PMT17-02375 City of Menifee Permit No.; PMT17-02375
29714 HAUN RD. Type: Pool/Spa -Residential
<A-CCEL/? MEN IFEE, CA 92586
MENIFEE Date Issued:
07/1112017
PERMIT
Site Address: 32889 LAMTARRA LOOP, MENIFEE, CA Parcel Number: 372-331-008
92584 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA,366 SF
Work:
Owner Contractor
VICKI&PERRY ROUMBOS PACIFIC COAST POOLS INCORPORATED
32889 LAMTARRA LOOP 26499 JEFFERSON AVE UNIT E
MENIFEE,CA 92584 MURRIETA,CA 92562
Applicant Phone:9512960199
BRANDI CORAL License Number:852237
PACIFIC COAST POOLS INCORPORATED
26499 JEFFERSON AVE UNIT E
MURRIETA, CA 92562
Fee Description city Amount ISI
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
$622.35
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_Pennit_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 1 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 o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effce�ct.--s the following reason:
t--License Class me J—2.) License No. .L By my signature below l acknowledge that,except for my personal residence
Expires all y Signature - a -. f�' 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 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 avallable 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.leeinfo.ca.eov/calaw.html.
Policy# Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZEDAGENT
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 worker's compensation insurance carrier and polity 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
nn A ��r1�(' c/ building construction.I authorize representatives of this city or county to
Policy#�Vf�l,�tr 17O� Expires O enter the above identified property for inspection purposes.
(This section need not to be completed is the permit Is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if i should become HAZARDOUS MATERIAL DECLARATION
subject tot orker's compensation provisions of Section 3700 of the Labor
Code,I shal• rthwit comply with those provisions. I I.� Will the applicant or future building occupant handle hazardous material or
Applicant 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 o Yes a7'�lo
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 construction
(SCAion or modification
permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES foastAirlini-
CONSTRUCTION LENDING AGENCY ❑Yes o'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 bound fa school?
(Section 3097 Civil Code) oyes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the permitting checklist.l understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California H a) Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardou to al reporting.
Business and Professions Code).Any city or county that requires a permit to oYes o No
construct,alter,improve,demolish or repair any structure,prior to Its Date (1�
issuance,also requires the applicant for the permit to file a signed statement
PROPERTY O' NER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Law(Chapter9(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 ownersand property
than($500). managers who do the paint-disturbing work themselves or through their
D 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.epa.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 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. o 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 Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule pleasefiil out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
®'�`Menifee
DATE PERMIT/PLAN CHECK NUMBER QMj
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME /SGIOOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES Cit
u Iding a Safety Dept.
DESCRIPTION OF WORK � �' (Z� n WGtA�'
` JUL 11 2017
PROJECTADDRESS 2 °1 1aYY2Y1 �r��,.p� Received
ASSESSOR'S PARCEL NUMBER 3?j1 Wp LOT TRACT
OWNER NAME 1/\ fi1Gl �,QYY �ppS
ADDRESS 32UPI, �ACY�-tcAYYoI. ��
PHONE kPZ( - i10! 1��Ii EMAIL
APPLICANT NAME Y W a y �.QYY�Jl.Ir q:�J
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? OYES O'NO-
BUSINESS NAME - n
ADDRESS 2,
PHONE qq ' ALP C 1,01 EMAIL
CONTRACTOR'S STATE LIC NUMBER ZZ� 1 _ LICENSE CLASSIFICATION C5
VALUATION$ S1lp(� SO.FT FT W POI &OT qsQ FT
APPLICANT'S SIGNATURE DATEwIa�^� 1
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE ...f.�.^� PAID AMOUNT ,
AMOUNT tJVp.• OCASH 0 CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O 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 2971= Noun Rd. Menifee, CA 92586 951-672-6777
WWW.Cityofinenlfee.US Inspection Request Line 951-245-5213
SPA SPILLWAY TO BE FULL LENGTH OF
kINING WALL POOL LIGHT 12" RETAINI
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GRASS AREA
30' \
3'6"DEPTH/
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