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PMT15-00479 i City of Menifee Permit No.: PMTIS-00479 29714 Type: Pool/Spa-Residential �tGCEhh.�' MENIFEE,EE, C CA 92 92586 MENIFEE Date Issued: 03/05/2015 PERMIT Site Address: 28734 MAHOGANY TRAL WAY, Parcel Number: 333-690-032 MENIFEE, CA 92584 Construction Cost: $30,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA; 536 SO FT-WITH CITY STANDARD WALL;48X25 Work: Owner Contractor KEITH&KATHY ERICSON BLUE FOUNTAIN POOLS INC 28734 MAHOGANY TRAIL WAY 221 W F STREET MENIFEE, CA 92584 ONTARIO, CA 91762 Applicant Phone: 9099837665 DAVID ARCE License Number: 331356 221 W F STREET ONTARIO, CA 91762 Fee Description gtv Amount is Building Permit Issuance 1 27.00 a ec a 'atd - . , GREEN FEE 1 2.00u �t4E T roo. $583.00 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_Bidg_Permit_Template.rpt Page 1 of 1 J 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��rT�i License N �2/)3 s(� who builds or improves thereon, and who contracts for the projects with a Expires'-"-'1—M. Signal ur licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ 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, cannot legally sell a structure that 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 ❑ 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:llwww Iere info ca gov/calaw html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier Property Owner or Authorized Agent Date Expires I Policy# 91 (7O Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property 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 constructio thorize representati s of this city or county to enter the above- 0 1 certify that in the performance of the work for which this permit is issued,I identif prop y for the inspect! purpo 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 the Labor Code, I shall forthwith comply with those provisio P ope wner or horized - nt Date Date; ^ S'-'"M1 Applicant City Business License# 101�4 WARNING: FAILURE SEC RE 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 ($900,000), IN ADDITION'TO THE COST OF COMPENSATION, AYES 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 LNO 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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPUCANTOR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT 0 DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS GUIDE LINES I hereby affirm under penalty of perjury that I am exempt from 16 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,, -N�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 O UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL. EPOR NG. compensation, will do ( )all of or( ) porting of the work, and the structure is PROPE O NER ORAU ORIZED NT not intended or offered for sale.(Section 7044,Business and Professions Code; X V The Contractor's State License Law does not apply to an owner of a property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK rki- Menifee � DATE 2j� �`J' 5 PERMIT/PLAN CHECK NUMBER TYPE: C) COMMERCIAL 4,4ESIDENTIAL MULTI-FAMILY 0 MOBILE HOME 0POOL/SPA O SIGN SUBTYPE: ".) ADDITION "ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW 'O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK EwI 5'�A GAT 4T� 11 HJt�f-I Ft-cei< WALL 2 S L L 011Q.6 PROJECTADDRESS N4AfAOG-ANJI '(12P�2L yaAy' ASSESSOR'S PARCEL NUMBER 333 " (o<jQ— n32 LOT TRACT OWNER NAME G 50P`j f NTH City of Menifee Building & Safety Dept. ADDRESS Z� �j �H� ArJ T�A�L A PHONE �o�• b2r'` " �EI�I�y EMAIL MAR 0 5 2015 APPLICANT NAME Reeeived ADDRESS PHONE EMAIL CONTRACTOR'S NAME FOoG S OWNER BUILDER? OYES ""NO BUSINESS NAME ADDRESS ZZ-t L•1 t' a ST arJ --AFZ?o Grp PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER �7�7 3 r71�/ LICENSE CLASSIFICATION G �� VALUATION$ O L�> SO FT L SO FT a2 APPLICANT'S SIGNATURE DATE 3" S ^ S DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT 0 CASH Cs CHECK# :i CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT : CASH 0 CHECK# C?CREDIT CARD VISA/MC OWNER BUILDER VERIFIED D YES 0 NO DL NUMBER NOTARIZED LETTER '0 YES C NO City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-245-6213 9 � y�s psi �N X J3 O 4��v �� C 1 tr S X M J O 3� c9' \ 7� 4.