PMT18-03811 City of Menifee Permit No.: PMT18-03811
29714 HAUN RD.
MENIFEE,CA 9258E Type: Pool/Spa-Residential
MENIFEE MENIFEE Date Issued: 08/02/2018
PERMIT
Site Address: 24927 REMINGTON CT, MENIFEE, CA Parcel Number: 358-690-024
92584 Construction Cost: $48,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL& SPA,480 SF,WITH U/G GAS LINE TO.FIRE PIT
Work:
Owner Contractor
SHAUNA KERSEY MAJESTIC POOL CONSTRUCTION
24927 REMINGTON COURT 31566 RAILROAD CANYON ROAD
MENIFEE, CA 92584 STE 2#106
Applicant Phone:9514456384
OBIE RODRIGUEZ License Number:889538
MAJESTIC POOL CONSTRUCTION
31566 RAILROAD CANYON ROAD
STE 2#106
CANYON LAKE, CA 92587
Fee Description QtV Amount ISI
Swimming Pool/In-Ground Spa 1 487.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 7.00
General Plan Maintenance Fee-Electrical 1 23.35
$642.35
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_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds car improves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)Pursuantto the Contractors State License Law).
Chapter9(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 the following reason:
License Class C S Z License No. f6/63
By my signature below I acknowledge that,except for my personal residence
Expires I " ZD/�k Signature In which l 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
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 websile:
this permit is issued. www.leginfo.m.gov/alaw.hun 1.
Policy P Date
have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
se ion 3700 of the Labor Code,for the performance of the work for which o By my signature below l 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 an 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
Policy Jl1 j 5E0``��7 f( E Tres / �ZU—/� building construction.I authorize representatives of this city or county to
xP 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,
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS UCENSEB
worker's compensation laws of California,and agree that If I should become
subject to the worker's compens on rovisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION
Code,I shallffpfE(p uhco t wilt se provisions. , / Will the applicant or future building occupant handle hazardous material or
Applicant 1 \ �♦ Date .;s, I, /`7 ///T mixture containing a hazardous material equal to orgreater that the
—�7 amounts�spec'I(ed an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE W KER'S OMPENSATION COVERAGE IS ❑Yes df No
UNLAWFUL,AND SHALL SUBJECT A P DYER TO CRIMINAL PENALTIES S
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the inI nded 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
fo 3N s
Yes
CONSTRUCTION LENDING AGENCY a Yes ne
I hereby affirm that under the penalty of perjury there ism 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) 0Yes rj(No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
i hereby affirm under penalty of perjury that l 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 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 h ,ardour material reporting.
Business and Professions Code).Any city or county that requires a permitto y �-J
construct,alter,improve,demolish or repair any structure,prior to its - Date 3 / _/
Issuance,also requires the applicant for the permit to file a signed statement PR N ORAUTH IZE GEM
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION.REPAIR AN GENT
(RRPI
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 7031.5 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-dhturbing work themselves orthrough their
01,as owner of the property,or my employee with wages as their sole employees.For more informatian about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eovAead 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 Contractor's State License Law does not apply to an owner of a
property who,through employees'or personal effort,builds or improves the aAn 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. o No EPA Lead-Safe Certified Firm Is required for this project bemuse:
01,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Cade: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
DATE: 9 Z /S PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA C SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
C NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK L Q OO s'Q/4 �/L&' /T' !.V
PROJECTADDRESS Z� (Z'J ��MJ��,� (fir ZIP L
ASSESSOR'S PARCEL NUMBER CgC1D _t3qL4 LOT TRACT
OWNER NAME /� City of Menifee
Building F)PPt
ADDRESS 2✓�{-r 2 F-4v-v ��„o
PHONE 7 -y,319 EMAIL
APPLICANT NAME 0,3/411' Received
iv
ADDRESS 1120
PHONE fir/ 6 D d EMAIL
CONTRACTOR'S NAME /-.1AW/C O aL �p�,�"— , OWNER BUILDER? O YES 0
BUSINESS NAME
ADDRESS 4_V4
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER g f LICENSE CLASSIFICATION
VALUATION$ 8 D D.a SQ FT L SO FT Q
APPLICANT'S SIGNATURE ATE L S
MSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL U GREEN - SMIP
OWNER BUILDER VERIFIED OYES 0 NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92S86 (951)672-6777
www.cityofinenifee.us
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