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PMT15-02458 i City of Menifee Permit No.: PMT15-02458 29714 HAUN RD. ` MENIFEE, CA92586 Type: Pool/Spa-Residential cm' xsam�Q MENIFEE Date Issued: 0 8/1 412 0 1 6 I I PERMIT Site Address: 30347 MOON STAR CIR, MENIFEE, CA Parcel Number: 360-640-031 92584 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA 300 SO FT Work: Owner Contractor DAVE&MARILYN BROWN A CUT ABOVE CONSTRUCTION POOLS& 30347 MOON STAR CIR LANDSCAPE INC MENIFEE, CA 92584 26025 NEWPORT ROAD#A533 Applicant Phone: 8007007754 CHRIS YOUNG License Number: 672202 A CUT ABOVE CONSTRUCTION POOLS&LANDSCAPE INC 26025 NEWPORT ROAD#A533 MENIFEE, CA 92584 Fee Description Qtv Amount immi - ;ou: S- a 1 , qQ 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_Blog_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 Professions Code and my license is in full fprc and effect. Code:The Contractor's License Law does not apply to an owner of a property License Cla s r=�Licens o. 2i who builds or improves thereon, and who contracts for the projects with a Expires Signatur licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLA TIO ❑ 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 permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have 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 ❑ 1 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://w .leginfo.ca.gov/calaw.html. permit is issued.My worke 'compensation insurance carrier and policy number are: Carrier —Z Property Owner or Authorized Agent Date Expires LI Policy#��J Name of Agent Phone# ❑ 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 author' a 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 grope or a inspection purposes. shall not emolov any persons in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become ( J subject to the workers'compensation prov" io0s of Section 3700 of the Labor property Owner Au ' e Agent Date Code,I shall forthwith comply with thos rovislp Date; Applican J City Business Lice e# CTL � � WARNING: FAILURE TO BE U W RKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLA F L, N SHALL SUBJECT AN EMPLOYER TO CRIMIN L EN T ES AND CIVIL FINES UP TO ONE HUNDRED TH SAND OLLARS WILL THE APPLICANT OR FUTURE BUILDING ($100,000), IN ADDITION TO THE COST O COMPENSATION, OYES 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 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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS 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 OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable items)(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, ❑NO 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 (Chapter9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES 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 2550 25533 AND 25534 CONCERNING El 1. as owner of the property, or my employees with wages as their sole HAZARDOUS MAT POKfING. compensation,will do( )all of or( ) porting of the work, and the structure is PROP NER O AU ZED 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 t i< Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: 0 COMMERCIAL NOESIDENTIAL ') MULTI-FAMILY <:; MOBILE HOME POOL/SPA <:; SIGN SUBTYPE: 0 ADDITI N _0 ALTERATION 0' DEMOLITION 0 ELECTRICAL 0 MECHANICAL NEW " PLUMBING ) RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK S (fi PROJECTADDRESS o EMEC/,Qr-_ ASSESSOR'S PARCEL NUMBER 3c00—(QL"31 LOT 151 TRACT ag7tio OWNERNAME /(�/J✓/p�� ADDRESS / F O)P G' PHONE ^, EMAIL �— APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME f &ukL OWNER BUILDER? 0 YES <: BUSINESS NAME ADDRESS Z(902T_ PHONE 0/o-a �7 EMAIL CONTRACTOR'S STATE LIC NUMBER `ZzQ 2 // `` ^^ LICENSE CLASSIFICATION VALUATION $ S ( FT W L SO FT APPLICANT'S SIGNATURE DATEIFC-ITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERItFIRE � N 0 71, INVOICE � 5°O AMOUNT HECK# OCREDIT CARD VISA/MC PLAN CHECK FEES HECK# <.>CREDITCARD VISA/MC OWNER BUILDER VERIFIED (.%YES 01 NO DLNUMBER NOTARIZED LETTER 01 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