PMT14-01892 City of Menifee Permit No.: PMT14-01892 {
_�y�. 29714 HAUN RD.
CCIECA. MENIFEE, CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued: 07/22/2014
it
PERMIT
Site Address: 28670 VELA DR, MENIFEE, CA 92586 Parcel Number: 339-481-005
Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of POOL&SPA 565 SO FT '..
Work:
Owner Contractor '..
DONNA O'BRIEN ALOHA POOL&DESIGN
28670 VELA DR 41083 SANDALWOOD CIRCLE STE I
MENIFEE, CA 92586 MURRIETA, CA 92562
Applicant Phone: 9514539728
MARK KLINGSPORN License Number: 965927
ALOHA POOL&DESIGN
41083 SANDALWOOD CIRCLE STE I
MURRIETA, CA 92562
Fee Description QQt+ Amount is
Building Permit Issuance 1 27,00
SMIP RESIDENTIAL 1 4.00
$499.00
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 th I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 70 of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my licenstELAAPATInN
f and eff`c Code:The Contractor's License Law does not apply to an owner of a property
License Class C .5 LiceG- who builds or improves thereon, and who contracts for the projects with a
Expires l� a Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATIO
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ I hereby affirm under penalty of perjury one of the following declarations:
following reason:
I. 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
y 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
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:ham'//www.leoinfo,ce.govicalaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property Owner or Authorized Agent Date
Carrier
i
Expires Policy#
By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# caner or auth zed to act on the property owner's behalf. I have read this
� (This section need not be completed if the permit is for application an he information I have provided is correct. agree to comply(This
hundred dollars t be c or less) with all applica city and county ordinances and state laws relating to building
constructo I thorize representatives of this city or county to enter the above-
, 110 certify that in the performance of the work for 4ch this permit is issued, I identified ro y for the inspection u o s.
shall not employ any persons in any manner so to become subject to the
workers'compensation laws of California, and a ee that if I should become
subject to the workers'compensation provisio f Section 3700 of the Labor Property O er or Authorized Agent Date
Code,I shall to hwith comply with those prov' ' s.
-" City Business License# Vf ��,✓/�L V-3
Date; _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 HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES 0 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 NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
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 items)(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, IFNO 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 Code)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
HAZARDOUS MATERIAL AEPOW�ING.
❑ I, as owner of the property, or my employees with wages as their sole
compensation, will do ( )all of or( )porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIFEE PLCK No: P it
29714 Haun Road Date: Date: 14-0
Menifee, CA 92586 -1 1aa
Phone: (951)672-6777 Amount: Amount:• '� co
l
Fax:(951)679-3843 Ck#: Ck#: i
Building Combination Permit
S
To Be Completed By Applicant
Legal Description: bG — Planning Case: F: L: Rt: R:
Property Address: D o Assessor's Parcel Number.
ProjectfTenant Name: F N 60
^v a Unit#: Floor#:
Name: y Phone No.
Fax No.
Property gddress:
Owner b'-� iU Q 2 Unit Number Zip Code
Email Address:
Name: A24 Phone No. Fax No.
01 L L� D
Applicant Address: Unit Number
Zip Code
Email Address:
Name: Phone No. Fax No.
6.3 —
Contractor Address: City State Us3 Zip Code SHnxOFICyi Doc cii- Sir Un } !i z
ontractor s City Busln sq Contt�tors City S;e of California License No. Classificalion: A
Number of Squares:
Square Footage �Oil
Description of Work:
L s IPA- Cost of Work:$
Applicant's Signature rG s B®8
Date:
Z
To Be Completed.By.City:Staff-Only � -
icate As R-Received or N/A-No[Applicatle
5 Completes sets of fully dimensioned,drawn to sale plans which in lode; 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'/,x it)
❑ Foundation Plan El Structural Calculations
❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for also.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New CoiTuFfirventery
Alteration' Addition' Means/Methods
Work Type: Repair' RetrofP Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):#Buildings: #Units: Will the Building Have a Basement? Y of N
Bldg. Code Occupancy Group Indicate Indicate all Geo-tech.Haz.ZaneAt Project YES or NOCompletion: Construction that apply: Coastal ZoneType(s): YES or NO Noise ZoneListed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit special Case:Bldg.
Official A rove)
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety Permit Specialist City Plannin—g—T Civil Engineering I EPWM-Admin Transportation MgmL Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY