PMT16-01434 City of Menifee Permit No.: PMT16-01434
29714 HAUN RD.
'JkCCEL/� MENIFEE, CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued:
05/06I2016
PERMIT
Site Address: 25534 BETH DR, MENIFEE, CA 92584 Parcel Number: 358-231-007
Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 300 SQ FT, 50 L FT GAS LINE
Work:
Owner Contractor
MATT DOLL A CUT ABOVE CONSTRUCTION POOLS&
25534 BETH DR LANDSCAPE INC
MENIFEE, CA 92584 26025 NEWPORT ROAD#A533
Applicant Phone:8007007754
CHRIS YOUNG License Number:672202
A CUT ABOVE CONSTRUCTION POOLS&LANDSCAPE INC
26025 NEWPORT ROAD#A533
MENIFEE, CA 92584
Fee Description gty Amount I$1
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_Bldg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 am exempt from licensure under the Contractors State License taw for
Professions Code and my license is in full f and eefj ct. the following reason:
License Class 1_ icens t 6. By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year priarto completion of
improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
D I hereby affirm under penalty of perjury one ofth eclarations: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 workers 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 www.leginfo.ca.goy/calaw.htmi.permit is issued.
Policy 0 Date
D 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 D By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are• application and the information I have provided Is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy g ( :5Q 1,z � Expires A enter the above identified property for inspection purposes.
(This section need not to be completed is the perm t is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE fi
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 370q of the Labor
Code,I shall forthw' comply wSth those provisions. Will the applicant or future building occupant handle hazardous material or a
J .i mixture containing a hazardous material equal to or greater that the
Applicant Date amounts s"cified on the Hazardous Materials Information Guide?
WARNING: URETOSECURE 0 LER'S COMPENSATION COVERAGE 15 DYes o
UNLAWFUL,AND SHALL SUBJE EMPLOYER TO CRIMINAL PENALTIES Will thein nded use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY D Yes (00
I 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) Dyes 10
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California HeoCk Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazard s ateria ep ing. �I
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 DYes -✓1.�
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY N H IZ DAGENT
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 REP AND P INTING RRP
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Rep ' ainting(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($500). managers who do the paint-disturbing work themselves or through their
D 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.aov/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or Improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. D No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7D44,Business and Professions
Code:The Contractors State License Lawdoes not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
t
.�4.
Menifee
DATE PERMIT/PLAN CHECK NUMBER —R(,o— 014-59
TYPE: 0 COMMERCIAL `OiRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION 0 ALTERATION O DEMOLITION 0 ELECTRICAL O MECHANICAL
O NEW O PLUMBING n0RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK '
i
s '
A c_E Imo.- 1
PROJECTADDRESS -2_V5Q yrr / -
ASSESSOR'S PARCEL NUMBER 39% _ A ✓_y-,1_01 LOT TRACT
OWNER NAME
ADDRESS c` - Uv1
PHONE () 1 70 - Ll)ZJ` EMAIL
APPLICANT NAME Ct�iLL
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME ( O S OWNER BUILDER? O YES
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER (c_7Z'LX)"L LICENSE CLASSIFICATION C J 3
VALUATION$ SO FT L SO FT
APPLICANT'S SIGNATURE DATE
e
DEPARTMENT DISTRIBUTION r� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING pENGINEEPING FIRE GREEN ` SMIP
AMOUNTINVOICE �3D• PAID AMOUNT
O CASH OCHECKM OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT --CASH OCHECKR OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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