PMT18-03009 City of Menifee Permit No.: PMT18-03009
77 . 29714 HAUN RD.
-/ ;? E, MENIFEE,CA 92586 Type: Pool/Spa-Residential
WIENIFEE MENIFEE Date Issued: 0611912018
PERMIT
Site Address: 30536 GALLUP CT, MENIFEE,CA 92584 Parcel Number: 358-490-072
Construction Cost: $35,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA,400 SF
Work:
Owner Contractor
JOSHUA&MELISSA BUSCH DYNASTY POOLS INC
30536 GALLUP COURT 23367 CASA BONITA AVENUE
MENIFEE,CA 92584 QUAIL VALLEY,CA 92587
Applicant Phone:9512442994
JEFF MITCHELL License Number:492871
DYNASTY POOLS INC
23367 CASA BONITA AVENUE
QUAIL VALLEY,CA 92587
Fee Description ,O�t Amount($1
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_Sldg_Pennil_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).
Chapter!)(commencing with section 7000)of Division 3 of the Business and o 1 am exempt from licensure under the Contractor's State License Law for
Professions Code and my license Is in full force and effect. t�. r the following reason:
6
License Class Ucense No. 4 vo /
By my signature below I acknowledge that,except for my personal residence
Expires 0�Signature G in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARA O 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
s a 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
by Section 3700 of the Labor Code,for the performance of work for which this application is submitted or at the following website:
this permit is issued. www.leginfo ca.gov/calaw htm1.
Policy q
Date
D I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 37DO 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 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_ ST19-I r^f7_ F04 with all applicable city and county ordinances and state laws relating to
,�, / / G building construction.I authorize representatives of this city or county to
POligB �.��z'—� ZA6G fs Expires�J^�/ enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
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 subject to the CITY BUSINESS LICENSE g
worker's compensation laws of California,and agree that if 1 should become
subject to the worker's compensation provisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION
Code,I shall forthwith comp) w hose provisions. C Will the applicant or future building occupant handle hazardous material or a
Applicant Date ^zip mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING AI RE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes o No
UNLAW L,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
CONSTRUCTION LENDING AGENCY for guidelines
in oNo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within LOW 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 o No
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
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25S05 and 2S534 concerning
checkmark(s)I have placed next to the applicable Rem(s)(Section 7031S hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to ciYes ❑No
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
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
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
and the basis for the alleged exemption.Any violation of Section 7032.5 by receiving compensation for most work that disturbs paint in a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with
than($500). required practices.This includes rental property Owners and property
managers who do the paint-disturbing work themselves or through their
01,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 1-80D-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 a 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
completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.:
not built or improved for the purpose of sale. ❑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 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
L <
DATE: PERMIT/PLAN CHECK NUMBER -
PLANNING CASE NUMBER
TYPE: O COMMERCIAL AQESIDENTIAL O MULTI-FAMILY O MOBILE HOME O 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
PROJECTADDRESS _?c .J6 . }L`UI/I r ZIP
ASSESSOR'S PARCEL NUMBER `5 b- �p� LOT TRACT
OWNER NAME a2drioa, * wk=2a &xych
City of Menifee
ADDRESS fQ C, Building Dept
PHONE EMAIL
APPLICANT NAME Received
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME i�'OWNER BUILDER? O YES 0
BUSINESS NAME iD) Or./'�cvL �
ADDRESS A- l�
PHONE D-1— ZL/L/77Z9 9 Z/ EMAIL �£.Y7`- P 7z ,(I %�VD`a r <CLO
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION'
VALUATION$ 7 5^-' Oc,;c SQ FT '"� L SO FT
APPLICANT'S SIGNATURE DATE C.�e�✓l4 l�"-��
CITY STAFF USE 6NLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: ' 'n CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 1A_A'YJ"1
INVOICETOTAL GREEN a SMIP 5—
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER C YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us "`'" "
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