PMT17-04287 City of Menifee Permit No.: PMT17-04287
29714 HAUN RD.
�CCECA_ MENIFEE,CA 92586 Type: Residential Addition
`"'""'"t!N"o MENIFEE Date Issued: 1 210 4/201 7
PERMIT
Site Address: 25350 FORREST WOOD CIR,MENIFEE, Parcel Number: 339-383-023
CA 92584 Construction Cost: $39,900.00
Existing Use: 1 & 2 Family Residence Proposed Use:
Description of 410 SO FT POOL AND SPA WITH HEATER AND 50 AMP SUB-PANEL
Work:
Owner Contractor
ANTHONY BARQUIENRO CAL/PACIFIC POOLS&SPAS INC
25360 FORREST WOOD CIR 17024 VAN BUREN BLVD STE C
RIVERSIDE, CA 92504
Applicant Phone:9517762002
CAL/PACIFIC POOLS&SPAS INC License Number:652876
17024 VAN BUREN BLVD STE C
RIVERSIDE, CA 92504
Fee Description Qy Amount($1
Swimming PoolAn-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE _ 1 2.00
SMIP RESIDENTIAL 1 6.00
$502.00
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 Templale.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 70D0)of Division 3 of the Business and ❑1 am exempt from licensure under the Contractor's State License Law for
Professions Cade and y license Is in full force and effect. the following reason:
License Class Vo Ucense 76
By my signature below I acknowledge that,except for my personal residence
Expires 3! Signature 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 DECLARATIO 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 thata copy of the applicable law,Section
have and will maintain a certificate of consent of self-Insure for workers 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.IeRInfo.ca.gov/caIaw.htmL permit is issued.
Policy# Date
�Vahave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
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 workers 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 bC Gl�4L/f!9 �{//��7 C with all applicable city and county ordinances and state laws relating to
building construct' m7 out prize rep gentatives of this city or county to
Policy If r;y<_4!sr-19y7 Expires /7- ^/ 3 enter th bo ei entr ed property for hspectlon purposes.
(This section need not to be completed is the permit Is for one-hundred Date /L 7
dollars($100)or less P OWNER OR AI CRAZED 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 BUSIN LICENSE#
workers compensation law f-Cal oifir 19 and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers pew.aa[[ionprovisions of Section 3700 of the Labor
Code,I shall f rt ith ythl ose provisions. Will the applicant or future building occupant handle hazardous material or a
Applican Date �'"y� mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FCROSECUR WORKER'S COMPENSATION COVERAGE IS ❑Yes .✓a'I'!o
UNLAWFUL, UBI AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FI UNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for gui Ines
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 boun of a school?
(Section 3007 Civil Code) o Yes No
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. ers requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health i' fety Code,Sect n 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardo ��_/ r Ing.
Business and Professions Code).Any city or county that requires a permit to °Ye o
Dale
construct,alter,improve,demolish or repair any structure,prior to Its
PROPERTYO Nl'� ER OR AUTH RIZEO AGENT
issuance,also requires the applicant for the permit to file a signed statement \N'REP that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATIO AND PAINTING(RRPI
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 fimis 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.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 Contractors 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:
o I,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.
DATE: PERMIT/PLAN CHECK NUMBER - 0C1
TYPE: O COMMERCIAL O RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O•DEMOLITION O ELECTRICAL O MECHANICAL
EW O PLUMBING O RE-ROOF NUMBER OF SQUARES
L
DESCRIPTION OF WORK 110 V L, /Zj Uf 414
PROIECTADDRESS ZIPS/
ASSESSOR'S PARCEL NUMBER LOST` �68 TRACT
OWNERNAME
ADDRESS Z S3 ro 7- wbov C//1 G G C'"
PHONE 98 4`- Y 98 EMAIL
APPLICANT NAME / L pLd- -�
ADDRESS l)OJ. .9 I2cO Cr,*- "C a Li` ,,5,-er- 6�?- 9yjz lie
PHONE R 776 - 1-o b I EMAIL
CONTRACTOR'S NAME 14C1,--14 BOLrf � 19J 16, S OWNER BUILDER? OYES, O
BUSINESS NAME Ac•IX,G ,QG s Q%YIQf'
ADDRESS �21 /�L' RY (�Gf� S•"o `r'
PHONE ( ls� 77� ' l-8�L qq EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION 6
VALUATION$ 3`j `36a L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE SMIP GREEN
- PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED 0 YES 0 NO DRIVERS LICENSE N NOTARIZED LETTER 0 YES 0 NO
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