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PMT18-03870 City of Menifee Permit No.: PMT18-03870 Mir 29714 HAUN RD. Type: Pool/Spa-Residential MENIFEE, CA 92586 MENIFEE MENIFEE Date Issued: 0 8/0 312 01 8 PERMIT Site Address: 31452 CAPRICE RD, MENIFEE, CA 92584 Parcel Number: 360-612-012 Construction Cost: $35,000.00 Existing Use: Proposed Use: Description of INSTALL 476 SQ FT POOL WITH SPA-2 LIGHTS Work: Owner Contractor RAFAEL E. ROLDAN 31452 CAPRICE RD MENIFEE, CA 92584 Applicant License Number: RAFAELE. ROLDAN 31452 CAPRICE RD MENIFEE, CA 92584 Phone: 9513179025 Fee Description 01tr Amount f5l 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 can ied 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_Templale.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects 1 hereby affirm under penalty of perjury that 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and �I 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: UQ/I¢ C LAIA/A-JP License Class License No. By my signature below I acknowledge that,except for my personal residence Expires 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 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 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,for the performance of work for which w .le inf ca vcal ht this permit is issued. Policy# Date ❑I have and will maintain worker's compensation insurance,as required by PR PERTy O VNER OR UTHORIZED 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 worker's compensation insurance carrier and policy fawner 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 with all applicable city and county ordinances and state laws relating to Carrier building construction.I authoriz representatives of this city or county to Policy# Expires enter the o ide ified o y for inspection purposes. (This section need not to be completed is the permit is for one-hundred (J Date dollars($100)or less P OPERTWOWNEWOR AUTHORIZED AGENT ❑I cer0fy that in the performance of the work for which this permit i ed, I shall not emolov any persons in any manner so as to become subject a CITY BUSINESS LICENSE# worker's compensation laws of California,and agree that if I sold be HAZARDOUS MATERIAL DECLARATION subject to the worker's compensation provisions Wefion 3 of the Zr Code,I shall forthwith comply with those provisio� N Applicant Will the applicant or future building occupant handle hazardous material or a -'�r� Ca7 mixture containing a hazardous material equal to or greater that the !E amounts,specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPE;&_ N CO AGE IS�AAAAAA ❑Yes �vO UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CQI ALP LTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 0``S',t��YC($100,000)'1 occupant require a permit for the construction or modification From South ADDITION TO THE COST OF COMPENSATION,DAMAG65Mi PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guide�li�'y�(' CONSTRUCTION LENDING AGENCY ❑Yes toNo I hereby affirm that under the penalty of perjury there Is a construction Will the prop ed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer bou sy of a school? { t/(Section 3097 Civil Code) ❑Yes o �XOWNER BUILDER DECLARATIONS I have re d the Hazardous Material Information Guide and the SCAQMD R I hereby affirm under penalty of perjury that 1 am exempt from the Perini g checklist.I understand my requirements under the State of Contractor's License Law for the reason(s)indicated below by the Calif is Health&Safety Code,Sectio 5505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ha rdous material p tin Business and Professions Code).Any city or county that requires a permit to es ❑N w, _ 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 4VNER AUT ORIZE 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 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 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 ttha 500). managers who do the paint-disturbing work themselves or through 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.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 Contractor's 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 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. ❑No EPA Lead-Safe Certified Firm is required for this 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 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 MEN_IFEE 4 BALL I, 8 AF,E;A DATE: PERMIT/PLAN CHECK NUMBER FI I euib O GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES TYPE: O COMMERCIAL * RESIDENTIAL O MULTI-FAMILY O MOBILE HOME C 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 Pow Lt Fly �zc S r0 F SS L .V/) OCCUPANCYGROUP CONSTRUCTION TYPE SPRINKLERS O YES O NO PROJECTADDRESS22 (� ►�A ;r�' -�. /bfE�l1xAcA ,�ZIP o�S� ASSESSOR'S PARCEL NUMBER J�l-J tC[2.0(a LOT TRACT OWNER NAME L nn ,4/V ADDRESS `� C/'1' _E ' J PHONE 6MI -,z,17— �©!�Jq EMAIL ,t RoLM.& e jQEAa4AJ, C-Q APPLICANT NAME , Q ADDRESS Ap PHONE EMAIL CONTRACTOR'S NAME F [Q CI of Menifee OWNER BUILDER BUSINESS NAME ADDRESS PHONE EMAIL Rpceived CONTRACTOR' STATE LIC NUMBER t L LICENSE CLASSIFICATION VALUATIONS 3F1000 SQFT '/TLl LSQFT APPLICANT'S SIGNATURE C_ DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION ACCEPTED Y: CITY OF MENIFEE BUSINESS UCENSE NUMBER BUILDING PLANNING If.NGINEERING FIRE INVOICE TOTAL GREEN 2 D SMIP 115 cz) OWNER BUILDER VERIFIED OYES O 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 i fee.us NIF mad, ayi;o woAoq ayi of ado!z aya;o doi ayi I� z ado JMUq i 0BUNu!8aq ayi al lle^s Yiol9 ayi;o walloq ayi -'woy aauWnP841'7aa;HR21 IaL PaN ; .iPa41 —_ " .—wm;wueislp a4l'iaa}2 sl tllemaPls ayi of ll^m'!ioi4 ayi)o woAaq ayi wa;l42!ay ul aauaia•i RAM S30le Oft. am vow ti i _:;w•:* — i i s vaawmosvrdxe.uz- -- fQot'iwde kfeetdeeG _ nt. _ �IaC, Za3✓SSPa - — .. Poi'- - _� • — - € ! W --� wr�..vmmr z'mv�:— ie w w ww�s: r 46 ft. A e —14ft. N f II -onuwc' EXISTI` WELL - — �— — ---3 2 Capri�i' d r- ,%* 01 fornia 925