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PMT16-00116 City of Menifee Permit No.: PMT16-00116 29714 HAUN RD. �CCEL/-? MENIFEE,CA 92586 Type: Pool/Spa-Residential MENIFEE Date Issued: 01/15/2016 PERMIT Site Address: 29565 PEBBLE CREEK CT, MENIFEE, CA Parcel Number: 333-550-045 92585 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of INGROUND 415 SQ FT POOL&SPA Work: Owner Contractor BARAJAS/LEGASPI ALOHA POOL&DESIGN 29565 PEBBLE CREEK CT 41083 SANDALWOOD CIRCLE STE I MENIFEE,CA 92585 MURRI ETA, 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(Sl Swimming Pool/In-Ground Spa 1 467.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 4.00 General Plan Maintenance Fee-Electrical 1 23.35 $522.35 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 Cade or of any other ordinance of City of Menifee.Except as otherwise staled,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 ❑ 1 am exempt from licensure under the Contractors'State License Law for the I hereby affirm under penalty or perjury that I am 'tensed under provisions of following reason: Chapter 9(commencing with section 7000)of D ision 3 of the Business and By my signature below I acknowledge that, except for my personal residence in Professions Code and my license is in full Iforceilind effect. which I must have resided for at least one year prior to completion of License Class CS Ucens No. /_J S'2 ,7 improvements covered by this permit, I cannot legally sell a structure that I have Expires 1! 4 Signature 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 WORKERS'COMPENSATION DEC TION Business and Professions Code,Is available upon request when this application is submitted or at the following Web site: ❑ I hereby affirm under penalty of perjury one the following declarations: hfto:/Aw .leginfb.m.gov/mlaw.htmi. I have and will maintain a certificate of consentt of self-insure for workers compensation,issued by the Director of Industrial Relations as provided for by Date Section 3700 of the Labor Code, for the performance of work for which this permit is issued. Property Owner or Authorized Agent Policy# lay my Signature below, I certify to each of the following: I am the property ❑ 1 have and will maintain workers' compensation insurance, as required by owner or surf rued to act on the property owner's behalf. I have read this section 3700 of the Labor Code, for the performance of the work for which this application a the information the provided is correct. I agree to comply permit is issued.My workers'compensation insurance carrier and policy number are: with all appli able city and county ordinances and state laws relating to building construction I Puthorize representatives of this city or county to enter the above- Carrier identified p for t urposes.-- - Policy# Expires Date Prope er or Authorized Agent2r� I (This section need not be completed if the permit is for City Business License# V ' _ '({f�J one-hundred dollars($100)or less) HAZARDOUS MATERIAL DECLARATION I certify lfbith a performance of the work for which this permit is issued,I Mail not ey persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a workers'coon laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the subject to tm'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I sha comply wi 'mn DYES `RAO / / 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 DYES 4N0 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 DYES WNO 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 DYES f NO I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT next to the applicable item(s)(Section 7031.5. Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING(RRP) Any city or county that requires a permit to construct,alter, improve,demolish, 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 1-800-424-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 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 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 Acknowledoement. SAFETY PERMIT/PLAN APPLICATION i Menifee Adin-b"ke? DATE PERMIT/PLAN CHECK NUMBER r1 1 ((/- o0ii(.o TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY C MOBILE HOME POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK {®'� PROJECTADDRESS Z j6Siy�,/�'jr��i ''r�B�L y/� ASSESSOR'S PARCEL NUMBER ; : F/ -0450T � TRACT OV'� OWNERNAME ADDRESS cl N1• I "� PHONE 7- ' 4-7,yri EMAIL APPLICANT NAME o ADDRESS PHONE //EMAIL JJ CONTRACTOR'S NAME OWNER BUILDER? OYES 0 BUSINESS NAME / ADDRESS /�D$� !�9✓OIRL-- 9d l%lIz. sv PHONE yr3—�77 / EMAIL CONTRACTOR'ISTATE LIC NUMBER 16S 7/7 LICENSE CLASSIFICATION L� VALUATION$ Q SQ FT L SQ FT APPLICANT'S SIGNATURE DATECITY STAFF USE ONLY 7 �� DEPARTMENT DISTRIBUTION Ip CITY6 I�11FfyB�s}LJFjiLICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP l//1 /✓1VIf 1V11� INVOICE ; 3 PAID AMOUNT 5I/'AMOUNT 4 CgSH O CHECK k O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT I O CASH O CHECK# O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 9S1-672-6777 www.cityofinenifee.usInspection Request Line951-246-6213 p a ........... aE . , § 4 Ewp � m \ � & � @ 2 » @ � % . « & .