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PMT16-00395 City of Menifee Permit No.: PMT16-00395 29714 HAUN RD. Type: Pool/Spa-Residential ACCEL/-> MENIFEE,CA 92586 MENIFEE Date Issued: 0 211 6/2 01 6 PERMIT Site Address: 30547 BUCKBOARD LN,MENIFEE, CA Parcel Number: 358-451-006 92585 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of INGROUND POOL AND SPA WTH 160'GAS LINE FOR POOL EQUIPMENT AND 39 GAS LINE FOR Work: FUTURE BBQ&FIRE PIT Owner Contractor RYAN RUSHING ALOHA POOL&DESIGN 30547 BUCKBOARD LANE 41083 SANDALWOOD CIRCLE STE I MENIFEE, CA 92585 MURRIETA, CA 92562 Applicant Phone: 9514539728 MARK KLINGSPORN License Number:965927 ALOHA POOL&DESIGN 41083 SANDALWOOD CIRCLE STE I MURRIETA,CA 92562 Fee Description Qtv Amount($ Swimming Pool/In-Ground Spa 1 467.00 Plumbing Fixtures and Vents,fixtures 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 4.00 General Plan Maintenance Fee-Electrical 1 23.35 $638.35 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_BIdg_Parmt_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that 1 am under provisions of Chapter9(commencing with section 7000)o ivision 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full fortt and effect, the following reason: License(lass c=-%7� Liceme No. By my signature below I acknowledge that,except for my personal residence Expires 149 11 Signature in which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legally sell a structure that I WORKER'S COMPENSATION DECIARA N have built as an owner-builder if it has not been constructed in its entirety by ❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website: by Section 3700 of the Labor Code,For the performance of work for which this permit is issued. www.leeinfo.ca.eov/calaw.html. Policy# Date ❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which �y my signature below l certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy _4er or iuthorized to act on the property owners behalf.I have read this number are: applicatic i and the information I have provided is correct I agree to comply Carrier with all a Iicable city and county ordinances and state laws relating to building c nstruction.I authorize representatives of this city or county to Policy# Expires enter ove identified ro (poses. (This section need not to be completed is the permit is for me-hundred Date dollars($100)or less PROP WNER OR AUTHORIZED AGENT rtify that int performance of the work for which this permit is issued, shall not emolov y persons in any manner so as to become subject to the CITY BU NESS LICENSE# workers compens ion laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worl Ws compensation prov' ' ion 3700 of the Labor Cade,I shall h th com I ose provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing a hazardous material equal to or greater thatthe amounts specified on the Hazardous Materials Information Guide? WARNING:FAA E TO SECURE WORKER'S COMPENSATION COVERAGE IS Dyes UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the int nded use of the building bythe applicant or future building AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,00(1),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air duality Management DisMct(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidVines CONSTRUCTION LENDING AGENCY ❑Yes 10 1 hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is Issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes 1. 0 OWNER BUILDER DECLARATIONS I have rea/d the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicted below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dyzard°�s�aterial reporting. Business and Professions Code).Any city or county that requires a permit to es �o Dale construct,alter,im prove,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their ❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.aov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of provingthat itwas not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Finn is required for this project because: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. : ;..` Menifee DATE Z t PERMIT/PLAN CHECK NUMBER S TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME X POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL 9tlN&41§104tety Dept. O NEW O PLUMBING O RE-ROOF-NUMBER/�OFSQUARES FEB 1 2016 DESCRIPTION OF WORK - L, ( t°T 6 PROJECTADDRESSaa- ASSESSOR'S PARCEL NUMBER � ��-{61 �((,(�[y LOT TRACT OWNER NAME (2-0- t'+' j ADDRESS PHONE EMAIL APPLICANT NAME 5Y' ADDRESS PHONE EMAIL n CONTRACTOR'S NAME �.� ` OWNER BUIL�DEER? O YES BUSINESS NAME 1 � Ur V -e--. p CC a- 5J'� ADDRESS ZQ PHONE [ ��—�� U EMAIL CONTRACTOR'S STATE LIC NUMBER 65 77 7/ [ LICENSE CLASSIFICATION VALUATION$ Z5708P SO,FT p L SO FT APPLICANT'S SIGNATURE ATE DEPARTMENT DISTRIBUTION 1 CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP Lf INVOICE �//�� PAIDAMOUNT /I� AMOUNT L0 • �p% O CASH 6 CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT OCASH 0CHECK# 0CREDIT CARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER 0-YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-5777 www.cityofinenifee.us Inspection Request Line 951-246-6213 s�^4t' b mac, A i v �u Syr � '( ' ✓ � \ + t7&t� Jt2 P� L� s � utu�ur.at.mtwrcw�ee�on.com (M�p��,=� �iZS$``l i ' 1t0ia SawNAwN Or. P (x tt owrbtiN Go.gnu 1 OS1-4534VF= 61c9i839i7 #ii# 334 { f i t ji( i i f t � 9 j �� i