PMT18-04957 City of Menifee Permit No.: PMT18-04957
29714 HAUN RD. Type: Pool/Spa-Residential
MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 10/11/2018
PERMIT
Site Address: 29092 RAMBLING BROOK DR, MENIFEE, Parcel Number: 333-360-004
CA 92585 Construction Cost: $20,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA,451 SF, U/G GAS&ELEC LINES FOR BBQ ISLAND WITH 2 OUTLETS
Work:
Owner Contractor
MICHAEL&TARRAH HORAK QUALITY CUSTOM POOLS INC
29092 RAMBLING BROOK DRIVE 30138 MARNE WAY
MENIFEE, CA 92585 MENIFEE, CA 92584
Applicant Phone:9516799732
LYNN STONE License Number:795820
QUALITY CUSTOM POOLS INC
30138 MARNE WAY
MENIFEE,CA 925B4
Fee Description p1 Amount
Receptacle,Switch,Outlet&Fixture 2 121.00
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 3.00
General Plan Maintenance Fee-Building 1 5.80
General Plan Maintenance Fee-Electrical 1 29.40
$770.20
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
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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 lam under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 70001 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:
License Class C S License No. G SG By my signature below I acknowledge that,except for my personal residence
Expires \\ Signature _ i in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION Improvements covered bythis 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
❑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 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 this permit is issued www.leeinFo.ca.eov/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 ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carder 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 state laws relating to
building construction.I authorize representatives of this city or county to
Policy#C(\ \C7 oo07 2�-1 Expires 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
in I certify that 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 LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant_ Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILUREiO-SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25S05 and 25534 concerning
checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(Section 7031.5 Ayes ❑No
Business and Professions Code).Any city or county that requires a permit to Dale
construct,alter,improve,demolish or repair any structure,prior to its 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 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 far 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($500).an Applicant far a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than
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 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 forthe purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑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 Law does not apply to an owner of a If your project does not comply with EPA RAP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: I a - I I - 1 PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME @ POOL/SPA O SIGN
SUBTYPE: C ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK 96 0,S—euc_
PROJECTADDRESS RCU-YN)DWAS r V0 r00 — Qf • ZIP
ASSESSOR'S PARCEL NUMBER -9916''6W - LOT TRACT
OWNER NAME '�-pr� (�1,7K#3J�+�{
L;Ity 01 Menitee
ADDRESS -yam Building Dept.
PHONE C\5 Oct 0 h EMAIL
APPLICANT NAME Tr S R
ADDRESS O 1 Yn a-X h� 1
J ax 1-Zo
PHONE EMAIL \N�-_U S4vy-1 OC>>S'� t
CONTRACTOR'S NAME ` OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS SG
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER A S% LICENSE CLASSIFICATION C_C,3
VALUATION$ fD 00 SQ FT L SO FT
APPLICANT'S SIGNATURE — _ DATE C= \
0
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PANNING ENGINEERING FIRE
INVOICETOTAL rQ0 GREEN SMIP
OWNER BUILDER VERIFIED O YES 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.cityofmenifee.us
ENIF