address: 25895 FARMINGTON RD, MENIFEE,CA Parcel Number: 358-100-054
92584 Construction Cost: $34,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 436 SO FT
Work:
Owner Contractor
CHRIS&TAMMY FIELD TAYLOR MADE POOLS INC
25895 FARMINGTON RD 18795 OAK VIEW WAY
MENIFEE, CA 92584 LAKE ELSINORE, CA 92530
Applicant Phone:9518166444
GEORGE BOULLON License Number.795053
TAYLOR MADE POOLS INC
18795 OAK VIEW WAY
LAKE ELSINORE, CA 92530
Fee Description Oty Amount i$1
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 5.00
General Plan Maintenance Fee-Electrical 1 23.35
$524.35
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
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 .41 am exempt from licensure under the Contr ctor's State License Law for
Professions Code and my license is in full farce and effect. +-fig the following reason: /Y6 �`�i✓�i CQS
License Class License l !/�� By my signature below I acknowledge that,except for my personal residence
Expires Signature i 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
❑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 forworker'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 www.leeinfo ca aov/calaw.html.
this permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain worker's compensa ton insurance,as required by
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 owner's behalf.I have read this
number are: 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
Policy# Expires 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
tPLI-certify that in the performance of the work for which this permit is issued, O�r L r'
1 shall not emolov any persons in any manner sous to me subject to the CITY BUSINESS LICENSE# • v
worker's compenVC1,
f California,an at if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wonsa ' n pr of Section 3700 of the Labor
Code,I shall fo ovisions. Will the applicant or future building occupant handle hazardous material or a
Applican � Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes iNo
UNLAWFUL,AND SHALLSUBIECT 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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit t construction or modification from South
IN SECTION 3706 OF THE LABOR CODE;INTEREST,AND ATTORNEYS FEES - Coast Air Duality Management District(SCAQMD).See permitting checklist
fogguidelines - —-- - _ --` - ---'-- - ---
CONSTRUCTION LENDING AGENCY ❑Yes Xwo
1 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 SCAOMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I unders and my requirements under the State of
California Health&S e ode,Section 255 an 34 Concerning
Contractor's License Law for the reason(s)indicated below by the hazardous matey' rting.
�e
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 . es ❑No
Business and Professions Code).Any city or county that requires a permit to to
construct,alter,improve,demolish or repair any structure,prior to its PROP TY OWNER OR THORIZED 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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($500).
managers who do the paint-disturbing work themselves or through their
o I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Lode:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERM IT/PLAN CHECK
,Menifee
DATE PERMIT/PLAN CHECK NUMBER I
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME WPOOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
*NEW OPLUMBING ORE-ROOF-NUMBEROFSQUAR
DESCRIPTION OF WORK /ILEGd 4C� S C�GIS /U ra
PROJECTADDRESS 2 G ,/ 1
ASSESSOR'S PARCEL NUMBER 3S0 �Ob—( +� LOT TRACT
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANTNAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME ��j�/y/{�� f(C OWNER BUILDER? O YESA(�ZLO
BUSINESS NAME
ADDRESS
PHONE 9S/ � �a�y EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 3'f,4D0 SSQQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFJ�D WSLI I SE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ?jS PAID AMOUNT C O
AMOUNT CASH CHECK# 0CREDIT CARD VISAIMC
PLAN CHECK FEES PAID AMOUNT OCASH 0 CHECK# •CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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