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PMT15-03370 City of Menifee Permit No.: PMT15-03370 29714 HAUN RD. 4ACCELA—> MENIFEE,CA 92586 Type: Pool/Spa-Residential no.m.gWtn.' MENIFEE Date Issued: 1 013 01201 5 PERMIT Site Address: 29153 CRESCENT BAY, MENIFEE,CA Parcel Number: 333-431-030 92586 Construction Cost: $39,000.00 Existing Use: Proposed Use: Description of INSTALL 432 SO FT GUNITE POOL AND SPA Work: Owner Contractor JIM DICKEY QUALITY CUSTOM POOLS INC 29153 CRESCENT BAY 30138 MARNE WAY MENIFEE, CA 92586 MENIFEE,CA 92584 Applicant Phone:9516799732 HANNAH EASLEY License Number:795820 QUALITY CUSTOM POOLS INC 30138 MARNE WAY MENIFEE,CA 92584 Fee Description Oft Amount($1 Swimming Pool/In-Ground Spa 1 467.00 Building Permit Issuance 1 27.00 GREEN FEE 1 2.00 SMIP RESIDENTIAL 1 6.00 General Plan Maintenance Fee-Electrical 1 23.35 $525.35 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 ❑ lam exempt from licensure under the Contractors'State License Law forth I hereby affirm under penalty or perjury that 1 am licensed under provisions of following reason: Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence i Professions Code and my license is In full force and effect. which I must have resided for at least one year prior to completion r License Class U. S ei License No. -J�c�cJ, —d improvements covered by this permit, I cannot legally sell a structure that I hay. Expires ) Signature—G-"��`Cl c built as an owner-building if it has not been constructed in its entirety by license contractors. I understand that a cqpy of the applicable law, Section 7044 of th, WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this appllcation i submitted or at the following Web site: I c— I hereby affirm under penalty of perjury one the following declarations: httpd/www.lecinfo.m.aov/mlaw.htmi. have and will maintain a certificate of consenttforworkers' of self-insure for workers' compensation,issued by the Director of Industrial Relations as provided for by Dale Section 3700 of the Labor Code, for the performance of work for which this permit is issued. Property Owner or Authorized Agent Policy# CtA I DO 0 r)_ ) Cj gl(By my Signature below, I cerfify to each of the following: I am the propert 4 I have and will maintain workers' compensation insurance, as required by ner or authorized to act on the property owner's behalf. I have read thi section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to compl permit is issued.Myworkers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildin! construction.I authorize representatives of this city or county to enter the above Carrierr J.z,r.¢Rst No" r`ovt oLA id✓e�r�ti—fie}�d properly fo�the inspection purposes. Policy# C4t01302(C(? Expires —7V//� w ' `� � �� Date I 4u L ,- PropertyOwnerorAuthorizedAgent p (This section need not be completed if the permit is for City Business License# ��FPS 1 �J 8 one-hundred dollars($100)or less) ❑ [certify that in the pertortnance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I shall forthwith comply with those provisions. OYES &-fJJO Applicant; Date; Will the intended use of the building by the applicant or future building occupant require a permit for the construction or modification from South WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES ZA0 CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES 0YES4_4NO CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide.and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) hazardous material reporting. OWNER BUILDER DECLARATIONS bay NO I hereby affirm under penalty of perjury that I am exempt from the Contractor's �, �/"?� Date ) O 3 D / License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORI AGENT next to the applicable item(s)(Section 7031.5. Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING fRRP1 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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978 Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit: www.epa.gov/lead or contact the National Lead Information Center at ❑ I, as owner of the property, or my employees with wages as their sole 1-800424-LEAD(5323). compensation,will do( )all of or( )parting of the work, and the structure is 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 properly ❑An EPA Lead-Safe Certified Renovator will be responsible for this project who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, Certified Finn Name: 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 Firm Certification No.: purpose of sale). ❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn is required for this project because: contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of a property Who builds or improves thereon, and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK 4 ' `,Menifee DATE l 0 36 1 S PERMIT/PLAN CHECK NUMBER "rl3r— D TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME OOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK —ua %Ae- gl AM y 3Z PROJECTADDRESS 201 I`J3 Qre,s "-t-* %a ASSESSOR'S PARCEL NUMBER 335- 4'6L- O'jC) LOT IOLi TRACT 31— q PROPERTY OWNER'S NAME Dfcv-e-4 . J i City of Menifee Buiding & Safety Bep�. ADDRESS 3 CAr"CkA-vj- PHONE Cl Lj ai -Z'D5 - S I`k I EMAIL APPLICANTNAME "ttvNYNZ L- Received GG ,,�, c�Sc ADDRESS 1 0 y� Lev PHONE 5 t - —f L-{(1 2—1 EMAIL CONTRACTOR'S NAME -I vh '�CtY'r u.�'� OWNER BUILDER? 0 YES ONO BUSINESSNAME u,¢>✓ � �c 1.� i,� ADDRESS O 3S W 2S® PHONE °t cl-132— EMAIL CONTRACTOR'S STATE LIC NUMBER �]a{ �j �j ZD LICENSE CLASSIFICATION VALUATION$ 39 OOD SO FT L SO FT ` APPLICANT'S SIGNATUR DATE IG I 1,C) 1 J DEPARTMENT DISTRIBUTION .{ $ CITY OF MENIFEE BUSINESS LICENSE NUMBER Bu1LDING PLANNING ENGINEERING FIRE GREEN R Z SMIP O©INVOICE �j AMOUNT Z�� PAID AMOUNT SZ<� 0CASH 0-CHECK A OCRED(f CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 pa i808 slot 0 E 130 4g5Z8 eo aa�ivayy'Aeg ;de(] A eg �R 6uipjin �uaosa,o eslsz eel! on ;o Aub eouevisaa Feaoia �h V a .r� .9d z✓ .6.6 wsa Omc� a�• .nwie x�• RLLn wna