PMT18-01159 City of Menifee Permit No.: PMT18-01159
29714 HAUN RD. Type: Pool/Spa -Residential
MENIFEE,CA 92586
ce..M.-Ke s:aaR� MENIFEE Date Issued: 0 311 4/20 1 8
PERMIT
Site Address: 27408 BRAMWELL ST, MENIFEE, CA Parcel Number: 360-650-009
92584 Construction Cost: $35,000.00
Existing Use: Proposed Use:
Description of INGROLIND POOL&SPA 500 SO FT
Work:
Owner Contractor
JESSE A. HERNANDEZ
27408 BRAMWELL ST
MENIFEE,CA 92584
Applicant License Number:
JESSE A. HERNANDEZ
27408 BRAMWELL ST
MENIFEE,CA 92584
Phone:9518408275
Fee Description -0—ty Amount I81
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 Templatexpt 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 contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑(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:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION Improvements covered by this permit.I cannot legally sell a structure that I
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 Profession ,is available upon request when
compensation,issued by the Director of Industrial Relations as provided fo - - this applicati n is submitted or at the folio 'ng website:
by Section 3700 of the Labor Code,for the performance of work for which ,,v� .le info. a. o law.ht
this permit is issued.
mf
Policypttt Date
o I have and will maintain workers compensation Insurance,as required by
ERTY OWNER OR UTHORIZED AGENT
section 3700 of the Labor Code,forthe performance of the work for which y my signature below I certify to each of a following:I am the property
this permit is issued.My workers compensation Insurance carrier and policy owner or authorized to act on the p owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all ap licable city and county ances and state laws relating to
atheTY
tructian.I authari repres tatives of this city or county to
Policy JJ Expires ove ident' ed pr erty for ins ction purposes.
(This section need not to be completed is the permit is for one-hundred Date 3 - -
dollars($100)or less WNERa AUTHORIZEDAGE
o I certify that in the performance of the work far which this permit is IssIshallnotemolov any persons in any ma s to become subject to SS LICENSE q
w pensati n laws of Californ' ,and agr that if 1 should become HAZARDOUS MATERIAL DECLARATION
bject to the orker cam ation rovisions of ction 3700 of the Labor
de,I shall fa wit th t ose provisions. nir j��./ Will the applicant or future building occupant handle hazardous material or a
Ap li1Z ate ✓- ► y t U mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
W RNING:F URE 70 SECURE WORKER'S COMP NSATION COVERAGE IS ❑Yes o No
UN , ND SHALL SUBJECT AN Ei�I O 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 r o ion occupant require a permit for the construct modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC ion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o 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 boundary of a school?
(Section 3097 Civil Code) o Yes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the 5CAQMD
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&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 ciYes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
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 Contractors State EPA RENOVATION,REPAIR 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 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
a 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.Rov/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 ❑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:
caner of the property am exclusively contracting with licensed
..tractors 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: 2j (� ((� PERMIT/PLAN CHECK NUMBER 1 p
PLANNING CASE NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME OOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Y�3 PDT
PROJECTADDRESS 2-94M OZAMW2ILL, c6 W1 CT ZIP g259-0
ASSESSOR'S PARCEL NUMBER �(�-�'�� LOT TRACT 318 E
OWNER NAME JI�^�1�VSE YYE CINDe�
ADDRESS 2�'Tv0 �1ZI�VVIW�(JL. OT(ZQ__T' M-CIJI9Ce. CIA- 6i25jgq
PHONE aS�'g��qq'g2 15- EMAIL CS �IZIS�`lT�t`� �1�1QlSC
APPLICANT NAME uKl WLe.
ADDRESS
PHONE EMAIL
q
CONTRACTOR'S NAME A YYILei OWNER BUILDER? SES 0 NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 5 b b SO FT S L SQ FT
APPLICANT'S SIGNATURE__ DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUT ACCEPTED BY: CITY OF MENIFEE BUSINE55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL 5 a�". GREEN _ SMIP ..._
OWNER BUILDER VERIFIED ikyES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
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