PMT17-02846 City of Menifee Permit No.: PMT17-02846
29714 HAUN RD.
4rnCCEL/1�. MENIFEE,CA 92586 Type: PoollSpa-Residential
MENIFEE Date Issued: 08/11/2017
PERMIT
Site Address: 28611 VELA DR, MENIFEE, CA 92586 Parcel Number: 339-482-001
Construction Cost: $25.,000.00
Existing Use: Proposed Use:
Description of INSTAL POOL AND SPA 30X16 360SF
Work:
Owner Contractor
JAQUI &FRANK VALENCIA PACIFIC COAST POOLS INCORPORATED
28611 VELA DR 26499 JEFFERSON AVE UNIT E
MENIFEE,CA 92566 MURRIETA, CA 92562
Applicant Phone: 9512960199
BRANDY CORAL License Number.852237
PACIFIC COAST POOLS INCORPORATED
26499 JEFFERSON AVE UNIT E
MURRI ETA, CA 92562
Fee Description 0tv Amount!$)
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
$522.35
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_Pernit 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 perjurythat 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 ❑1 am exempt from licensure underthe Contractors State License Law for
Professions Cod and y license is in full force and effgct._��� the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires Signatureb in which I must have resided for at least one year priorto 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
in 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 thi !cation 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. w .Ie info.ca. ov alaw.html.
Polity# Date
PR ERN 6VAER-OR AUTHORIZED AGENT
❑I have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which in 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 owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier I / with all applicable city and county ordinances and state laws relating to
p �I C� build[n construction.I authorize representatives of this city or county to
Policy#_`, ) A .A 1 tiv Expires U e e th hove identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred � /,1�
dollars($100)or less ` v — Date 1
PROP TY ANER OR AUTHORIZED AGENT
❑I certify that 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#
workers comp s tion laws of California,and agree that if 1 should become HAZARDOUS MATERIAL DECLARATION
subject to[he rl Ys compensation provisions of Section 3700 of the Labor
Code,I shall fo h> i a p ith those provisions. �� Will the applicant or future building occupant handle hazardous material or
Applicant Date r� mixture containing a hazardous material equal to or greaterthat the
amounts specified on the Hazardous Materials Information Guide?
WARNING:F LURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes
UNLAWFUL,AND SHALLSUBIECTAN EMPLOYERTO CRIMINAL PENALTIES Will the intended use of the building bythe applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TOTHE COST OF COMPENSATION,DAMAGESAS PROVIDED FOR occupant require a permitforthe construction ormodification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guid"l
CONSTRUCTION LENDING AGENCY ❑Yes ❑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 of a school?
(Section 3097 Civil Code) ❑Yes o�fJo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting check' .I u derstand my requirements under the State of .
I hereby affirm under penalty of perjury that I am exempt from the Clalifomia Hea 'Saf Cod Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the azardou at lal portin . I _ I
checkmark(s)I have placed next to the applicable items)(Section 7031.5 oyes ❑No i� ` l
Business and Professions Code).Any city or county that requires a permit L
to Date
construct,alter,improve,demolish or repair any structure,prior to Its PROPERTY OW R OR 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(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
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to he RRPcertified firms and comply with
than($500). required practices.This includes rental property owners and property
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.epa.gov/lead or contact the National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors 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:
❑1,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 & SAFETY PERMIT/PLAN CHECK APPLICATION f
DATE — — PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME "POOL/SPA C'SIGN
SUBTYPE: O ADDITION O ALTERATION ()DEMOLITION OELECTRICAL O MECHANICAL
ONEW OPLUMBING ORE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 00
PROJECTADDRESS 11 /Ny�
ASSESSOR'S PARCEL NUMBER Tl � OS � WI LOT TRACT
OWNER NAME
ADDRESS
PHONE �' l�• S�o< EMAIL l ,
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES O 0
BUSINESS NAME
ADDRESS41;
PHONE or-4� �/ I L� EMAIL 2
CONTRACTOR'S STATE LIC NUMBER Li2� / LICENSE CLASSIFICATION S "
VALUATION $ �- D�L) SOFT 3l V L SO FT r
APPLICANT'S SIGNATURE DATE I
DEPARTMENT DISTRIBUTION epI' 1 '1..1� CITY OF MENIFEE BU,S/IN LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE C� +jS PAID AMOUNT �.
AMOUNT J .+CASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED DYES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
wwvo.cityojmeni,Fee.us inspection Request
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