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PMT15-02459 City of Menifee Permit No.: PMT15-02469 29714 HAUN RD. MENIFEE, CA 92586 Type: Pool/Spa-Residential MENIFEE Date Issued: 08/14/2015 PERMIT Site Address: 29714 PEPPERCORN DR, MENIFEE, CA Parcel Number: 333-690-004 92584 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA 300 SO FT Work: Owner Contractor APARICIO RESIDENCE A CUTABOVE CONSTRUCTION POOLS& 29714 PEPPERCORN DR LANDSCAPE INC MENIFEE, CA 92584 26025 NEWPORT ROAD#A533 Applicant Phone: 8007007754 APARICIO RESIDENCE License Number: 672202 A CUT ABOVE CONSTRUCTION POOLS&LANDSCAPE INC 26025 NEWPORT ROAD#A533 MENIFEE, CA 92584 Fee Description Owl Amount f$1 Building Permit Issuance 1 27.00 F. '-. M , I F SMIP RESIDENTIAL 1 4.00 $499.00 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 Bldg 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 fort and effect. License Cls s '" Code:The Contractor's License Law does not apply to an owner of a property ZJs Licens t�(o. who builds or improves thereon, and who contracts for the projects with a Expires 41117 Signatur f licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLA TIO ❑ I am exempt from Iicensure 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 Section 3700 of the Labor Code, for the performance of work for which this which must have resided for at least one year prior to completion of 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 ❑ 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://Www leginfo ca govlcalaw html. permit Is issued.My worker 'compensation insurance carrier and policy number are: Carrier // Property Owner or Authorized Agent Date Expires , Policy# ��( � 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($100)or less) with all applicable city and county ordinances and state laws relating to building construction. I author' a representatives of this city or county to enter the above- El I certify that in the performance of the work for which this permit is issued, I identified grope or the ins action purposes. shall not employ any persons in any manner so as to become subject to the D-7 workers' compensation laws of California, and agree that if I should become subject to the workers'compensation prov' i s of Section 3700 of the Labor 12 Code,I shall forthwith comply with thos rovisWIEN Property Owner rAu(4orif Agent Date 1City Business Lice s`# CyJI Date; Applican WARNING: FAILURE TO KERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UHALL SUBJECT AN EMPLOYER TO CRIM AND CIVIL FINES UP TO ONE HUNDREDLARS WILL THE APPLICANT OR FUTURE BUILDING ($'100,000), IN ADDITION TO THE COTION, []YES 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 ❑NO 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 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 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 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 Stale 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 DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Iicensure 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 sale HAZARDOUS MAT�RIALR PORING. compensation,will do ( )all of or ( ) porting of the work, and the structure is PROP T tlVNNER O AU ZED 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). & SAFETY PERMIT/PLAN CHECK APPLICATION i Menifee DATE DATE U/ PERMIT/PLAN CHECK NUMBER ( 17 -O,;1 TYPE: C COMMERCIAL RESIDENTIAL "D MULTI-FAMILY t:% MOBILE HOME �(POOL/SPA O SIGN SUBTYPE: "ADDITION ' ALTERATION Ct DEMOLITION C ELECTRICAL C% MECHANICAL 0 NEW 0 PLUMBING RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Sf Y'� PROJECTADDRESS Z�7�i CUZGl�YL/y L ASSESSOR'S PARCEL NUMBER 3IF4- (0 IO-WT LOT 14 TRACT OWNER NAME ADDRESS T nZ�/�1 t�7I�Z//L�J � >/L PHONE !S ( ��l G < J EMAIL APPLICANT NAME l�/'F'Ll j 041 ADDRESS PHONE //�� pEEMAIL CONTRACTOR'S NAME 4,so pG OWNER BUILDER? C%YES O BUSINESS NAME ADDRESS 2�&ozsS Ak 4T- kP Arg3 PHONE �S/L'Z(l�7ZS� EMAIL CONTRACTOR'S STATE LIC NUMBER &7Z-Zc-'�77_ LICENSE CLASSIFICATION C-S- VALUATION FT L SO FT /,� APPLICANT'S SIGNATURE DATE �7 /(}✓ DEPARTMENT DISTRIBUTION ,M CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE N I SMIP �V INVOICE PAID AMOUNT AMOUNT ,CASH i%CHECK# C%CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT "')CASH 'CHECK# Ci CREDIT CARD VISA/MC OWNER BUILDER VERIFIED ""YES C NO DL NUMBER NOTARIZED LETTER '> YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213