PMT18-03526 City of Menifee Permit No.. PMT18-03526
�d 29714 HAUN RD.
O Ar MENIFEE,CA 92586 Type: Pool/Spa-Residential
MENIFEE MENIFEE Date Issued: 07/17/2018
PERMIT
Site Address: 30177 NIGHT PASSAGE PL, MENIFEE, Parcel Number: 358-501-005
CA 92584 Construction Cost: $20,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA,296 SF,3 POOL LIGHTS, 1 SPA LIGHT
Work:
Owner Contractor
RAYMOND&CINDY BLUCHER DIAMOND VALLEY ENTERPRISES
30177 NIGHT PASSAGE PLACE 41097 QUAIL RD
MENIFEE, CA 92584 HEMET,CA 92544
Applicant Phone:9512326451
STEVE CLARK License Number.955482
DIAMOND VALLEY ENTERPRISES
41097 QUAIL RD
HEMET, CA 92544
Fee Description Q_yt Amount f51
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
Administrative Fee 467 467.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 3.00
General Plan Maintenance Fee-Electrical 1 23.35
$988.35
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 carded 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_Pennit Terrplate.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 7D00)of Division 3 of the Business and o I am exempt from Iicensure under the Contractor's State License Law for
Professions Code an _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 /Z^� Signatur 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 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 Professions Cade,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 wwwleeinfo.ca.zov/calaw.html.
this permit is issued.
Policy JJ Date
PROPERTY OWNER OR AUTHORIZED AGENT
tprhave and will maintain workers compensation insurance,as required by
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 behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
1-11 with all applicable city and county ordinances and state laws relating to
Carrier / IV14 building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified propertyfor inspection purposes.
(This section need notto be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work forwhich this permit is issued,
I shall not employ any persons in any manner so as to become subjectto the CITY BUSINESS LICENSE R
worker's compensatia��on l of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers hfmpensation provisions of Section 3700 of the Labor/
Code,I shall fo w' amply with rov' ' ns. ¢ I Will the applicant or future building occupant handle hazardous material or a
Apo' nt Date ��p (/l/ mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
W :FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes E 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 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 forguidellnes
CONSTRUCTION LENDING AGENCY ❑Yes a 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) ❑Yes ;PNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
hereby affirm under penalty of perjury 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&Safe •ode,Section 25505 and 25534 concerning
hazardous material r rting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DYes o
Business and Professions Code).Any city or county that requires a permit to Date ;Z.1d�
construct,alter,improve,demolish or repair any structure,prior to its 00.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(RRP)
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 Iicensure 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($500). managers who do the paint-disturbing work themselves orthrough their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.aov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employeee or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required forthis project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
�>�r�e�i i Lr�:I ry�kF1"sra Eirivd�I
DATE: - PERMIT/PLAN CHECK NUMBER
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL 'WRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ELECTRICAL O MECHANICAL
Fi NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK [ �'w
OCCUPANCY GROUP CONSTRUCTION TYPE L SPRINKLERS O YES ONO
PROJECTADDRESS a2/ 22 /l//4_-*T ZIP �$
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME 2 Building Dept.
ADDRESS J30,1 JUL 17 2018
PHONE EMAIL
APPLICANT NAMES/J
ADDRESS "�-
PHONE 9Si Z�2 (P�G� EMAIL �LYJL�j/i(J /CLvdO. e7dwl
CONTRACTOR'S NAME OWNER BUILDER? O YES OPNO
BUSINESS NAME
ADDRESS A_ AKAW 11jLl11c�_
PHONE EMAIL �U�L{�GS oj/ /[i�OU.D• Cdril
CONTRACTOR'S STATE LIC NUMBER 9�S��z LICENSE CLASSIFICATION
VALUATION $ ';ea SO FT ri L SQ FT
APPLICANT'S SIGNATURE DATE 1--7
0TYSTAFFUSE0IMM,, AM
DEPARTMENT DISTRIBUTION ACCEPTED BY: , , CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE �\` P-;)
INVOICE TOTAL I GREEN SMIP
OWNER BUILDER VERIFIED O YES 0 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.cityofinen ifee.us
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