PMT17-04436 City of Menifee Permit No.: PMT17-04436
29714 HAUN RD.
�ACCEL/-> MENIFEE,CA 92586 Type: Pool/Spa•Residential
0-1q;.h— MENIFEE Date Issued:
1 211 5/2 01 7
PERMIT
Site Address: 24365 COMANCHE CREEK DR, Parcel Number: 358-720-029
MENIFEE, CA 92584 Construction Cost: $18.500.00
Existing Use: Proposed Use:
Description of INGROUND CONCRETE POOL ONLY,380 SQ FT, NO GAS
Work:
Owner Contractor
SCOTT&PAM STACY AMERICAN POOL CONSTRUCTION
24365 COMANCHE CREEK DR 27902 RUGGIE RD
MENIFEE,CA 92584 MENIFEE, CA 92585
Applicant Phone:3107531717
ROY DICKERSON License Number:481500
AMERICAN POOL CONSTRUCTION
27902 RUGGIE RD
MENIFEE, CA 92585
Fee Description Q1t r Amount fSl
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_Permft Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and 0I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is In full force and effect// the following reason:
Yl �UD
License Class 0 S Ucens lo. By my signature below 1 acknowledge that,except for my personal residence
Expires Signature in which l 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
❑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 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.leginfo.ca.goy/calaw.htmi.permit is issued.
Policy fJ Date
❑I have 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 0 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.)agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy k Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
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 8 �� 7
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall f!oltpqith comply with 6se provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date IR /S / mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILUR TO SECURE WORKER'S COMPENSATION COV RAGE IS ❑Yes 00
UNLAWFUL,AND SHALL SUBJECT 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(SCtionor modification
permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for st Ai.rQua
CONSTRUCTION LENDING AGENCY ❑Yes IVNo
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) 0 Yes_92 Jo
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
Contractors License Law for the reason(s)indicated below by the California Health @I Safety Code,Section 25505 and 25534 concerning
ha ardous material repo rti
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 zng.
Business and Professions Code).Any city or county that requires a permit to es 0
construct,alter,improve,demolish or repair any structure,prior to its Date�a
issuance,also requires the applicant for the permit to file a signed statement PROP RTYO NEROR AUTHORIZED AGENT
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 receiving compensation for most work that disturbs paint in a pre•1978
and the basis for the alleged exemption.Any violation of Section 7D31.5 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 sale 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.ena.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a 0 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. SigEPA Lead-Safe rtIfted Firm is required for this project because:
❑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.
PERMIT/PLANBUILDING & SAFETY APPLICATION
- Menifee
DATE: PERMIT/PLAN CHECK NUMBER O
TYPE: O COMMERCIAL xkESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ELECTRICAL ,e MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK -> . I'6cJ>7 CYO Las a ✓LC Ur7
0 SPA
PROIECTADDRE55 _'t�fe&"S' ��jOY✓Q�GIIP� ( - /-�2..? ZIP ry�S U
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME S ` y�/r✓j �� � L..
ADDRESS 7�.Gr'[G� ✓ G*zG-
PHONE !�� Sp� 3 7 �I'/f EMAIL
APPLICANT NAME// ��d 161e A sox'l
ADDRESS T rQ �vc:-�v [• /Z--koG-C GCL/f-
PHONE EMAIL ,,e G
CONTRACTOR'S NAME OWNER BUILDER? O YES O
BUSINESSNAME / dz2Z 77 p
ADDRESS � rJ B /-7J/�? CGZ'r P/�ravt,e1G.. e�/..� 7oZ
PHONE J 3 EMAIL
CONTRACTOR'S STATE LIC NUMBER J'74?6> LICENSE CLASSIFICATION
VALUATION$ S LSD S�QQ FT rig L SQ FT
APPLICANT'S SIGNATURE .ESA-u DATE
Q STAFF USE ONLY _
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE ;;"ptl•3S SMIP GREEN I �
PLAN CHECK FEE I INVOICE TOTAL 6al.3S
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us
gt,5� City of Menitee
Building Dept.
if l ra DEC 1
Receive,,
\� vW��L 1� c
L `)4 , •
� N i'- \ 2'y 1.i�r ..n Y. � � \ U � �,•
c ,t;
l�
r
e�
CITY OF MENIFEE
BUILDING AND SAFETY DE ' THE
FLAN APPROVAL
1 f
ov, •„c;i not be construed to be a permit for,or art-, \.���h
131 of,any violation of any provisions of the federal,state or city \ FE:
f.- ans and ordinances. This set of approved plans must be kept on the
jcn;, Jorilcompletion. ;�