PMT18-02133 City of Menifee Permit No.: PMT18-02133
29714 HAUN RD.<A—CCELA MENIFEE, CA 92586 Type: PoollSpa-Residential
MENIFEE Date Issued:
05/03/2018
PERMIT
Site Address: 23694 CANYON HEIGTS DR, MENIFEE, Parcel Number: 351-271-017
CA 92587 Construction Cost: $30,000.00
Existing Use: Proposed Use:
Description of 282 SQ FT POOL AND 38 SO FT SPA. RELOCATE HVAC-MECHANICAL INSPECTION REQ'D.
Work: REMOVE AND REPLACE 6FT X 6.5 L FT BLOCK WALL TO CITY STANDARD-BB INSPECTION
REQ'D
Owner Contractor
t' ANTHONYADCOCK ,
r 23694 CANYON HEIGHTS DRIVE
MENIFEE, CA 92587
t.
Applicant License Number:
ANTHONY ADCOCK -
23694 CANYON HEIGHTS DRIVE
MENIFEE, CA 92587
Phone:9512071385
Fee Description City Amount lSl
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
Inspections not specified 129 129.07
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Electrical 1 23.35
$781.49
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.rpl 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).
Chapter-9(commencing with section 7000)of Division 3 of the Business and ;+em exempt from licensur nder the/Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason: �'/ �v^ ° O WA4 r
License Class License No. B m signature below I ackn ed a that,except for m y y g g p y personal residence
Expires 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 DECLARATION have built as an owner-builder if it has not been constructed in Its entirety by
o 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 70"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.leginfo.ca.eov/calaw.html.
Policy p Date 3
❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWN R 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
number are: 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 p 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
o 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 subjectto the CITY BUSINESS LICENSE 0 J
worker's 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 forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts e ified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes
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 See permitting Soutist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines
Qua
CONSTRUCTION LENDING AGENCY ❑Yes
1 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 3W7Civil Code) Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 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 al Safety Code,Section 25505 and 25534 concerning
checkmark(s)i have placed next to the applicable items)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to *es o No /
Date
construct,alter,improve,demolish or repair any structure,signets its PROPE tTY 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 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.S 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 than($500). required practices.This includes rental property owners and property
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.epa.gov/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
property who,through employees'or personal effort,builds or improves the O An EPA Lead-Safe Certified Renovator will be responsible for this project
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:
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7D44,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 ARP rule please till out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN
CHECK APPLICATION L - � l JMENIFEE-
mo
DATE: PERMIT/PLAN CHECK NUMBERS "•T vg
PLANNING CASE NUMBER
TYPE: O COMMERCIAL rd RESIDENTIAL - MULTI-FAMILY O MOBILE HOME Q-"POOL/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 I /,Sp,, ReIClco}Q V vc.c- (ZewAov¢ t' e., IGct
n W4\\
PROJECfADDRESS oC3�11(/A CGy\�? 00 4A4t'ol1,x Zip
ASSESSOR'S PARCEL NUMBER •�51 •a"� 1 • C-)rl LOT TRACT
OWNER NAME Al ri n
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ADDRESS 23 ci L %4 V\Ir f \QAI, 'i£e-e Lw 2
PHONE (qsl) )0OI -'1q qS 11 EMAIL Yc� '�N vGI 1n \ 1�6p • GW,
APPLICANT NAME C o
ADDRESS GH fl NA S 1Dv 1IN\ev\1Y,.e p
PHONE r-(5j I ^,�,01 - 11 -0 5` EMAIL ewe f-• "Cl ' %n
CONTRACTOR'S NAME OWNER BUILDER? ES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 3O l o o o SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE S/g//Y
XITYSTAFFVSE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENG E1ERI_NG FIRE Nim- uicAC
INVOICE TOTAL , 'gI •49 GREEN 4# aOt-J SMIP I L+.=
OWNER BUILDER VERIFIED O YES 0 NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun GG1I RdAT"IlAft 92586 (951)672-6777
p•*r aP
www.cityofinenifee.us 6UIlding D8pt.
MA I 0 ^ 20ig ENIFE
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