PMT18-03725 City of Menifee Permit No.: PMT18-03725
29714 HAUN RD.
MENIFEE, CA 92586 Type: Pool/Spa -Residential I/f
MENIFEE MENIFEE Date Issued: 0 713 012 01 8
PERMIT
Site Address: 28606 MISSION DR, MENIFEE, CA 92584 Parcel Number: 372-061-037
Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INSTALL POOL AND SPA 437 SQ FT
Work:
Owner Contractor
JEFF&ANDREANA ATHERTON PACIFIC COAST POOLS INCORPORATED
28606 MISSION DRIVE 26499 JEFFERSON AVE UNIT E
MENIFEE, CA 92584 MURRIETA,CA 92562
Applicant Phone:9512960199
PACIFIC COAST POOLS INCORPORATED License Number:852237
26499 JEFFERSON AVE UNIT E
MURRIETA, CA 92562
Phone:9512960199
Fee Description gty Amount(SI
Swimming Poollln-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Electrical 1 23.35
$522.35
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_Bkig_Permit Template.rpt Page 1 of 1
Brandy Coral-Premier Pools
Cn1Y 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 I am exempt from licensure under the Contractors Slate License Law for
Professions Code and my license is in full farce and ecffeecct the following reason:
License Class C'S3 License No. UJZZ�� By my signature below l acknowledge that,except for my personal residence
Expires all X Signature's - ac;4'r,�_ in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION 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
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 workers 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,for the performance of work for which www le=inFo.<a.eov/calaw.iatinl.
this permit is Issued. -
Policy R Date
-
o I have and will maintain workers compensation Insurance,as required by PROPERLY 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 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
carrier I kh)'s`- LJIVVs�- with all applicable city and county ordinances and stale laws relating to
--r �(� Cy building construction.I authorize representatives of this city or county to
Policy g U"1�/n WC 10 � Expires O 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
❑I certify that in the performance of the work for which this permit is issued, Ijs�/Sd[L/04(P5
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSEg ®'"�
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject tat orkees compensation provisions of Section 3700 of the Labor
CAode,Ishal• rthwit comply with those provisions. ��II� Will the applicant or future building occupant handle hazardous material or
mixture containing a hazardous material equal to or greater that the
pelican[ Date amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes
UNLAWFUL,AND SHALL SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TD ONE HUNDRED THOUSAND DOLLARS($100,000),IN ouupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management hecoDistrict(SCtionor See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlin
CONSTRUCTION LENDING AGENCY a Yes [fRo
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 bound fa school?
(Section 3097 Civil Code) Dyes 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 checklut.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California H�a)t . :Safety Code,Section 25505 and 25534 concerning
hazardou to al reporting.
chsiness and
I have placed next to the applicable item(s)(Section permit oyes o No
Business and Professions[ode).Any city or county that requires apennit to (1� /
construct,alter,improve,demolish or repair any structure,priorto its DatePROPERTY OWNER 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 IRRPI
License Law(Chapter9(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
than
Applicant fora permit subjects the applicant too civil penalty of not more required practices.This includes rental property ownersand 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 wrww.eoa.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 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 1,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 If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION AL MEWIFEE
DATE: PERMIT/PLAN CHECK NUMBER NI { V
PLANNING CASE NUMBER
TYPE: O COMMERCIAL A RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME COOL/SPA 0SIGN
SUBTYPE: OADdITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS ZIP
^
ASSESSOR'S PARCEL NUMBER �'7Z'�V I 'b3 / LOT TRACT
OWNER NAME l g
ADDRESS l LLSS
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL CONTRACTOR'S NAME r,afh // U J1 COLS OWNER BUILDER? ^ YES C#NO/
BUSINESS NAME //�, l -
ADDRESS (_0 (-1`"[
PHONE QS] 33 (_9 cz C7 EMAIL �J
CONTRACTOR'S STATE LIC NUMBER �A CV L�SZ.Z J /LICENSE CLASSIFICATION
VALUATION$ R''00 U� (sQ FT q3 :2 L SQ FT
APPLICANT'S SIGNATURE /," J DATE
DEPARTMENT DISTRIBUTION ACCEPTED BY: n CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING EN INE£RING FIRE ly
INVOICE TOTAL �y'L. 'J� GREEN SMIP
OWNER BUILDER VERIFIED O YES 0 NO DRIVERS LICENSE# NOTARIZED LEITER O YES 0 NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us rS" `'" 1;
ENIF
S' TALL WOOD FENCE PL
3CM TRAVERTINE COPING
NE FACE
WHITE PLASTER
6' dept
'6" depth
W TALL WOa
2 3
L
1
UMBRELLA HOLE
DECKS BY OTHE
POOL EQI
E
E