PMT16-01548 City of Menifee Permit No.: PMT16-01548
_ 29714 HAUN RD. Type: Pool/Spa -Residential
�CCEL/� MENIFEE, CA 92586
MENIFEE Date Issued: 05/1712016
PERMIT
Site Address: 25396 GANT CT, MENIFEE, CA 92584 Parcel Number: 358-422-021
Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL AND SPA, 595 SF
Work:
Owner Contractor
BRANDON CHILD ALOHA POOL&DESIGN
25396 GANT COURT 41083 SANDALWOOD CIRCLE STE I
MENIFEE, CA 92584 MURRIETA, CA 92562
Applicant Phone:9514539728
MARK KLINGSPORN License Number:965927
ALOHA POOL&DESIGN
41083 SANDALWOOD CIRCLE STE I
MURRIETA, CA 92562
Fee Descrlotion O_yt Amount f$1
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 carded 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_Pe"it_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 I am under provisions of
Chapter9(commencing with section 7000)okpivision 3 of the Business and D I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full fo c and effect. the following reason:
r
License Class U a No By my signature below I acknowledge that,except for my personal residence
Expires 119 Signature in which 1 must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that 1
WORKER'S COMPENSATION DECLA ION have built as an owner-builder if it has not been constructed in its entirety by
D I hereby affirm under penalty of per ury 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 workers 7044 of the Business and Professions Code,is available upon request when
cam pensation,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.leeinfo.ce.aov/calaw.html.
this permit is issued.
Policy#
Date
o 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 o 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
numberare: application a d the information I have provided is correct.I agree to comply
Carrier with all appi able city and county ordinances and state laws relating to
building co truction.I authorize representatives of this city or county to
Policy# Expires enter a ve id ifi arty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPE TY WNER OR AUTHORIZED AGENT
I cefl �
in-t performance of the work for which this permit is issued,
['shall to y persons in any manner so as to become subject to the CITY BU ESS LICENSE#
workee ation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjecw r ers compensation r. ection 3700 of the Labor
Code, rt ith cthose provisions. Will the applicant or future building occupant handle hazardous material or a
Applic Dale �( mixture containing a hazardous material equal to or greater that the
amounts specked on the Hazardous Materials Information Guide?
WARN1 URE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes via
UNLA DSHALLSUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CS 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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidgl_iges
CONSTRUCTION LENDING AGENCY in Yes rYNo
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) ❑Yes pr ;
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardou3 material reporting.
checkmark(s)I have placed next to the applicable items)(Section 7031.5 cryes ,rflNo
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 OWN ER 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 IRRPI
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
o I,as owner of the property,or my employee with wages as their sale 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.e oa�Lov/lead/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 o 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:
D 1,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
x
& SAFETY PERMIT/PLAN CHECK APPLICATION
L
A" Menifee
DATE '\gyp PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHA��IICALaf Menitee
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES Building & Safety De t.
DESCRIPTION OF WOR-�K� `` /c.. P
PROJECTADDRESS G.� Q/So �}cJ d (�—I Receive
ASSESSOR'S PARCEL NUMBER3AM •(A=-Cal LOT Slot TRACT 3
OWNERNAME C�[t [r
ADDRESS Z,S3 / 6 /Vgff
PHONE b EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME �' L OWNER BUILDER? O YES O
BUSINESS NAME 4�
ADDRESS /L/l0�3 ,S�`JO�I'L-i/��-� �/`/L, � V;� p v60-
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 7 LICENSE CLASSIFICATION GS
VALUATION$ ZS(p _v SQ FT L SO FT .fib Qfr-
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ��MM PAIDAMOUNT
AMOUNT -..Jdb�• OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 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 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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