PMT17-02468 City of Menifee Permit No.: PMT17-02468
29714 HAUN RD. Type: Pool/Spa -Residential
{ACCELA? MENIFEE,CA 92586
MENIFEE Date Issued:
07/14/2017
PERMIT
Site Address: 26310 ADELINA DR, MENIFEE, CA 92584 Parcel Number: 360-600-005
Construction Cost: $16,000.00
Existing Use: Proposed Use:
Description of NEW 14 X 281N GROUND VINYL LINER SWIMMING POOL. NO GAS, ELECTRICAL ONLY. ONE LOW
Work: VOLTAGE LIGHT.
Owner Contractor
ANDRE CUTHBERTSON SECARD POOLS
26310 ADELINA DRIVE 9292 NINTH ST
MENIFEE,CA 92584 RANCHO CUCAMONGA, CA 91730
Applicant Phone:9099804407
RICARDO JOYA License Number:233403
9292 NINTH ST
RANCHO CUCAMONGA, CA 91730
Phone:9094770373
Fee Description O_yt Amount ISI
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 3.00
General Plan Maintenance Fee-Electrical 1 23.35
$521.35
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 carded 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).
hereby affrm under penalty of perjury that I am under provisions of
apter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractor's State License Law for
rofessions Code and my license is in full force and effect. the following reason:
License Class �.S License o. Z. By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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 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 vvwwleeinfo.ca.zmv/calaw.html.
this permit is issued.
Policy# Date
❑I have and will maintain worker's compensaLlon 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 worker's 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 1 have provided is correct.1 agree to comply
Carrier LIZFi with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# SQ5C1 15W 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
❑I certify that in the performance of the work for which this permit is issued,
I shall not emolov 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 to the worker's comp ions of Section 3700 o ytheabor
Code, orthwit with[ oovisions. y Will the applicant or future building occupant handle hazardous material or
Code,I sh orthwit vvitht 0�
Appllca t Date ! mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide.
WARNING:FAILURE TOSEC� WORKER'S COMPENSATI COVERAGE IS ❑Yes An
UNLAWFUL,AND SHALI.5CIBIECT 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(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideli ,es
CONSTRUCTION LENDING AGENCY 0Yes ono
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 bouryfery of a school?
(Section 3097 Civil Code) ❑Yes o
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
California Health&Safety Code,Section 255 d 25534 conce ing
Contractor's License Law for the reason(s)indicated below by the hazardous in repo
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 es o
Business and Professions Code).Any city or county that requires a permit to - Date lTpr
construct,alter,Improve,demolish or repair any structure,prior to its PROP R OR ALIT D A T
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 P NTING IRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repai nd Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from Iicensure 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 www.eoa.eov/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 D 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:
❑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 please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
kMenifee
DATE 7 / 1:7 PERMIT/PLAN CHECK NUMBER PV/ I P —Q14ILQ9'
TYPE: O COMMERCIAL `RESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA O 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 M 2 N V l_Ilu tital 00 L4.
�
PROJECTADDRESS 3(D /,J 172., 92�D%
ASSESSOR'S PARCEL NUMBER 3(ob(o- Qlhm -0,cS LOT (yQ TRACT
OWNER NAME - a
ADDRESS -
PHONE ((,10) 452 ' 1511 EMAIL
APPLICANT NAME A
ADDRESS 9ZR2- M,yrg S1•
PHONE EMAIL Y' C 6cd,'L.f) LS.COM
CONTRACTOR'S NAME SocAQb Ls OWNER BUILDER? O YES O NO
BUSINESS NAME Lc L5
ADDRESS 'Z NWTt.L Sr.
PHONE f Tg) 1750-(p74.1 EMAIL
CONTRACTOR'S STATE LIC NUMBER �33q-p3 LICENSE CLASSIFICATION C- 5 .3
VALUATION SQ FT 3y2 L SQ FT
APPLICANT'S SIGNATURE DATE
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF CM-EENNIIF--E-EE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP ` �L/ ✓
INVOICE PAID AMOUNT �,
L ��• O CASH O CHECKk CREDIT CARD VISA/MC
N CHECK FEES PAID AMOUNT OCASH OCHECK# 0CREDITCARD VISA/MC
UILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
0
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 925�"0972 67 Gaiety
www.cityofinenifee.us Inspection Request Line 951-246-6213 �UL 14 2011
Received
Ca Pools, Inc.
9292 NINTH STREET,STE.B
e
4RANCHO CUCAMONGA,CALIFORNIA 91730
(909)980-4407
August 9,2016
LETTER OF AUTHORIZATION
To whom it may concern,
Secard Pools, a Corporation, hereby authorizes Ricardo Joya (R.J.), Permit Tech,
to act as a representative on behalf of our company. He is authorized to get
business licenses, pull permits, appear in a court of law and act as any necessary
agent required by entities he may incur. This will include, but is not limited to, the
counties of Los Angeles, Orange, San Bernardino, Riverside, Ventura and San
Diego.
This authorization is imposed as valid today on August 9, 2016 and will remain J
valid until August 8, 2017. Thank you. ,� I
City of Menifee ( �1
Building &Safety Dept.
JUL 14 2017 I
ReceWd
x
oe Secard
President
x
Robert Cannon, Notary (�
x ` 7 ROBERT CANNON
Jodi Secard Kidder ��—' ,' COMM. #2002481 m
Notary Public-CalAomla N
CFO/Secrets BANBERN MN0000NIY
M Comm.F .DEC.X"2 16
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