PMT15-00963 a
City of Meniffee Permit No.: PMT15-00963
29714 HAUN RD. Type: Pool/Spa-Residential
9t 6CEL-A�. MENIFEE, CA 92586
MENIFEE Date Issued: 04/16/2015
PERMIT
Site Address: 25483 WATER WHEEL CT, MENIFEE, CA Parcel Number: 358-430-034
92585 Construction Cost: $30,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA
Work:
Owner Contractor
KEVIN JOHNSON VETERAN POOLS& PLASTERING
25483 WATER WHEEL COURT 6578 ALEXANDRITE COURT
MENIFEE, CA 92585 MIRA LOMA, CA 91752
Applicant Phone: 9518082674
JEFF LUCAS License Number: 914937
VETERAN POOLS&PLASTERING
6578 ALEXANDRITE COURT
MIRA LOMA, CA 91752
Fee Description qty Amount
�5wimmgn�?ool/ih, roundSpa� z. 1` 46�Q0
Building Permit Issuance 1 27.00 `
SMIP RESIDENTIAL 1 4.00
$500.00
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 building 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_Permlt_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 force and a ct. Code:The Contractor's License Law does not apply to an owner of a property
License Class— License o. 93 who builds or improves thereon, and who contracts for the projects with a
s Sign
Expireature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATIO DECLAIZ4TION
❑ I am exempt from licensure under the Contractors'State License Law for the
A
ffirm under penalty of perjury one of @ followi decla lions: following reason:
wave ndvwill maintain a certificate onsent D If-ins for w rkers' By my signature below I acknowledge that, except for my personal residence in
comp ensatid is ed b t irector of nd �ytrial Re ti s as ro 'de for by which I must have resided for at least one year prior to completion of
o�l Sect on 3700 thabor C % for th perfarmanc of ork for ich this improvements covered by this permit, I cannot legally sell a structure that I have
permit is is
Policy# 2 H /0 Z 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
tj�Y 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:htto'//www.leuinfo.ca.aovicalaw.htm].
permit is issued.My//workers'compensation insurance carrier and policy number are:
Carrier 5"nI' mp
C / u,4J Property Owner or Authorized Agent Date
l Expires -/O-1 Policy#
Name of Agent XXT 1 2lS / (o[,N� II V. Phone# p�6._757� ❑ 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
construction.I authorize representatives 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 identified property for fire inspection purposes.
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 =License
er or Authorized Agent Date
Code, I shall forthwith comply with those provision . #
Date; / Applicant;
WARNING: FAILURE T. 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
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DYE OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES UKO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
' 3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
- Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
./O FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address f$ff "'NNN 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 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 [BYES 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 I EPOkfING.
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNE 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).
i
Menifee
DATE -��p - I�" PERMIT/PLAN CHECK NUMBER r_5
TYPE: 0 COMMERCIAL ESIDENTIAL 0 MULTI-FAMILY 0:?✓R MOBILE HOME ' POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ELECTRICAL " MECHANICAL
t4NEW OPLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK S LA)_.1"/7,s7 Foo S(9/1 $-�6
PROJECTADDRESS z ` F3 UjC{,+ty— L( hed CT. M e4; Fe-
ASSESSOR'S PARCEL NUMBER -t-{',3jj-(� LOT TRACT aUI1I q,Ityding g t
& Safety p -
�^'7' /�
OWNER NAME Leovi l vOv(�iscwl APR6 z0 5
ADDRESS 2 s5/83 wa�r°r- wkeel C4, / eon; Fe
p
PHONE 7 S/_15-81 _952 EMAIL ReceiVOId
APPLICANT NAME V`7err Peols
ADDRESS 6pS78'
CT• /;I;/�A^^ ,� c'A, 175R_
PHONE �,�-"/ - F0'3- t
./Z67AI EMAIL �X t'T �/ ('rrN 1S •ru
CONTRACTOR'S NAME V��e�'t h T60l'S If F-F C_H MINER BUILDER? t YES ;A' 0
BUSINESS NAME ve` e frv, Z o/
ADDRESS 6 /•TLeX4l�LUYrr 4e C4 - ln1 y-A [-.--p/ ,t GA 9175 Z
PHONE /S1- 86�- up7 / EMAIL
CONTRACTOR'S STATE LIC NUMBER Q11g37 LICENSE CLASSIFICATION L'cS3
VALUATION$ cao SO FT SZb LSO FT
APPLICANT'S SIGNATURE DATE
ICITYSTAFF USE ONLY
-DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT :. CASH 0CHECKq +CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C)CASH CHECK k C'CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED �0 YES 0 NO DL NUMBER NOTARIZED LETTER YES '"% NO
City of Menefee Building& Safety Department 29714 HDun Rd, Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213