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PMT15-00709 y City of Menifee Permit No.: PMT15-00709 29714 HAUN RD.<A�—A> MENIFEE, CA 92586 Type: Pool/Spa-Residential 6wemanv 8'A.° MENIFEE Date Issued: 03/25/2016 PERMIT Site Address: 29020 SMOOTH SAILING CT, MENIFEE, Parcel Number: 333-523-005 CA 92585 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA, GAS LINE FOR BBQ &FIRE PIT Work: Owner Contractor JEFF&TESSA MAHAFFEY ALOHA POOL& DESIGN 29020 SMOOTH SAILING CT 41083 SANDALWOOD CIRCLE STE I MENIFEE, CA 92585 MURRI ETA, CA 92562 Applicant Phone: 9514539728 MARK KLINGSPORN License Number: 965927 ALOHA POOL& DESIGN - 41083 SANDALWOOD CIRCLE STE I MURRIETA, CA 92562 Fee Description OQt Amount 467'00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 $615.00 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 perju that I am licensed under provisions of CII, as owner of the property an exclusively contracting with licensed Chapter 9 (commencing with section 000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions Professions Code and my license is full force and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class _Ucens o. �5 GZ� who builds or improves thereon, and who contracts for the projects with a ture — licensed contractor(s)pursuant to the Contractors State License Law). Expires (0/ x 6 Signs WORKERS'COKADENSATIA DECLARATION ❑ 1 am exempt from licensure under the Contractors'State Llcense Law for the ❑ 1 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 1 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 ❑ I 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:http://www.leginfo.ca.aov/calaw,html. permit Is Issued.My workers'compensation insurance carrier and policy number are: Carrier Property Owner orAuthorized Agent Date Expires Policy# y my Signature below, I certify to each of the following: I am the property Name of Agent Phone# per 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 lh information I have provided is correct. I agree to comply one-hundred dollars($100)or less) with all applicable ity and county ordinances and state laws relating to building construction.I au orize representatives of this city or county to enter the above- certify that in the performance of the work for which this permit is issued, I Identified props for the inspection purposes. Pall not employ any persons in any manners as to become subject to the workers' compensation laws of California, and �dgree that if should become subject to the workers'compensation provisio # of Section 3700 of the Labor Code,I shall forthwith comply with those prov' ons. Property O Jnl or Authorized Agent Date Date; Applicant; City Business License# 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, ❑YES 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 WJ'NO DISTRICT (SCAQMD) SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS I` GUIDE LINES I hereby affirm under penally 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 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, 0 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 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 ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING. 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 City of Menifee Building & Safety Dept. Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SPA []SIGN SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION []ELECTRICAL ❑MECHANICAL []NEW PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS GpZ-C7. y ASSESSOR'S PARCEL NUMBER 3-l�f-Cj�.�-�GJ LOT _ TRACT �p OWNER NAME '� J� IGSS ADDRESS PHONE EMAIL APPLICANT NAME G ADDRESS PHONE EMAIL CONTRACTOR'S NAME y� OWNER BUILDER? ❑YES BUSINESS NAME ®>JD- .l ✓� ADDRESS Lp© C,,�, Si, d 1402 t PHONE S,3—S7 EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION (id VALUATION $ S^ae6 S .62,p L SO FT APPLICANT'S SIGNATURE DATE CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION ./'{ /�, CITY LF MENIFEE BUSINE5S LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP _/1`•flV INVOICE C�FoPAID AMOUNT AMOUNT � C%CASH +CHECK# C-CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH %CHECK# CREDITCARD VISA/MC OWNER BUILDER VERIFIED E:e YES NO DLNUMBER NOTARIZED LETTER .v YES 3 NO City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 9 i J I i wt� a i � f tk \ I 1�6 Is i