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PMT14-01018 City of Menifee Permit No.: PMT14-01018 29714 HAUN RD. 4 CCFl,.I�k MENIFEE, CA 92586 Type: Pool/Spa-Residential MENIFEE Date Issued: 06/07/2014 PERMIT Site Address: 30644 WHETSTONE CIR, MENIFEE, CA Parcel Number: 364-320-055 92584 Construction Cost: $35,000.00 Existing Use: Proposed Use: Description of POOL, SPA WITH WATERFALL AND GAS HEATER Work: Owner Contractor DIRK SYBURRA PACIFIC COAST POOLS INCORPORATED 30644 WHETSTONE CIRCLE 29792 ANDROMEDA STREET MENIFEE, CA 92584 MURRIETA, CA92563 Applicant Phone: 9516001175 PACIFIC COAST POOLS INCORPORATED License Number: 852237 43020 BLACKDEER LOOP SUITE 106 TEMECULA, CA92591 _ Fee Description ,Q�t Amount Building Permit Issuance 1 27.00 SMIP RESIDENTIAL 1 4.00 $500.00 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 I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions Professions Code and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class—5'), —Licens o. who builds or improves thereon, and who contracts for the projects with a Expires 11-i Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION LARATION ❑ I am exempt from Iicensure under the Contractors'State License Law for the ❑ I hereby affirm under penalty of perjury one of the following declarations: following reason: I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in compensation,Issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have permit is issued. built as an owner-building If it has not been constructed in its entirety by licensed Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the iI have and will maintain workers' compensation insurance, as required by Business and Professions Code,Is available upon request when this application is ction 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:httoJUwww lectinfo.ca.gov/-calaw.html. permit Is issued.My workers'compensation insurance carrier and policy number are: .�V t_l G Property Owner or Authorized Agent Date Carrier Expires i 9-1L� Policy# VAC So � ❑ By my Signature below, I certify to each of the following: I am the property Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this (This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this city or county to enter the above- ElI certify that in the performance of the work for which this permit is issued,I iden d proVellinspection purposes. // / shall not emolov any persons in any manner so as to become subject to the �. workers' compensation laws of California,and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor ProPeJqWn&or Authorized Agent Date Code,I shall forthwith comply with those 5i�� ions City Business License# Date; \ I !I I Applicant; WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DYES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? I hereby affirm that under the penalty of perjury there is a construction lending agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE 3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE - Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address DNO DISTRICT (SCAQMD) SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS PRINT NAME'. I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the reason(s)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL? or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the I HAVE READ THE HAZARDOUS MATERIAL provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Iicensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECT E S IION 2ATE 505I�E5533 GD 25534 CONCERNING HAZARDOPOKY ❑ 1, as owner of the property, or my employees with wages as their sole compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; X The Contractor's State License Law does not apply to an owner of a property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). CITY OF MENIFEF6Ity Of Menifee PECK No: Permit No: Building & Safety Dept. _0 29714 Haun Road Date: Date: Menifee, CA 92586 MAY 01 2014 -1 kLk Phone: (951)672-6777 Amount: Amount: Fax:(951)679-3843 Received Ck#: Ck#: Building Combination Permit To Be Completed By Applicant Legal Description: Plannin Case: 9 F: Property Address: Assessor's Parcel Number. Project/Tenant Name: G nit#: ZFm Name: ' No _Prope Ownertydress: 3 �� I�L�`CUnit Number , Email Address: l• Name: L Phone No. Fax No. Applicant Address: Unit Number Zip Code Email Address: �zz7G �LU�� (�l L LN ujw6f- i t_ p Name; 7.&� r�s Phone No. Fax No. Contractor Address: 3 � City s to zip cC.crda � � Z I ULA ontractor sicense o. State of California License No. 3 Classification: Number of Squares: 3 Square Footage Description of Work: b 0 L ,S-Q{} C.AYGz_ Cost of Work:$ Applicant's Signature Date: 7 / To Be Completed.By,City Staff Only Indicate As R-Received or N/A-Not Applicable 5 Completes sets of fully dimensioned.drawn to sale plans which include: 1 set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gee Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Trtle 24 Energy(on 8 Y x 11) ❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations ❑ Single Line diagram for elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration- Addition' Means/Methods Work Type: -]Repair* Retroftf Revision to Existing PenniP Required? YES NO Proposed Building Use(s): Existing Building Use(s): #Buildings: #Units: #Stories: Will the Building Have a Basement? Y of N Bldg.Code Occupancy Group Indicate if At Project Indicate YES or NO Indicate all Geo-tech.Haz.Zone Construction Spdnkleretl that apply: Coastal Zone Completion: Type(s): C Of O YES or NO Noise Zone Required? Listed on Historic Resources Inventory CITY PLANNING STAFF ONLY APPROVALS: I Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit Speclal Case:Bldg_ 0(fciWA roval ar Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing F Staff Use Only Building/Safety1 Permit Specialist I City Planning I Civil Engineering EPWM-Admin Transpodalion Mgml. Rent Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY