PMT18-02015 City of Menifee Permit No.: PMT18-02015
29714 HAUN RD.
<A-CCELA— MENIFEE, CA 92586 Type: Pool/Spa-Residential
r.,...�-Krs.�e..�• MENIFEE Date Issued: 04/27/2018
PERMIT
Site Address: 30194 STAGE COACH RD, MENIFEE, CA Parcel Number: 358-430-021
92584 Construction Cost: $18,000.00
Existing Use: Proposed Use:
Description of 10 X 10 GUNITE SPA WITH 1 LIGHT
Work:
Owner Contractor
NANCY REES AMERICAN POOL CONSTRUCTION
30194 STAGE COACH ROAD 43040 ARGO CT
MENIFEE, CA 92584 TEMECULA, CA 92592
Applicant Phone:9513650736
43040 ARGO CT License Number:481500
TEMECULA, CA 92592
Fee Description Q1 Amount f$1
Swimming PooVIn-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 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 Template.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 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:
' 3 �d r
License Class C - Ucens lo. By my signature below l acknowledge that,except for nrypersonal residence
Expires Signature '-� Lc in which l must have resided for at least one year prior to completion of I
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
D 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 370D of the Labor Code,for the performance of work for which
this permit is issued. www.leginfo.ca.eov/calaw_htmL
Palicyfl Date
0 l 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 O By 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
numberare: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy g Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
, Icertlfy that Inthe 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 g
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 or the Labor
Code,Ishall fort ith comply with '6se provisions. Will the applicant or future building occupant handle hazardous material or
Applicant Date/� /S / mixture containing a hazardous material equal to 4r greater that the
amounts sp cified on the Hazardous Materials Information Guide?
WARNING:FAILUR TO SECURE WORKER'S COMPENSATION COV RAGE 15 Dyes XIo
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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguideltnes
CONSTRUCTION LENDING AGENCY aYes I'NO
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10DO 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) ❑Yes 11- .0
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD i
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Cuntracmr's License Law for the reason(s)indicated below by the �ardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7032.5
Business and Professions Code).Any city or county that requires a permit to es D� Date -
construct,alter,improve,demolish or repair any structure,prior to its PROP RTY O NER 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 70DO)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 70315 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a perm it 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.gov/lead or contact the National Lead information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a O 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. 4EPA Lead-Safe C rtyied 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
Cade: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 RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: /PI L oZ p20�/ PERMIT/PLAN CHECK NUMBER P r DL{/ I V'
PLANNING CASE NUMBER
TYPE: O COMMERCIAL -ESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ELECTRICAL MECHANICAL
X1NEW PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK (7 / X 115r/ !/'A/!
PROJECTADDRESS C{J �.Q �Gyr-� ZIP
ASSESSOR'S PARCEL NUMBER bl:)Op J43Q ' l_.bC l LOT TRACT
OWNER NAME G 5e R 6 `J
ADDRESS 3z7/ - z� 72e .-`r04 /
PHONE 7e If EMAIL / keele'e e
APPLICANT NAME Gr12tPD
ADDRESS 6-b G 7—j
PHONE 72e6 EMAIL a C/
CONTRACTOR'S NAME ' �/'!L' /J -LJZ C. OWNER BUILDER? OYESrito
BUSINESS NAME J � (y
ADDRESS T✓ D O 1'//74 O C'/ G'l lC r G C� e5 - 707S�rJ O�
PHONE Ytp& Q 23 EMAIL C/ /p
CONTRACTOR'S SS TE LIC NUMBER �f s(7� LICENSE CLASSIFICATION
VALUATION$ �09 SQ FT L SO FT
APPLICANT'S SIGNATURE LLB--. DATE -
DEPARTMENT DISTRIBUTION ACCEPTED BY I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE " _
INVOICETOTAL V I�I -�� GREEN I - W SMIP Fs
.�
OWNER BUILDER VERIFIED YES O NO DRIVERS LICENSE## NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun h In91 9p 92586 (951)672-6777
www.cityofmenifee.us KAMM
APR 27 2018 NIF
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