PMT15-01668 i
City of Menifee Permit No.: PMT16-01668 p
29714 HAUN RD. Type: Pool/Spa-Residential
MENIFEE, CA 92586
MENIFEE Date Issued: 06/17/2016
PERMIT
i
MI
Site Address: 29942 TWIN LAKES RD, MENIFEE, CA Parcel Number: 333-590-002
92585 _ Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of CONSTRUCT INGROUND POOL&SPA 740 SO FT AND 6'X 150 L FT CITY STANDARD BLOCK
Work: WALL
Owner Contractor
RUDOLPH ARREOLA ALOHA POOL&DESIGN
29942 TWIN LAKES RD 41083 SANDALWOOD CIRCLE STE I ,
MENIFEE, CA 92585 MURRIETA, CA 92562
Applicant Phone: 9514539728
MARK KLINGSPORN License Number: 965927
ALOHA POOL&DESIGN
41083 SANDALWOOD CIRCLE STE I
MURRIETA, CA 92562 -
Fee Description Qtv Amount
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
� �I JAL
$582.00
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 proporyy 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-Cod�e and-my license is in full- -r nd-effect.-- - -- -- ----- -- - ------Code:The Contractors License Law does notCapply to an owner of a property-'
License Class-�-License No. 9J �-� who builds or improves thereon, and who contracts for the projects with a
Expires / -Signature -`- licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION LARATION
❑ 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, I cannot legally sell a structure that I have
permit is issued.
Policy# 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
❑ 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'L/www.leginfo.ca.gov/calaw.htm].
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires Policy#
fGYBy my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# ,//o__wner 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 nd the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all ap. :cable city and county ordinances and stale laws relating to building
construct: . I authorize representatives of this city or county to enter the above-
rcertify that in the performance of the work for which this permit is issued, I identified perty for the inspection purposes.
a11 not employ any persons in any manner so as to become subject to the ---- /�
orkers' compensation laws of California, and gree that if should become
subject to the workers'compensation pro
visio of Section 3700 of the Labor prop rt caner or Authorized Agent Date
Code,I shall forthwith comply with those provi ons. _
Date; 6 y-7 Applicant; City Business License# Z/o 5
/
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, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE fi MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES `m 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
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:
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, Lt}W0 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 ❑YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption, Any CHECKLIST UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to 0 UNDER THE ATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE, SEC N 25505, 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOU ATERIAL REPORTING.
compensation, will do ( ) all of or( )porting of the work, and the structure is PROPERTY NER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, _----
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
=BUILDING & SAFFFTY PFRMIT/PLAN CHECK APPLICATION
JUN 17 2015 _Menifee
DATE Wingeived PERMIT/PLAN CHECK NUMBER PWI Q 15- (0bS
TYPE: 0 COMMERCIAL RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME OOL/SPA " SIGN
SUBTYPE: ADDITION O ALTERATION O DEMOLITION 0 ELECTRICAL 0 MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS ZCJ Z22 c.JI AJ LF - , �^
ASSESSOR'S PARCEL NUMBER �;/� �Cj�D i ooa LOT 10 1 TRACT y,/ Ieo
OWNER NAME Aq/�•.Q
ADDRESS '_
PHONE 0760-_2'?t-06977 EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME � ,�--.4 ( WNER BUILDER? <>YES ^
BUSINESS NAME "
ADDRESS /�� ✓/l�l/ Grivatl� �-f�" cSJ „(� 1 . �Z
PHONE �S��,f3 �Ty� / EMAIL
CONTRACTOR'S STATE LIC NUMBER �65�yZ7 LICENSE CLASSIFICATION GS
VALUATION$ 7�� SQ FT L SQ FT
i
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINj5jUCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ISO SMIP
INVOICE Q'^y� PgID AMOUNT
AMOUNT �O v O CASH CI CHECK# '0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT (.' CASH %CHECK# QCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER " YES 0 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