PMT17-02957 City of Menifee Permit No.: PMT17-02967
29714 HAUN RD.
4/7X C L/> MENIFEE, CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued: 0 812 112 01 7
PERMIT
Site Address: 29047 BLUE MOON DR, MENIFEE, CA Parcel Number: 340-350-014
92584 Construction Cost: $35,000.00
Existing Use: Proposed Use:
Description of INGROUND GUNITE POOL&SPA 426 SQ FT
Work:
Owner Contractor
MICHAEL ROBERTS QUALITY CUSTOM POOLS INC
29047 BLUE MOON DR 30138 MARNE WAY
MENIFEE, CA 92584 MENIFEE,CA 92584
Applicant Phone: 9516799732
HANNAH BARRETT License Number:795820
30138 MARNE WAY
MENIFEE, CA 92584
Fee Description gty Amount l$)
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
$524.35
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjurythat I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑i am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class—CSCQ �LicyeLns/e-No �7g3-$-^2-0`/' By my signature below l acknowledge that,except for my personalresidence
Expires 2 o 11 Signature in which 1 must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
O 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 ww,�,,leeinfo.ca.eov/calaw.html.
this permit is issued. _
Policy# Date
1,e4 have and will maintain worker's 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 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 I have provided is correct.I agree to comply
Carrier &Qres4 N trey%" with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# CA i n n o Zt A`t Expires �7/1 /11 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
m I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with thosepprroviisions. '' ��'' ��''�� Will the applicant or future building occupant handle hazardous material or
Applicant` IH A-y, O/z�r�$ Date TA-7 mountsre specified
ifiedoning a hazardous material Materials
Ivto or ationrthat the
amounts specified on the Hazardous Materials Information Guider'
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS d Yes ffNo
UNLAWFUL,AND SHALLSUBJECI'AN EMPLOYERTO CRIMINAL PENALTIES WWWilithe intended use ofthe 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 Ant Quality Management District(SCtionor See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
Air
s
CONSTRUCTION LENDING AGENCY Yes 90
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) O Yes CNVO
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.I understand my requirements under the State of
California Health&Safety Code,Section 25SOS and 25534 concerning
Contractor's License Law for the reason(s)Indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 r.csY Business and Professions Code).Any city or county that requires a permit to �/ O 1 - - Date 3//
6/17
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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)orthat he or she is exempt from Ilcensure
residence compensation for most work that disturbs painta comply
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms
andd comply with
an Applicant for a perm it 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
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.aov/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 ci 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 I,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. .
---I m �I
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATER it PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL []RESIDENTIAL MULTI-FAMILY ❑MOBILE HOM POOL/SPA []SIGN
SUBTYPE: []ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL [:]MECHANICAL
[-]NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK and
PROJECTADDRESS -jq,0N1 �U/I�U,Q V)Co�}.,G�,,`0 y,1 t1
ASSESSOR'S PARCEL NUMBER 540 ' ',/ -(A LOT "Jp` TRACT 7 O
PROPERTY OWNER'S NAME 9, k s 4ke4
ADDRESS 15�Ok'\ lug o r
PHONE OAS\ IBIS $�-11-1 EMAIL
APPLICANT NAME }�ann rr
ADDRESS l
PHONE EMAIL
CONTRACTOR'SNAME 34m v OWNER BUILDER_ ❑Y jONO
BUSINESS NAME
ADDRESS Q
PHONE O><S 1 ( 'Z q, 0.,1 3 L- EMAIL
CONTRACTOR'S STATE LIC NUMBER -191 S'j L C LICENSE CLASSIFICATION e 3
VALUATION$ O j� e,) 60 SO FT Li 1 b L SQ FT
APPLICANT'S SIGNATUR CITY STAFF USE ONLY
C' DATE i l
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMRER
BUILDING PLANNING ENGINEEFING FIBE GREEN SMIP
INVOICE 9. PAIDAMOUNT
AMOUNT J OCASH CHECK# <-CREDO CARP VISq/MC
PLAN CHECK FEES PAIDAMOUNT OCASH CCECCK# OCREDITCARO VISVMC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Ibienifee Building&safety Department 29714 Houn Rd. Aelenifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Reouest Line 951-245-6212
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
City of Menifea
REVIEWED BY Building & safety "PIL.
AUG 2I 201r
*Approval of these plans shall not be construe e a permit for,or� an
t efede r Received
approval of,any violation of any pr ns oft
ans must be kept on the
regulations and ordina is set of app
ro jobsite until etion.
36 Deep
4260 Pool
5'6"Wood Fence
O
6'Deep. Reef
o r
'6
D o 0 0
v
Usiting Patio
Roberts Residence
l7 29047 Blue Moon Dr.
Menifee, Ca 92584
1 1/2"Poly Cas a,[e 951-675-5874
1"Sch 50 UL
pow
Scale: 3/32" = 1 ft.
I