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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 Q Ci G] n c u u1 O 3° x� ew ❑ W LL 2 Q U r N w N Z z0 �o ❑m W� F❑ N Z YO f� Z m O W ® N❑ f Q a. •� NF _2 2 Y F ppp w O F/ ❑a J Q W a w w ❑ C 0 O a. a � rc awz y� rcw!lo �-`'!U' �� IX-W M WSJ �5 mCLLa Y Y voi 0. a p OO w ❑ � U e \ W1 N 2 M1 l J m QO2 y< ❑ 2 F W _ 3 O d Q K g U 6 J 3 O5 w \ x� aZDw Mww w Jam wN * N2 �aoo 3Eo0 ' wW .-ODU OQLL u NI