PMT16-03082 City of Menifee Permit No.: PMT16-03082
29714 HAUN RD. Type: Pool/Spa-Residential
'C—ACCIEU� MENIFEE,CA 92586
MENIFEE Date issued: 0911912016
P E R M I T
SiteAddress: 28145 RUSTLING V\nND CV, MENIFEE, Parcel Number: 333-612-022
CA 92585 Construction Cost: $14,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 320 SQ FT
Work:
Owner Contractor
JONATHON LORD TEMECULA VALLEY LANDSCAPE&
28145 RUSTLING VVIND CIR CONSTRUCTION INC
MENIFEE,CA 92585 27537 COMMERCE CENTER DRIVE
Applicant Phone: 9516930952
ERIC PLAIN License Number:738882
TEMECULA VALLEY LANDSCAPE&CONSTRUCTION INC
27537 COMMERCE CENTER DRIVE
SUITE 101
TEMECULA, CA 92590
Fee Description Qtv Amount($1
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Electrical 1 23.35
$520.35
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_Pemit Template.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)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following maison:
UcenseClass' License No. 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 prior to completion of
WORKERS COMPENSATION DECLARATION improvements covered by this permit.I can not legally sell a structu re that I
have built as an owner-builder if it has not been constructed In its entirety by
n I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the appi icable 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 Industria I Rela tions as provided for this application is submitted or at the following website:
by Section 3700 of the La bar Code,for the performance of work for which
this permit is issued. www.leginho.ca.goy/calaw.litmi.
Policy# Date
a I have and will maintain worker's 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 follming:I am the pmperty
this permit Is Issued.My worker's compensation insurance carrier and policy owner or authorized to act an the property owner's 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
Poficy# Expires enter the a have identified property for inspection purposets.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
!kI certify that In the performance of the work for which this permit is issued,
I shall not employ a ny persons in a ny me nner so as to become subject to the CITY BUSINESS LICENSE# o7.)q :Xo60'
workees corn pensafion laws of Ca Iffornia,a nd agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the La bar
Code,lshallfio=hwlth comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant —Date 9 mixture containing a hazardous material equal to or greater that the
amountss ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TOSEVWE WORKER'S COMPENSATION COVERAGE Is oYes TrNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended 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 COM PENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for Build NImes
CONSTRUCTION LENDING AGENCY o Yes 0
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 dary of a school?
(Section 3097 Civil Code) 0 Yes brr
a No
OWNER BUILDER DECLARATIONS I have readthe Hazardous Material Information Guideand theSCAQMD
I herebyaffimn underpenalty of perjurythatl am exemptfrom the permitting checklist.I understand my requirements under the State of
Contractoes License Law for the reason(s)indicated 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 hazardo material rep n
Business and Professions Code).Any City or county that requires a permit to ;im��Date
construct,alter,improve,demolish or repair any structure,prior to its ES;��
issuance,also requires the applicant for the permit to file a signed statement PRDP1RT1ffW5WAUTHORIZED AGENT
that he or she Is licensed pursuant to the provisions of the Contractar's 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 Pena ltv of not mom required practices.This Includes renta I property owners a nd property
than($500). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the propeft or my employee wilth wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do I )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(5323).
Code;The Contractor's 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 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
W.onile,
DATE Cj- PERM IT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL E]RESIDENTIAL F]MULTI-FAMILY F]MOBILEHOME FZ]POOL/SPA [JSIGN
SUBTYPE: []ADDITIONE]ALTERATION [—]DEMOUTION F]ELECTRICAL F]MECHANICAL
[—]NEW F]PLUMBING [:IRE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK Swimming Pool&Spa
PROJEcTADDRESS 28145 Rustling Wind Circle
ASSESSOR'S PARCEL NUMBER 333-612-022 LOT TRACT
PROPERTY OWNER'S NAME Jonathon Lord
ADDRESS 28.145 Rustling Wind Circle
PHONE (951)490-9118 EMAIL
APPLICANT NAME P1
ADDRESS 'ZjD4,&< JA,
r, 0 1 e_jYj f QQ 071
PHONE 6 S-1) -7 5 7-i> ��i EMAIL
CONTRACTOR'S NAME Creative Pools&Landscape OWNERBUILDER? OYESZNO
BUSINESSINAME Temecula Valley Landscape&Cons. Inc. dba Creative Pools&Landscape
ADDRESS 27537 Commerce Center Dr. Ste. 101 TemeculaCA92590
PHONE (951)693-0952 EMAIL creativepoolsandlandscape@gmail.com
CONTRACTOR'S STATE LIC NUMBER 738882 LICENSE CLASSIFICATION C53
VAUJATION$ �L-( br)(, SQ FT '�)2 L SO FT
APPLICANT'S SIGNATURE
DATE
DEPARTMENT DISTRIBUTION SMIP � ae/D CITY OF MENIFEE BV& ESSUCEMENUMBER
BUILDING PLANNING ENGINEERM FIRE GREEN 0-S 4 2NO
INVOICE I PAIDAMOUNT
AMOUNT I I OCASH OCHECK# CREDIT CARD VISA/MC
LPLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER 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 951-246-6213
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