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PMT14-02534 City of Menifee Permit No.: PMT14-02634 29714 Type: Pool/Spa-Residential .C3—!�.' MENIFEE,EE, C CA 92 92586 MENIFEE Date Issued: 09/19/2014 PERMIT Site Address: 28809 HILLSIDE DR, MENIFEE, CA 92584 Parcel Number: 372-244-002 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of IN GROUND GUNITE POOL&SPA 15X30-300 SO FT Work: Owner Contractor OSCAR DIEGUEZ A CUT ABOVE CONSTRUCTION POOLS& 28809 HILLSIDE DR LANDSCAPE INC MENIFEE, CA 92584 26025 NEWPORT ROAD#A533 - Applicant Phone: 8007007754 CHRIS YOUNG License Number: 672202 26025 NEWPORT ROAD#A533 MENIFEE, CA 92584 Phone: 9513014175 Fee Description C& Amount 1$) Building Permit Issuance 1 27.00 - - EE 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 slated, 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. t i AA_Bldg_Permit_Template.rpl 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 Co and y license is in f II force and effect. Code:The Contractor's License Law does not apply to an owner of a property License Cla s - Lice o. '2- 'T�� who builds or improves thereon, and who contracts for the projects with a Expires Signatu licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLA A ❑ 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 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. Policy# built as an owner-building if It has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application Is seM 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:MID'Llwww Ieci nfo ca cov/calaw html. p rmit is issued.My workers'compensation insurance carrier and policy number are: " Property Owner or Authorized Agent Date Carrier r� I Expires 1 `2i� Policy �_ ❑ Byy�rfiy Signature below, I certify to each of the following: I am the property Name of Agent Phone# owrfer 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 constr do . hori' represe atives of this city or county to enter the above- 0 certify that in the performance of the work for which this permit is issued, I ide ified p perry for t ins purp she I not employ any persons in any manner so as to became subject to the C workers'compensation laws of California, and a that if I should become subject to th workers'compensation provisio of S ction 3 -of-the-tabor­ Pr ner or thori A t Date Code, shall forthwith comply with thos rov ions. City Business Licens Date; Applican WARNING: FAILURE TO SE WORKS S' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLAWFUL, M''DD'"'..iiHALL 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, OYES 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 ONO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE? 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 []YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS GUIDE LINES 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 OYES 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 provisions of the Contractor's State License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL Section 7000)of Division 3 of the Business and Professions Code)or that he or []YES 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, TO 25533 AND 25534 CONCERNING El I, as owner of the property, or my employees with wages as their sole HAZA OU ERIAL f EPOWTING. compensation,will do( )all of or( )porting of the work, and the structure is PR PERTY WNER HORIZED 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). CllllY O MENI FE PLCK No: P III City of Menifee 29714 Haun Road3tlilding & Safety Dept, Date: Date: Menifee, CA 92586 Phone: (951)672-6777 SEP 19 M4 Amount mount �� rD Fax:(951)679-3843 Ck#: Ck#: RecOiyed Building Combination Permit G S4 To Be Completed By Applicant Legal Description Z Co —7 qT _ `\42 / Planning Case: F: L: Rt: R: Property Address: —\� 11, \ Assessor's Par-5—7 bhp: _ Z (N — Dd Z ag�sc�q �ls �dt 7 q2 s G Project/Tenant Name: 1�C Cam j� Unit#: Floor III: VJ 1�1 J.e Z Name: ✓'1 P, �r}. No. _�` S� Fax No. PropeLJ C �J. "1 t— Ownerty Address: �1�� Unit Number « I dR f-- Zip Cod II g2 �y O -( tj Email Address: Name: Phone No.e No. ±Faxo. f L'S Dv. Applicant Address: Unit Number de all e 0,3t S r�\ S33 Email Address: Name: No P�Ol S . =�7 Fa Contractor dies � a� �1 �3 '"il ` Sta Zip Code �C ontractor s Cify 13 s Icennse o. Contractor's ity State of California LicenseNo, CIyS�ifi J Number of Squares: �Y Square Footage 3 C) Deso`ription�Work: S Cost of Work: %Applicant' www Date: y l4 - I To Be Completed By;Clty'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 ❑ Goo Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11) ❑ Foundation Plan ❑ Plumbing Plan ❑ Structural Calculations ❑ Cross Section ❑ Single Line diagram for elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration' Addition' Means/Methods Work Type: Repair• Retrofit Revision to Existing Permit 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 Indicate if Indicate all Geo-tech.Haz.Zone At Project Spdnklerad YES or NO Completion: Construction that apply: Coastal Zone Type(s): C Of O YES or NO Noise Zone Required? Listed 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:nag. OffictalA royal Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing For Staff Use Only Building/Safety Permit Specialist I City Planning I Civil Engineering I PWM-Admin Transportation Mgmt. I Rent Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY