PMT18-04443 City of Menifee Permit No.: PMT18-04443
29714 HAUN RD.
Ar MENIFEE,CA 92586 Type: Pool/Spa -Residential
MENIFEE MENIFEE Date Issued: 09/11/2018
PERMIT
Site Address: 29401 FALL RIVER LN, MENIFEE, CA Parcel Number: 364-310-088
92584 Construction Cost: $40,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL ONLY,390 SF, NO HEATER
Work:
Owner Contractor
KIM JUDGE ALWAYS RELIABLE POOL&SPA SERVICE
29401 FALL RIVER LANE 30580 STERN DRIVE
MENIFEE, CA 92584 MENIFEE,CA 92584
Applicant Phone: 9516724447
HEATHER GAGATCH License Number:908042
ALWAYS RELIABLE POOL&SPA SERVICE
30580 STERN DRIVE
MENIFEE, CA 92584
Fee Description Oty Amount(S)
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 6.00
General Plan Maintenance Fee-Electrical 1 23.35
$526.35
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Penn ft Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
CLicense Class - S 7 UcenillNo. C 0$Q 42— By my signature below 1 acknowledge that,except for my personal residence
Expires 0 2 G 1 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
❑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 forworkers 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 Cade,forthe performance of work for which
this permit is issued.
www.leginfo.ca.gov/calaw.html.
Policy# Date
❑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 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 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 STILh� YuN7 building construction.I authorize representatives of this city or county to
Polity# 1 q 4 3A G}0 Expires G(/261 Q enterthe above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certlfythat in the performance of the work for which this permit is issued,
I shall not emolov any persons In any manner so as to become subject to the CITY BUSINESS UCENSE#
workers comper#ion laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to thew rker:compensation provisions ction 3700 of the Labor
Code,I shall fo hw' omply with those provisl ns. Will the applicant or future building occupant handle hazardous material or
Applicant Date O q I 1) ($ mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILUIR14CI SECURE WORKER'S COMPENSATION COVERAGE 15 o Yes ❑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 ion occupant requires permit for the construct or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC ion or See permitting checklist
IN SECTION 3706 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑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 Cade) o Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAOMD
I hereby affirm under penalty of perjury that 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 al Safety[ode,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable items)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes ❑No
construct,alter,improve,demolish or repair any structure,signets its Date
PROPERTY 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(FIRM
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-certlfied 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 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.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-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 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
Cade: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
DATE: OQ 11 is PERMIT/PLAN CHECK NUMBER 3
PLANNING CASE NUMBER
TYPE: O COMMERCIAL Jp RESIDENTIAL O MULTI-FAMILY O MOBILE HOME �OVOL/SPAPnC SIGN
tfee
SUBTYPE: OQDDITIONPLUMBING A OGRE-ROOF NUMBER OF SQUARES ILL O I E A CAept.
YF! uI Ing U
DESCRIPTION OF WORK pp`, hexSEP 11 2018
PROJECTADDRESS 291401 'Fq�•,�, '(LN LI(ht ZI `}v
ASSESSOR'S PARCEL NUMBER _6PQ- Z10 • LOT TRACT
OWNER NAME U
ADDRESS L{QI E 2
PHONE EMAIL 3 LA G(0 2 @ C„ CO(Y)
APPLICANT NAME 'A
ADDRESS 365 tJ Denje , f 2 '$4
PHONE -15 1- rj(I-}- U&o9 EMAIL � 1r (a , CO
CONTRACTOR'S NAME pp OWNER BUILDER? OYES0
BUSINESS NAME Qp
ADDRESS 36586 p, Q q2594
PHONE q51 - .`�i�4 ' (p��p1 EMAIL 1 ,CO
CONTRACTOR'S STATE LIC NUMBER q O g O LA 2. LICENSE CLASSIFICATION
VALUATION$ 4� OpC) SO FT 390 L SQ FT }�O
APPLICANT'S SIGNATURE DATE 59/ I 1
M -
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICETOTAL 1 5a5.35 GREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES 0 NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us
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30580 Stern Drive
Menifee, Ca 92584