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PMT16-01766 City of Menifee Permit No.: PMT16-01766 29714 HAUN RD. �l-�CCEL/!7. MENIFEE, CA 92586 Type: Pool/Spa-Residential MENIFEE Date Issued: 06/0812016 PERMIT Site Address: 28423 NORTH STAR UN, MENIFEE,CA Parcel Number: 372-400-004 92584 Construction Cost: $25.000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA 300 SO FT Work: Owner Contractor JOSHUA GARDNER A CUT ABOVE CONSTRUCTION POOLS& 28423 NORTH STAR LN LANDSCAPE INC MENIFEE, CA 92584 26025 NEWPORT ROAD#A533 Applicant Phone: 8007007754 CHRIS YOUNG License Number:672202 A CUT ABOVE CONSTRUCTION POOLS&LANDSCAPE INC 26025 NEWPORT ROAD#A533 MENIFEE, CA 92584 Fee Description ON Amount($) 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 Code or of any other ordinance of City of Menifee.Except as otherwise slated,a permit for construction underwhich 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 70110)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for Professions Codpgaffirmunder and rn license is in full force and effect. the following reason: LicenseCl 'eense ` L�C-' / By my signature below I acknowledge that,except for my personal residence ExpiresSignatur In which l 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 N DECLARATION have built as an owner-builder if it has not been constructed in its entirety by o I herealty of perjury one of t g declarations:I licensed contractors.I understand that 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 Cade,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.leeinfo.ca.¢ov/calaw.html. this permit is issued. Policy# Date e and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT ction 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 number are: application and the information I have provided is correct.I agree to comply with all applicable city and county ordinances and state laws relating to Carrier building construction.I authorize representatives of this city or county to Policy# Expires en hgabov 'defi d nti property for inspection purpose (This section need not to be completed is the permit Is for one-hundred /) Date 16 dollars($100)or less PROPERTY OWNER oryrfi UTHORI GEM o I certify that in the performance of theworkforwhich this permit Is issued, I shall not employ any persons in any mannerso as to become subject to the CITY BUSINESS UCEN # workers compensation laws of California,and agree that if 1 should become HAZARDOUS MATERIAL bIC&RATION subject to the workers compensation provisions of Section 3700 of the Labor Code,1 shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing a hazardous material equal to or greater that the amounts sp!e�cified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes Y t UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the inended 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 forguideevindes CONSTRUCTION LENDING AGENCY DYes TO 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) o Yes o OWNER BUILDER DECLARATIONS I have re d 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 Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning hazardous ma d reporting. !d chsiness and I have placed next to the applicable item(s)(Section 7031.5 permit es o N �` Business and Professions Code).Any city or county that requires a permit to Date (s! NJ v construct,alter,improve,demolish or repair any structure,prior to its OWNERCJ AI RIZED AGENT issuance,also requires the applicant for the permit to file a signed statement W/ that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATIO REPAI ND PAINTING RRP 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 01,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.epa.eov/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. o No EPA Lead-Safe Certified Firm is required for this project because: o 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. SAFETYBUILDING & PERMIT/PLAN CHECK APPLICATION ,Menifee DATE -�-I PERMIT/PLAN CHECK NUMBER w ISO` ©17 G(o TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS 2-./ Z75 &tj ASSESSOR'S PARCEL NUMBER //�� gS(;1- �,p� LOT �_ TRACT OWNER NAME pp,�W--77�/�l N&A _ Jb5�cx__ ADDRESS ZU4Z-S O I P F L1 PHONE L - ,��7',,�77(O EMAIL APPLICANTNAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME ��'Ok �l -k��LRj OWNERBUILDER? OYES O BUSINESS NAME CVL C)L ADDRESS(�l �Z��/� PHONE / ��-Z�� G S EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ ZS zn SQAT ?�� L SO FF/T�� / - APPLICANT'S SIGNATURE DATE r DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE I ^_y^ . N pAID AMOUNT AMOUNT ✓.Jp r O CASH O CHECKk U CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH 0 CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menefee Building&Safety Department 29714 Noun Rd. Menefee, CA 92586 951-572-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 kk IF L I Im