PMT18-04149 City of Menifee Permit No.: PMT18-04149
29714 HAUN RD. T e: Pool/Spa a-Residential
h,. 'r MENIFEE. CA 92586 yp p
MENIFEE MENIFEE Date Issued: 08/22/2018
PERMIT
Site Address: 28434 STORMY SKIES CIR, MENIFEE, Parcel Number: 333-581-015
CA 92585 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND SWIMMING POOL ONLY 336 SO FT, NO HEATER
Work:
Owner Contractor
WILLIAM BREGLIO BLUERIDGE POOLS
28434 STORMY SKIES CIR 30097 SWAN POINT DRIVE
MENIFEE, CA 92585 CANYON LAKE, CA 92587
Applicant Phone;9517600152
ROB BEECH License Number:825370
BLUERIDGE POOLS
30097 SWAN POINT DRIVE
CANYON LAKE, CA 92587
Fee Description pty Amount(S)
Swimming Pool/In-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_Bldg_Permit 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 contractors)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and 01 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[lass 5 3 e�rr<r, rise tj o. '�2S 370 By my signature below lacknowledge that,except for my personal residence
Expires /G 31 /`� Signature//�3 J"/1 '1^�`� 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 legallysell a structure that I
have built as an owner-builder if it has not been constructed in Its entirety by
D I hereby affirm under penalty of perjury one of the fallowing 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
by Section 3700 of the Labor Code,for the performance of work for which this application is submitted car at the following wehsile;
this permit is issued. wsvw.leeinfo.ca eov/calavv.html.
Policy# Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which aBy my signature below l 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 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 stale laws relating to
building construction.I authorize representatives of this city or county to
Policy Expires 1�- 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
-VI certify that in the performance of the work for which this permit i5 issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws OF California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Sectfan 3700 of the labor
Code,I shall to t f h o�plywith those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant i Date / mixture containing a hazardous material equal to orgreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION OVERAGEIS oyes ONO
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the buildin AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN g 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
forguidellnes
CONSTRUCTION LENDING AGENCY oyes ONO
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within IBM feet of the
lending agencyfor the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) Oyes ONO
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
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 255D5 and 25534 concerning
checkmark(s)I have placed next to the applicable itemis)(Section 7031.S hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to OYes ONo
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING QUIP)
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 Rcensure receiving compensation for most work that disturbs paint in pre-1978
and the casts or the alleged exemption.itsthapplicant
violation it Section of not by residence or childcare facility to be RRP-certified firms and comply with
than
Applicant fora permit subjects the applicant taacivtl penalty of not more required practices.This includes rental property owners and property than($S00). p p y
managers who do the pain[-disturbing work themselves or through their
❑1,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.eov/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 D 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. D 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 Contractors State License Lawdoes 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: c6 PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME Xq00 SPA O SIGN
SUBTYPE: 'O ADDITION O ALTERATION O DEMOLITION 0 ELECTRICAL O MECHANICAL
Y4 NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK f t11CJ\V'� Ol '�,�j�w1
PROJECT ADDRESS �CV�7\'G ZIP
ASSESSOR'S PARCEL NUMBER 33-5SI" I �/ LOT TRACT
OWNER NAMEP'41N.
ADDRESS Z- x ' NI LC �/
PHONE 4'!, f 640 EMAIL
APPLICANT NAMEkah Qf-� !g e_ee
ADDRESS (`jG SL.J><b Af rr
PHONE U 1 7LC'Q EMAIL 611jaTI Q Q 6MAI I Qo'-
CONTRACTOR'S NAME jj OWNER BUILDER? O YES-,TNO
BUSINESS NAME ,
ADDRESS J- /A j
PHONE 61 '7(�'(�j Gl5 `3.. EMAIL 0j PAJ
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION l
VALUATION$ 2 _C'z��C� SQ FT 33.E L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL � GREEN 1 SMIP
OWNER BUILDER VERIFIED O YES O No DRIVERS LICENSE# NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
G, o
www.cityofinenifee.us le
MENIFEE