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PMT15-01114 City of Menifee Permit No.: PMT15-01114 29714 HAUN RD. Type: Pool/Spa-Residential �CCEL MENIFEE, CA 92586 MENIFEE Date Issued: 04/29/2015 PERMIT Site Address: 25310 HIGH NOON CT, MENIFEE, CA Parcel Number: 358-460-009 92584 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA 325 SQ FT, 16 L FT GAS&ELECTRIC LINE FOR BBQ&FIRE PIT Work: Owner Contractor JOHN PEURIFOY A CUT ABOVE CONSTRUCTION POOLS& 25310 HIGH NOON CT LANDSCAPE INC MENIFEE, CA 92584 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 (City Amount f$1 veimrr�"Po�I%In r a " Building Permit Issuance 1 27.00 Inspections not specified 116 116.00 E se, SMIP RESIDENTIAL 1 4.00 $731.00 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 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 j 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��NQQJJ 472^2�2 who builds or improves thereon, and who contracts for the projects with a Expires Z- Zc N Signatures 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 entirely by licensed Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the Z 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:/Iwww.leeinfo ca oovlcalaw htmi. permit is issued.My workers compensation insurance carrier and policy number are: Carrier 5f'AYcS FuNYi Properly Owner or Authorize Agent Date Expires I I to I 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- ❑ I certify that in the performance of the work for which this permit is issued, I identifie prp erty 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 Code, I shall forthwith comply with those provisions. �ertVbhner or Authorizejjd''�� Cl Date; Applicant;_xg Agent Date (�i2 c City Business License# R.I' � � ��IJ 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, ❑YES OCCUPANT HANDLE AHAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST, AND ATTORNEYS FEES ONO 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ai�0 DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS GUIDE LINES I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME: y0-41-� License Law for the reason(s)indicated below by the checkmark(s)I have placed ❑YES 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, 4940 SCHOOL? or repair any structure, prior to its issuance, also requires the applicant for the permit to fie 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 p &S INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from licensors 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 ❑ 1, 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 OyYNE OR FjI gHORIZED AGENT not intended or offered for sale.(Section 7044, Business and Professions Code; The Contractor's Slate 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). BUILDING & SAFETY PERM IT/PLAN CHECK APPLICATION Y-,ti:ti Menifee DATE I` 2c�N c) g PERMIT/PLAN CHECK NUMBER (5 -O 11 y TYPE: C COMMERCIAL * RESIDENTIAL C% MULTI-FAMILY 0, MOBILE HOME d4 POOL/SPA ',.':'SIGN SUBTYPE: J ADDITION C)ALTERATION O DEMOLITION O ELECTRICAL (' MECHANICAL `F NEW D PLUMBING C} RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK {�cs ¢ S P QC! R-K R FSB 12C PROJECTADDRESS Z5310 Ct �jirL e� CA 9 ZS V 2 ASSESSOR'S PARCEL NUMBER 3S p - 4w oy LOT (nS_ TRACT 3 OWNER NAME LAM ADDRESS Z5710 HII,14 ,) .7 I' rrJ r-eG' CA 72,Frl PHONE EMAIL APPLICANT NAME C.OIC ADDRESS 3Z57 leA ocoi meljj=ee CA a ,S PHONE %J/ 7'/,? CPO60 EMAIL CONTRACTOR'S NAME C I14 IC YC)ukj4OWNER BUILDER? C% YES AAO BUSINESS NAME A ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER _j "?L2d'L LICENSE CLASSIFICATION 53 VALUATION $ LS,cno SO FT ,�2� L SQ FT APPLICANT'S SIGNATURE DATE Cl"Z9 S CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITYU EpyEE BU�SINNEESSS.UCENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP INVOICE IO PAID AMOUNT AMOUNT -) CASH O'CHECK# CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH <JCHECKN =?CREDITCARD VISA/MC OWNER BUILDER VERIFIED " YES C% NO DL NUMBER NOTARIZED LETTER O YES 0 NO City of Menifee Building& Safety Department 29714 Houn Rd, Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-5213