PMT18-00002 City of Menifee Permit No.: PMT18-00002
29714 HAUN RD.
<rnCCELAI�. MENIFEE, CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued: 0110 2/2 01 8
PERMIT
Site Address: 31912 WHITFIELD ST, MENIFEE, CA Parcel Number: 360-660-028
92584 Construction Cost: $45,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA,400 SF,WITH 1 POOL LIGHT, 1 SPA LIGHT
Work:
Owner Contractor
ANDY RUIZ CAL/PACIFIC POOLS&SPAS INC
31912 WHITFIELD STREET 17024 VAN BUREN BLVD STE C
MENIFEE, CA 92584 RIVERSIDE, CA 92504
Applicant Phone:9517762002
GARY SOPER License Number:652876
CAL/PACIFIC POOLS&SPAS INC
17024 VAN BUREN BLVD STE C
RIVERSIDE,CA 92504
Fee Description Qtv Amount ISl
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 6.00
General Plan Maintenance Fee-Electrical 1 23.35
$525.36
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_aldg_Permit Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and D 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 fallowing reason:
a
License Class '? --titan By my signature below I acknowledge that,except for my personal residence
Expires Signa 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 DECLA 101 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 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
this permit is issued. www.leeinfo.ca.eov/calaw.html.
Policy g Date
(I 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 �crary 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 r"-C d2/TGr /L/blz� with all applicable city and county ordinances and state laws relating to
huild' gconstractl I authorize representatives of this city or county to
Policy tf5 Z•a C_ /IS q'7. 7 Expires Y- a3 ^/\ mart heaboveidentifie�rty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred - Date
dollars($100)or less PROPeR-TY-OWNE R AUTHORIZED AGENT
0I certify that in the performance of the work for which this permit is issued,
I shall not e� erws o C In nner so as to become subject to the CITY BUSINESS LICENSE N
worker's co io laws of Califomia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subje the orker's compensation p isions of Section 3700 of the Labor
C/o�1 ,I shall forth�wi h comply wit ose provisions. WIII the applicant or future building occupant handle hazardous material or a
/@plicaa Date ` 1- 0 mixture containing a hazardous material equal to or greater that the
amounts sia9zified on the Hazardous Materials Information Guide?
WARNINGLEA RE TO SE[��RE WORKER'S COMPENSATION COVERAGE IS ❑Yes No
UNU�ANOSHIk B1ECr 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(SCAQMD)?See permitting checklist
IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for gufdeI'
CONSTRUCTION LENDING AGENCY 0 Yes %
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
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
CaPF!F7
25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hacheckmark(s)I have placed next to the applicable items)(Section 7031.5 Business and Professions Code).Any city or county that requires a permit to DY Date
construct,alter,improve,demolish or repair any structure,prior to its PROPER NE ORAUT ED 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 IRRPI
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 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 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.eaa.eov/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).
Cade,The Contractor's 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. D No EPA Lead-Safe Certified Firm is required for this project because:
0 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 RAP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE: /- Z / U PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL ESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME ' IrOOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL O MECi 9 Dept.
EW O PLUMBING0 RE-ROOF NUMBER OFSQUARES
DESCRIPTION OF WORK L/� ESL �S/ JAN 0 2 2018
v
PROJECTADDRESS �/ `�/Z (/f�j�/%Je/,5Z-,o7 J T ZIP
ASSESSOR'S PARCEL NUMBER 3dCG 660- 02-� LOT Y3 TRACT 34,?-�/
OWNERNAME V/� 11 jets/ 'Y- /VLTCo4'f
ADDRESS 31 Cj J L 44✓ / S-7 • �c�G/ -r
PHONE 1 —7/c3 -9,5r y EMAIL ,
APPLICANT NAME
ADDRESS /70 W Al �T�G Jidc� Ji b
PHONE 25l-7? EMAIL
CONTRACTOR'S NAME A&- 5%7,/6,C OWNER BUILDER? O YES,
BUSINESS NAME i&LqL �, 1,147/-of p,
ADDRESS 170 �
V /(S & 6�>O -4,1 fZ � q- /�,/-6 �
PHONE /�f1--2-7// // �-Larsti / ) /EMAIL
CONTRACTOR'S STATE LIC NUMBER D �i �7(. LICENSE CLASSIFICATION lS-3
VALUATION$ Ys; bb5 FT 41D LSO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: . ,n CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 'M-----
PERMIT FEE VJ SMIP — GREEN
PLAN CHECK FEE INVOICETOTAL 5
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenIfee.us
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