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PMT15-03851 City of Menifee Permit No.: PMT15-03851 _ 29714 HAUN RD. <ACCEL/-> MENIFEE, CA 92586 Type: PoollSpa•Residential MENIFEE Date Issued: 12/16/2015 PERMIT Site Address: 29578 LIGHT SHORE CV,MENIFEE, CA Parcel Number: 333-560-024 92585 Construction Cost: $20,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA 536 SO FT Work: Owner Contractor LAUGHEAD/ORTIZ ALOHA POOL& DESIGN 29578 LIGHT SHORE CV 41083 SANDALWOOD CIRCLE STE I MENIFEE, CA 92585 MURRIETA, CA 92562 Applicant Phone:9514539728 MARK KINGSPORN License Number.965927 ALOHA POOL&DESIGN 41083 SANDALWOOD CIRCLE STE I MURRIETA,CA 92562 Fee Description 2 . Amount Swimming Pool/in-Ground Spa 1 467.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 3.00 General Plan Maintenance Fee-Electrical 1 23.35 $621.35 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 carded on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as otherwise stated,a peril 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_61dg_Pennit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'Stale License Law ford following reason: I hereby affirm under penalty or perjury that I am licensed under provisions of Chapter 9(commencing with section 7000)of Divi ion 3 of the Business and By my signature below I acknowledge that,except for my Personal residence Professions Code and my license is in full force a d effect. which I must have resided for at least one year prior to completion License Class Licen a o. lw.�'/7i� improvements covered by this permit,I cannot legally sell a structure that I he built as an owner-building if it has not been constructed in its entirely,by livens Expires_be e 7 Signature contractors. I understand that a copy of the applicable law, Section 7044 of t ORKERS' OMPEN AT[ON DECLA TON Business and Professions Code,is available upon request when this application submitted or at the following Web site: ❑ I hereby affirm under penalty of perjury one of the following declarations: htto•/Mw leginfo.ca.aov/mlaw.html. I have and will maintain a certificate of consent of self-insure for workers' compensation,Issued by the Director of Industrial Relations as provided for by Date Section 3700 of the Labor Cade, for the performance of work for which this permit is issued. Property Owner or Authorized Agent Policy# )E�gy my Signature below, I certify to each of the following: I am the prope ❑ I have and will maintain workers' compensation insurance, as required by owner or autho ad to act on the property owner's behalf. I have read I section 3700 of the Labor Code, for the performance of the work for which this application an t e information I have provided is correct. I agree to corn permit is issued.My workers'compensation insurance carrier and policy number are: with all appli I city and county ordinances and state laws relating to buildi construction.I u horize representatives of this city or county to enter the abo, Carrier identified for tthe in oses. �� Policy# Expires Date Property 0 erorAuthorized Agent (This section need not be completed if the permit is for City Business License# one-hundred dollars($100)or less) HAZARDOUS MATERIAL DECLARATION certify that in a performance of the work for which this permit Is Issued,I all not amolov y persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material of workers comps lion laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the subject to the ers'cempensa.an provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I shall forith comply with those provisions. DYES Applicant; Date; 6 T Will the int nded 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 check) COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES &,PO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the ou DAMAGES AS PROVIDED IN ADDITION OFOR IN THE SECTION3706 OF THE boundary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES tV40 CONSTRUCTION LENDING AGENCY I have reaO the Hazardous Ma rial Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I unders d my requirements under the State of agency for the performance of the work which this permit is issued (Section California Health&Safety C e,Section 25505 and 25534 concerning 3097 Civil Code) hazardo terial reportin . OWNER BUILDER DECLARATIONS DYES NO I hereby affirm under penalty of perjury that I am exempt from the Contractors Date License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNE O A THORIZED AGENT next to the applicable Rem(s)(Section 7031.5.Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, EPARENOVATION EPAIRA D PAINTING RRP 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 contractor. 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 ❑ 1, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323). compensation,will do( )all of or( )porting 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 property ❑An EPA Lead-Safe Certified Renovator will be responsible for this proje 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 Firm 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). ❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm 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 ";Menifee DATE 7i PERMIT/PLAN CHECK NUMBER X5— ;5$5I TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME OOL/SPA OSIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES ( - T� DESCRIPTION OF WORK 0©L " " / /7 PROJECTADDRESS �y7��52 ��JJL /y^�.5 /TU _,_, CiQ.(;!'•r- ASSESSOR'S PARCEL NUMBER ✓`✓✓�f/� ' �� LOT TRACT �- OWNER NAME GNU(, ADDRESS S - G�u-C.,• I" PHONE ���-Z�3 EMAIL APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME ,/� '� $L. �, �oD OWNER BUILDER? O YES NO BUSINESS NAME ADDRESS PHONE ���- 7 J �� y�7�/d EMAIL CONTRACTOR'S STATE LIC NUMBER/ s/Z LICENSE CLASSIFICATION VALUATION$ 0-44�1 O96 I SO.FT �3� � L SO FT APPLICANT'S SIGNATURE ,l DATE �- CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION �QQ .Al CITY OF MENIFEE BUSINESS�L(I�CEGNSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP V J INVOICE r11 �rj PAIDAMOUNT AMOUNT r,X • OCASH OCHECK# 0CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 FP,6 a" ! � � l 44 = a a o r-b