PMT15-01112 tl
City of Menifee Permit No.: PMT15-01112
29714 HAUN RD.
/ `" MENIFEE, CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued: 04/29/2016
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PERMIT
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Site Address: 27833 POINTE BREEZE DR, MENIFEE, Parcel Number: 333-351-004
CA 92585
Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 300 SO FT, 10 L FT GAS LINE FOR FIRE PIT
Work:
Owner Contractor
SCOTT LEVESQUE A CUT ABOVE CONSTRUCTION POOLS&
27833 POINTE BREEZE DR LANDSCAPE INC
MENIFEE, CA 92585 26025 NEWPORT ROAD#A533
Applicant Phone: 8007007754
COLE YOUNG License Number: 672202
A CUT ABOVE CONSTRUCTION POOLS&LANDSCAPE INC
26025 NEWPORT ROAD#A533
MENIFEE, CA 92584
Fee Description Piz Amount lS)
g 67.
Building Permit Issuance 1 27.00
Irt n s C " IMMINUMMMMbxi .
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 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_Bldg_Permit_Templale.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
1 hereby affirm under penalty or perjury that I am licensed under provisions of ❑ 1, 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 -S3 License IN 67^22oZ who builds or improves thereon, and who contracts for the projects with a
Expires 2c (IC SignatureJ� 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
❑ 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 b this permit, I cannot legally sell a structure that I have
permit is issued. P y
P 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 Cade,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 lecinfo m ocovv/calaw html.
permit is issued.My workers compensation insurance carrier and policy number are:
roperty caner or uthorized Agent Date
Carrier 5TAr� FcuNn
Expires_I /a( I2c� 11 Policy# la'Z99�o
❑ By my Signature below, I certify to each of the following: I am the properly
Name of Agent Phone# owner or authorized to act on the property owner's behalf. 1 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-
El I certify that in the performance of the work for which this permit is issued,I identifie any for the 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 a Per or Authorized Agent Date
Code,I shall forthwith comply with those provisions. O A' ,.��/
2� City Business License# .011 I
Date; ��15 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, OYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEESy10 EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending
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 jAO 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 Lawforthe 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, 'EP'O 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 I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law(Chapter 9 (commencing with
Section 7000)of Division 3 of the Business and Professions Code)or that he or 91PS 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($500).) CODE SECTION
C M N 25505RIAL 1';E 5533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole
compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY OyJN OR Al1T.HORIZED A ENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that It was not built or improved for the
purpose of sale).
SAFETYPERMIT/PLAN CHECK APPLICATION
�Wenifee
DATE AWIL 29rx 20I; PERMIT/PLAN CHECK NUMBER
TYPE: " COMMERCIAL O RESIDENTIAL C11 MULTI-FAMILY OMOBILEHOME POOL/SPA C%SIGN
SUBTYPE: 0 ADDITION f),ALTERATION DEMOLITION () ELECTRICAL 0 MECHANICAL
NEW 0 PLUMBING " RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK o j
PROJECTADDRESS 2-1833 2-S 6'f
ASSESSOR'S PARCEL NUMBER 333- 35I-OO4 LOT TRACT '30'7m
OWNER NAME S CQrr t c--VCS uz
ADDRESS 2 g33 c,l,-,Te Cze 17 IU ` ME NIF E G7 CA gZSBS
PHONE EMAIL
APPLICANT NAME C. IC YDJ N y
ADDRESS -?2s 33 NAYO,-N p-D AACNll-f1E A z-Sg
PHONE SSI 193 e06o EMAIL
CONTRACTOR'S NAME A LVt gOVe Pcx,Ldj ''HNt! OWNER BUILDER? C;YES OPNO
BUSINESS NAME
ADDRESS
PHONE TSj ZL111 EMAIL
CONTRACTOR'S STATE LIC NUMBER 47Z:Z6'2- LICENSE CLASSIFICATION C -f 7
VALUATION$ ZS Qio SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTIDN OD oo I CITYOFMENIFEEBUSIN 5 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP T CJ
INVOICE 00 PAIDAMOUNT
AMOUNT 616 t-%CASH :%CHECK# `)CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT QCASH CHECKH -CREDITCARD VISA/MC
OWNER BUILDER VERIFIED C1 YES C1 NO DL NUMBER NOTARIZED LETTER C YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-572-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213