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PMT16-03205 City of Menifee Permit No.: PMT16-03205 `_ 29714 HAUN RD. Type: Pool/Spa-Residential ACCELA-> MENIFEE, CA 92586 MENIFEE Date Issued: 0912812016 PERMIT Site Address: 29860 BANKSIDE DR, MENIFEE, CA Parcel Number: 333-591-003 92585 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA 485 SO FT Work: Owner Contractor JASON CROOK ALOHA POOL&DESIGN 29860 BANKSIDE DR 41083 SANDALWOOD CIRCLE STE I MENIFEE, CA 92585 MURRIETA, CA 92562 Applicant Phone: 9514539728 MARK KLINGSPORN License Number: 965927 ALOHA POOL&DESIGN 41083 SANDALWOOD CIRCLE STE I MURRIETA, CA 92562 Fee Description O0t Amount181 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 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 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of DI Sion 3 of the Business and D I am exempt from[!censure under the Contractors State License Law for Professions Cade and my license is in full force d effect. the following reason: License Class_ � Ucen No. _ By my signature below I acknowledge that,except for my personal residence Expires GO , Signature JI in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARAT Improvements covered by this permit.I cannot legally sell a structure that 1 I have built as an owner-builder if it has not been constmcted in Its entirety by o I hereby affirm under penalty of perjury one of the following declarations:[ 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 N Date ❑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 b.8y 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 4enterthe au orized to act on the property owners behalf.I have read this number are: n d the information I have provided is correct.I agree to comply Carrier li able city and county ordinances and state laws relating to n ruction.I authorize representatives of this city or county to Policy# Expires ert for inspection purposes(This section need not to be completed is the permit is for one-hundred dollars($100)or less Date ; WNER OR AUTHORIZED AGENT `11 certify that to the performance of the work for which this permit is issued, .}� yI(shall notem I any persons in any mannerso asto become subject to the NESS LICENSE# O:l - O J workers camp nsation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subjed to the IFUfKCF s compensation provisions OF Section 3700 of the Labor Code,lsha mply_vl*h*hose.provisions. tl Will the applicant or future building occupant handle hazardous material or Applicant Date mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING: ILURE TO SECURE WORKER'S COMPENSATIONAGE LS ❑Yes N Nb UNLAWFUL,ANO SHALLSUBIECf 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 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 for guldel! CONSTRUCTION LENDING AGENCY oNes D o 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 b-Pdo 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 hazardou aterial reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s�" Business and Professions Code).Any city or county that requires a permit to oyes ❑(Vo construct,alter,improve,demolish or repair any structure,prior to its r Date 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 Contractors 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 penalty of not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their o I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a D An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or improved for the purpose of sale. D No EPA Lead-Safe Certified Firm is required for this project because: D I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA ARP rule pleasefill outthe RRP Acknowledgement. Menifee DATE PERMIT/PLAN CHECK NUMBER V TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME OOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS Z b b ASSESSOR'S PARCEL NUMBER J'✓ 'W J LOT TRACF mil/ OWNER NAME L ADDRESS PHONE 6/ l--7Z6-` 7- y_ EMAIL APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME !J 7io 17-A !` D�is�6 OWNERBUILDER? OYES MO BUSINESS NAME ADDRf SS IO;s- 9s/ PHONE — Z$ EMAIL CONTRACTOR'S STATE LIC NUMBE f g(� 7J� LICENSE CLASSIFICATION VALUATION$ j O O SO F — _ L SO FT �/ APPLICANT'S SIGNATURE DATE 0 & CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION i hl CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE G^ PAIDAMOUNT AMOUNT CASH O CHECK B O CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKW 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O 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 - B �\� --�. �� 7� �i � _�°� �� ti '"'�,` �i � . . - �� 1 � �a ,. �� .. �� s � �. �: ..,.. ... csJ . ... �`+ � � �. 7� Cr \ 6- .�' . __._. ... � •2 \ ... 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