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PMT14-03114 1, City of Menifee Permit No.: PMT14-03114 29714 HAUN RD. Type: Pool/Spa-Residential r MENIFEE, CA 92585 s�`"` MENIFEE Date Issued: 11/24/2014 PERMIT Site Address: 28846 ALMONDWOOD CT, MENIFEE, CA Parcel Number: 333-680-072 92584 Construction Cost: $32,000.00 Existing Use: Proposed Use: Description of INSTALL INGROUND GUNITE POOL AND SPA Work: Owner Contractor VICTOR&SHARON GAUTIER 28846 ALMONDWOOD COURT MENIFEE, CA 92584 Applicant License Number: VICTOR&SHARON GAUTIER 28846 ALMONDWOOD COURT MENIFEE, CA 92564 Phone: 9516795548 Fee Description ON Amount is Building Permit Issuance 1 27.00 SMIP RESIDENTIAL 1 5.00 _ $501.00 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_Eldg Permil_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 w 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 License No. who builds or improves thereon, and who contracts for the projects with a Expires Signature licensed contractor(s)pursuant to the Contractors State License Law), WORKERS'COMPENSATION DECLARATION ❑ I am exempt from Iicensure under the Contractors'Slate License Law for the ❑ 1 hereby affirm under penalty of perjury one of the following declarations: followin on: I have and will maintain a certificate of consent of self-insure for workers' By y signature belo ck wledge that,except for my personal residence in compensation,issued by the Director of Industrial Relations as provided for by whic must hav resided for at least one year prior to completion of Section 3700 of the Labor Cade, for the performance of work for which this permit is issued. improvements b this ermit, I cannot legally sell a structure that I have Policy# built as an own -building i s not been constructed in its entirety by licensed contractors. I nderstand the y of the applicable law, Section 7044 of the ❑ 1 have and will maintain workers' compensation insurance, as required by Business a Profs sio e,is vailable up request when this application is section 3700 of the Labor Code, for the performance of the work for which this submi d rat 0 htt :/ .e Info.ca.00v/c w.himl. permit is issued.My workers'compensation insurance carrier and policy number are: /7 ? Carrier Pro /eror ut rized Date Expires Policy# Name of Agent Phone# By t a my Signa below, I certify to each of the following: I am the property owner or auttKrized 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 informati I ave provided is correct. I agree to comply one-hundred dollars($100)or less) with/applice city and c n ordinances and state laws relating to building contho ize repre ntatives oft is city or county to enter the above- ❑ 1 certiy that in the performance of the work for which this permit is issued, I iden in ec ion purpo s. shall not employ 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 Pr perry Owner or thorized Agent Date Code,I shall forthwith comply with those provisions. Date; Applicant; City Business Lic rise# WARNING: FAILURE TO SECURE WORKERS' AZARDOUS 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, 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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION _ Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT ❑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 OYES 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, SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I EPORIING. 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). PERMIT/PLANBUILDING & SAFETY � Etulldlnq & Safety Dept. Menifee NOV 2 4 2014 DATE II IaLI PERMIT/PLAN CHECK NUMBER TYPE: " COMMERCIAL 4#RESIDENTIAL C% MULTI-FAMILY 0 MOBILE HOME a POOL/SPA C' SIGN SUBTYPE: ADDITION "' ALTERATION "', DEMOLITION C1 ELECTRICAL "I MECHANICAL O NEW CO PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECT ADDRESS V116 LrC/ ASSESSOR'S PARCEL NUMBER3-(Q.Stp.�a, LOT TRACT OWNER NAME 06764 (�( ADDRESS PHONE G1611 67q SSA EMAIL GAkr dl Ca," APPLICANT NAME ADDRESS �0� PHONE gS�� / ,Sj� EMAIL CONTRACTOR'S NAME 7"c. OWNER BUILDER? &YES NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR' STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION $K� p0.d SO FT L SO FT /7G L6 APPLICANT'S SIGNATURE DATE Ci7 �` CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION ^d CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GR EN O SMIP 5— INVOICE � AMOUNT �O`� PAID AMOUNT �00\� ) CASH <'1CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT C'CASH %CHECK# 0 CREDITCARD VISA/MC OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES �3 NO City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213