PMT18-02750 City of Menifee Permit No.: PMT18-02750
29714 HAUN RD.
y MENIFEE, CA 92586 Type: Pool/Spa -Residential
MENIFEE MENIFEE Date Issued: 06/06/2018
PERMIT
t
Site Address: 31751 HALEBLIAN RD, MENIFEE, CA Parcel Number: 372-221-009
92584 Construction Cost: $35,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 677 SQ FT, 3/4"GAS LINE AND CONDUIT STUB FOR FUTURE BBQ
Work: ISLAND
Owner Contractor
REID&REBECCA SINERUD CREATIVE OUTDOOR CONCEPTS
31751 HALEBLIAN RD 43400 CORTE BARBASTE
MENIFEE,CA 92584 TEMECULA,CA 92592
Applicant Phone:9512165815
DAVE JURASKY License Number:985533
CREATIVE OUTDOOR CONCEPTS
43400 CORTE BARBASTE
TEMECULA, CA 92592
Fee Description 9ty Amount($1
Swimming Pool/In-Ground Spa 1 467.00
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 5.00
General Plan Maintenance Fee-Electrical 1 23.35
$640.35
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
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 ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effecct. _ the following reason:
Ucense Class C 6-5OTC—ens No.—"2 By my signature below I acknowledge that,except for my personal residence
Expires 7�3(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
❑I hereby affirm under penalty of perjury one of the fallowing 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,far the performance of work for which twnv.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy N Date
16'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 ❑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 beha If.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier S-�q� '* rNrJ 17 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 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 l certify that in the performance of the work for which this permit is issued, o �5
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE N
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wgfJc@rs compensation provisions of Section 3700 of th Labor
Code,I sh IL( hwt omply with thus.provisions. �{ Will the applicant or future building occupant handle hazardous material or a
Appit'. Date (/ mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING: IUBE TO SECURE ORKER'S COMPENSATION COVERAGE IS oYes --,-No
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 7O THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District tSC lion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forCoast
Airlines
Qua
CONSTRUCTION LENDING AGENCY ❑Yes )410
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 agencyfor the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes T¢plo
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&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 70315 hazard terlal reporting.
Business and Professions Code).Any city or county that requires a permit to _o No
construct,alter,improve,demolish or repair any structure,prior to its Date
ER OR plJ7�i0RIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement CiFA W
that he or she is licensed pursuant to the provisions of the Contractors State E PPAR R #OVATION.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 he 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
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 1-800-424-LEAD(5323).
Code,The Contractors 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. O No EPA Lead-Safe Certified 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
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
.DkVQ 7k y- Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION r MENIFEE
DATE: -'7 s PERMIT/PLAN CHECK NUMBER Mu OC J50
PLANNING CASE NUMBER !/-�
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME p4OOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O PLUMBING O RE-ROOF NUMBER OF SQUARES�7
DESCRIPTION OF WORK
SigP2S
PROJECTADDRESS __-5 k'IS ( N L'114T1L.D�` ZIP ✓`ZGS, ��-/1 /
ASSESSOR'S PARCEL NUMBER //a� LOT 1 TRACT
OWNER NAME E(/ s &66,cr,A
ADDRESS �:3 1 ✓� L �� r"I.�''�`-�I r' b /ZS�`�`"
PHONE a�j7 01s6 6o�q Z-q EMAIL
APPLICANT NAME -10K
ADDRESS
PHONE EMAIL ,�,,,,��^^
CONTRACTOR'S NAME (l OWNER BUILDER? O YES Y�
BUSINESS NAME � „Q ✓ �(J 1pr`JCE-�T�
ADDRESS
PHONE 951 , EMAIL C-Uh�pv✓l _ l�
CONTRACTOR'S STATE LIC NUMBER ( P� SS�� LICENSE CLASSIFICATION es-5 C Z
VALUATION$ SO FT Co-7`7 L SQ FT/
APPLICANT'S SIGNATURE 'V� DATE L! "! Z®/il_�>
CffYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY`,.- CITYOFMEN]FEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE llelz_ O Lfo to
INVOICETOTAL GREEN SMIP S-
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE p NOTARIZED LETTER O YES C NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee,CA 92586(951)672-6777
www.cityofmenifee.us
NIF