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PMT15-00457 I' City Of Menifee Permit No.: PMT16-00457 29714 HAUN RD. [i 'C;k6CE1...X? MENIFEE, CA 92586 Type: Pool/Spa-Residential c Not.. MENIFEE Date Issued: 03/03/2016 PERMIT Site Address: 25324 APACHE HILL CIR, MENIFEE, CA Parcel Number: 358-461-017 ''.. 92584 Construction Cost: $36,500.00 '.. Existing Use: Proposed Use: Description of INGROUND POOL&SPA Work: Owner Contractor JOSEPH MEHOCHKO SUBIC BAY POOLS AND LANDSCAPES 25324 APACHE HILL CIRCLE CONSTRUCTION MENIFEE, CA 92584 37139 HIGH VISTA DRIVE Applicant Phone: 9513238417 EDUARDO SALAZAR License Number: 889971 SUBIC BAY POOLS AND LANDSCAPES CONSTRUCTION 37139 HIGH VISTA DRIVE MURRIETA, CA 92563 Phone: 9513238417 Fee Description Qty Amount 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 bulliding 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 f rc n ct. Code:The Contractor's License Law does not apply to an owner of a property License Class License 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). WORK RS'COMPENSATION ECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for the hI hereby affirm under penalty of perjury one of the following declarations: following reason: ave 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 y 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:htto//www leginfo ca aov/calaw html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier Property Owner or Authorized Agent Date Expires Policy# ❑ 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- Xscertify that in the performance of the work far which this permit is issued,I identified property for the inspection purposes. all notnot emo_yloyloy 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 Property Owner or Authorized Agent Date Code, I shall forthwith comply with those provisis City Business License# Date; Applicant; WARNI G: 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, 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 ❑NO 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 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 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 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 ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL AEPOktING. compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). & SAFETY PERMIT/PLAN CHECK APPLICATION ' Menifee DATE -3 PERMIT/PLAN CHECK NUMBER 5 — TYPE: 0 C MMERCIAL R RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME O POOL/SPA C SIGN SUBTYPE: &ADDITION O ALTERATION G DEMOLITION O ELECTRICAL C> MECHwit�f Safety nillee O NEW O PLLUMBING O RE-ROOF-NUMBER OF SQUARES Building Dep DESCRIPTION OF WORK MAR 0 3 201 Pived PROJECTADDRESS Z � I ASSESSOR'S PARCEL NUMBER /?' -UtAj-01-1 LOT TRACT OWNER NAME G` ADDRESS C - i !� PHONE EMAIL APPLICANT NAME ADDRESS PHONE EMAIL /� CONTRACTOR'S NAME OWNER BUILDER?` ES 0 1 BUSINESS NAME ADDRESS / PHONE EMAIL CONTRACTOR'S STATE LLIC NUMBER LICENSE CLASSIFICATION CZ Z C �3 VALUATION$ SQ FT L SO FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE , PAID AMOUNT AMOUNT .i CASH 0CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT Ci CASH C3 CHECK if O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED DYES 0 NO DL NUMBER NOTARIZED LETTER YES `? NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 lVl�(2C�F 201� (�- SiJNC IS �u1rr�12rZln,Cj �bu�lnoc� �t�Z,�n � 6 , C�1 ✓rv�� �� 3T�'N �p777- 32-V APAc +lN� fLL MN1 f - YOiJii Cu AjS(be r��7�a �kj . I i California Jurat Certificate A notary public or other officer completing this certificate verifies only the Identity of the individual who signed the { document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California S.S. County of px , n Subscribed and sworn to (or affirmed) before me on this 3 day of t-k �ct4 Month 20 _p, by �-L . t ec M 14 Ca-W't.r i4 and Name of Signer(1) i proved to me on the basis of (dame of Signer(2) - satisfactory evidence to be the person(s) who appeared before me. �. BRANDY CWJ.EEhI MCGOWAN > rh'<. GOA#M.t�194S1�8 C '``� S N07ARXPU84.I�•CALIFORNIH a Signature of No`:ar u51ic RNEgSIpE G9�NTY My Comm.E%pites Jdy 28,20t5 For onicr required inforrnatlon'Notary ida me.Cmninlssion No,etc.) Seal OPTIONAL INFORMATION Although the information in this section is not required by law. it could prevent fraudulent removal and reattachrnent of this jural to an uneulhorized document and may prove useful to persons relying on the attached document. Description of Attached Document ✓ s r°,l i,Uf,rllCf „�ir� P The certificate is attached to a document titledtfor the purpose of Method of Affiant Identification Proved to me on(he basis of satisfactory evidence: O form(s)of Identification O credible wilness(es) Notarial event is detailed in notaryjournal on: Page#_ Entry#_ Notary contact: containing pages, and dated Other Affiant(s)Thumbprint(s) E] Describe: 6 2009-2015 Notary Learning Center-All Rights Reserved You can purchase copies of this form rrom our web site at wvw,rTheNolarysSlnre,com