PMT15-02557 City of Menifee Permit No.: PMT15-02557
29714 HAUN RD. Type: Pool/Spa-Residential
4q CCELX> MENIFEE, CA 92586
a e esmr n MENIFEE Date Issued: 08/21/2015
PERMIT
Site Address: 29027 SHORECLIFF CIR, MENIFEE, CA Parcel Number: 333-541-009
92585 Construction Cost: $20,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 506 SO FT
Work:
Owner Contractor
JOHN HOFFMAN ALOHA POOL& DESIGN
29027 SHORECLIFF CIR 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 ON Amount
Building Permit Issuance 1 27.00
E
SMIP RESIDENTIAL 1 3.00
$498.00
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 Templatarpt Page 1 of 1
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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 70r00)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in fwll force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class C S 3 License N a G Z—2 who builds or improves thereon, and who contracts for the projects with a �
Expires t (-r— Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION VECLARATION
❑ 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 must have resided for at least one year prior to completion of
Section 3 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. built as an owner-building if it has not been constructed In its entirety by licensed
Policy# contractors. 1 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:http://www.leginfo.ca.gov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires Policy#
gy my Signature below, I certify to each of the following. I am the property
Name of Agent Phone# (F�owner or authorized to ct on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the inf?fmation I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city yynd county ordinances and state laws relating to building
constructior. authoring representatives of this city or county to enter the above-
(ertify that in the performance of the work for which this permit is issued, I identified prope for�fhe inspection purposes. _
fi'Fall not employ any persons in any manner s as to become subject to the rj\N
(workers' compensation laws of California, an agree that if I should become
subject to the workers'compensation provisi s of Section 3700 of the Labor
Code,I shall fg hwith comply with those pro signs. Property Owner pr uthorized Agent D to
Date; _Z_e� Applicant; City Business License# S
WARNING: FAILURE TT 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, DYES 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 �1d0 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 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:
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 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, VIO 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 R 'AD THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or ❑YES INFORMATIO 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 ryi�l0 UNDER THEISTATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) r CODE, SECTION 25505 25533, AND 25534 CONCERNING
❑ I, as owner of theproperty, or m em Io employees with wages as their sole HAZA US MATERIAL IAEPORTING,
Y P Y 9 t(„
compensation,will do ( )all of or ( ) porting of the work, and the structure is PRO ERTY:OWNER OR.AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; `I
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, i
the building or improvement is sold within one year of completion, the Owner-
Builderwill have the burden of proving that it was not built or improved for the J
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
P!,
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: ^ COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME OOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL 0 MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 41062 S .A
PROJECT ADDRESS
ASSESSOR'S PARCEL NUMBER 333-5141-pL0I LOT TRACT "1
OWNER NAME /� Lk � tJ p ,
ADDRESS Z �// Z� 0Iz-g— - L�
PHONE 5 �7G"`�~'7 � � EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME w4®L h J (/� OWNER BUILDER? OYES 40
BUSINESS NAME ,A1,� /
ADDRESS l o ? �/T�o �"O��//t�K?Ol�l CIA s L#5 T—
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 675
7• / LICENSE CLASSIFICATION 4 r 3
VALUATION $ Q SO FTv L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION �/,c,w��-] CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP ✓
INVOICE PAID AMOUNT
AMOUNT +'CASH OCHECK# .1 CREDIT CARD- VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK IF '`O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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