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PMT16-02793 City of Menifee Permit No.: PMT16-02793 29714 HAUN RD. Type: Pool/Spa-Residential <A—CCEL�� MENIFEE, CA 92586 C.—A SA— MENIFEE Date Issued 08/2512016 P E R M I T Site Address: 31404 WEST WIND LN, MENIFEE, CA Parcel Number: 372400-024 92584 Construction Cost: $19,000.00 Existing Use: Proposed Use: Description of INGROUND POOL AND SPA,460 SIF Work: Owner Contractor MIKE&JULIE NULL R L J ENTERPRISES 31404 WEST WIND LANE 36499 CHERVIL WAY MEN]FEE,CA 92584 LAKE ELSINORE,CA 92532 Applicant Phone:9092614516 LEE JOUGLARD License Number: 1007383 R L J ENTERPRISES DBA FOUR SEASONS POOL CONST 36499 CHERVIL WAY LAKE ELSINORE, CA 92532 Fee Description 99z Amount Swimming Pool/In-Ground Spa 1 467.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 3.00 General Plan Maintenance Fee-Electrical 1 23.35 $521.35 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 buillding 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,B1dg_Pe"l1—TempIate.rpt Page 1 of I 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)pursua at to the Contractors State License Law). Chapter9(commencing with section 700D)of Division 3 of the Business and u I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full force and effect the following reason: License Class (, A 3 U nNeNo. IM-) li:i`ia By my signature below I acknowledge that,except for my personal residence r c Expires 01-30-11 Signatur In which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legallysell a structure that I WORKER'S COMP---�­-�-,nECLARATIO�� have built as an owner-builder if it has not been constructed in its entirety by o 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.legInfo.ca.gov1calaw.htmL Policy# Date o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,forthe performance of the work for which ci By my signature below I certify to each of the following:I am the property this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's 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 enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT %,,�I certify that in the performance of the work for which this Perm it is issued, I shall not am Ploy any persons in any me imer so as to become so bject to the CITY BUSINESS LICENSE# worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subjecttothewof r's compensation provisions of Section 3700 of the Labor Code,ishallf. rit A5 ith compi ft!h�tse provisions. Will the applicant or future building occupant handle hazardous material or a Applican Date mixture containing a hazardous material equal to orgreater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE�g SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or futu re building AND CIVIL FINES UP TO ON E HUNDRED THOUSAND DOLLARS($100,000),IN occupant req ulne 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 SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY a Yes o No 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) aYes uNo 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 Health&Safety Code,Section 2550S and 25534 concerning Contractor's License Law for the reason(s)indicated below by the hazardous material reporting. checkmark(s)I have placed next to the applicable Bemis)(Section 7031.5 aYes u No Businessand Professions Code).Any city or counlythat requires a permitto Date construct,alter,improve,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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(FIRM 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 a nd 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($SOD). managers who do the paint-disturbing work themselves or through their a 1,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.epa.gov/lead or contact the National Lead Information Center at not Intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(S323). Code,The Contractor's State License Law does not apply to an owner of a a An EPA Lead-Safe Certified Renovator will be responsible for this project property who,th rough employees!or personal effort,builds or Improves the property provided that the improvements a re 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. ci No EPA Lead-Safe Certified Firm Is required for this project because: o 1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's 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. & SAFETY PERM IT/PLAN CHECK APPLICATION Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: CICOMMERCIAL 4-RESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN SUBTYPE: OADDITION 0ALTERATION ODEMOLITION OELECTRICAL CMECHANICAL AkNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES— DESCRIPTION OF WORK !Q-t )iMin41AM g6l -kf3jK& PROJECTADDRESS ;S(4QZ� Ln 0�aek�-i ASSESSOR'S PARCEL NUMBER LOT T&P Of Menifee u ng & Saksty uept. OWNERNAME twxt- AUG 2 5 zui6 ADDRESS *�14()4 kA )I"S1I1 )(VIj PHONE 9(.0 -7 1 !� !2 16 9 EMAIL Received APPLICANT NAME 1-6- ,IoL�I(I Y-fj ADDRESS PHONE EMAIL CONTRACTOR'S NAME f4:A)ip_ 5FA�t:;IIJe, 41�1, aAl e,—I - OWNER BUILDER? 0 YES 4-NO BUSINESS NAME ADDRESS cvervil Ik� I Y.- f�-r'll'icn2c PHONE qt)q ?(, I 41SJ� EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ [Q no () A _AFT LSQFT APPLICANT'S SIGNATURE fe'/N\�111�t DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAIDAMOUNT AMOUNT tq\- ",�51 - 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC PLAN CHECK FEES I PAID AMOUNT CASH 0 CHECK# 0 CREDIT CARD VISA/MC :IED 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.cityofmenifee.us Inspection Request Line 951-245-6213 J7 -t.7 m -7 o 14 SEAT, 6 Fai i4lL9WL,-3jjLjg wiLL L 6MUIP Ned--1 1�7 *i4b,-