PMT16-03222 City of Menifee Permit No.: PMT16-03222
29714 HAUN RD. Type: Pool/Spa-Residential
<A-CCr=LA> MENIFEE, CA 92586
MENIFEE Date Issued: 09/3012016
P E R M I T
Site Address: 26457 ADELINA DR, MENIFEE, CA 92584 Parcel Number: 360-612-007
Construction Cost: $19,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL 200 SQ FT
Work:
Owner Contractor
ORIN &PAT KNOWLTON INFINIUM CONSTRUCTION
26457 ADELINA DR 42801 LARRY LEE LANE
MENIFEE,CA 92584 TEMECULA, CA 92592
Applicant Phone:9517979476
KAREN MCROBERTS License Number, 976676
INFINIUM CONSTRUCTION
42801 LARRY LEE LANE
TEMECULA, CA 92592
Fee Description P!Y. Amount f$
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 builicling 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_B1dg_PerrTfiLTempIate.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 a in under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractoes State License Law for
Professions Code and my license is in full force and effect the following reason:
License Class -+ B LI By my signature below I acknowledge that,except fo'r my persona I residence
Expires Signa e In which I most have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
7 ereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understa nd that a copy of the applica ble law,Section
a4l, and will maintain a certificate of consent of self-insure for worker's 7044 of the Business a nd 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.gov/calaw.litmi.
this permit is issued.
Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date
*,;have a6d&W-Ill maintain worker's compensation insurance,as required by
J�ection 3700 of the Labor Code,for the performance of the work for which 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 1wrier or authorized to act on the property owner's behalf.I have read this
numbe application and the information I have provided Is correct.I agree to com ply
with all applicable city and county ordinances a nd state laws relating to
_�>Carfle 1_7 building construction.I authorize representatives of this city or county to
enter the ove Identified�p�ropjrfor inspection purposes.
Policy# IT
(This section need not to be completed is the permit is for one-hundred Date
e0 d 1 ($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
0 s 4
,l",e'rt,-'fy that in the performance of the work for which this permit is issued, 0-2
1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 37011of the Labor
Code,I h II Vortw I fth those provisions. Will the applicant or future building occupant handle hazardous material or a
Appli-- I Date mixture containing a hazardous material equal to orgreater thatthe
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 o Yes '�No
UNLAWFUL,AND SHALL SU RJECT 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)?See permitting checklist
IN SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCrION LENDING AGENCY a Yes prNo
I hereby affirrin 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) ci Yes 60
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQJYD
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&5*ty Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the zardous mater
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 py I
faYes n N,,�repcirting
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 —PROPTRTY 4014N 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 REN REPAIR AND PAINTI G(RRP)
License Law(Chapter 9(commencing With Section 7000)of Diviision 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-1_q78
and the basis for the alleged exemption.Any violation of Section 7032.5 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 1,as owner of the propeft or my employee with wages as theirsole employees.For more information about EPA's Renovation Program visit:
compensation,will do( I all of or( I portion of the work,and the structure is www.epa.govIlead 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 Contractoes 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 im proves 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 pu rpose of sa le. o No EPA Lead-Safe Certified Firm is required forthis project bemuse:
u 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions n t'�w
Code:The Contractor's State License Law does not apply to an owner of a If your project does not compl with EPA RRP rule please fill out the RAP
Acknowlt
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"Wenifee
DATE PERMIT/PLAN CHECK NUMBER Pmok- ovx>-
TYPE: OCOMMERCIAL 4RESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADD16N OALTERATION 0DEMOUTION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOFtUMBER OF SQUARES-
DESCRIPTION OF WORK Se
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME nlr;
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ADDRESS 8CqeJ�NnC1 _, I)r-
PHONE EMAIL
APPLICANTINAME j��,W) L_)K)
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ADDRESS �_Q - (j T
PHONEc�*�,_k 2_1(.�P EMAIL
CONTRACTOR'S NAME OWNERBUILP_ S� 40
ER? 0 YE_?_
A
BUSINESS NAME
ADDRESS
PHONE9C��)
CONTRACTOR'S STATE LIC NUM13ER LIC�ENSE CLASSIFICATION 4-
VALUATION$ �q 000 SO FT L SO FT
APPLICANT'S SIGNATURE
CITY STAFF USE ONLY
DEPARTMENT DISI KIHU I IUN CITYOFMU41F 5Ub1N6b2LN=NUMULR
BUILDING PLANNING ENGINEERING FIRE I GREEN Ito I SMIPTV7 069,
INVOICE PAIDAMOUNT
AMOUNT -�bS I I I OCASH OCHECKN OCREDITCARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT I I --CASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 9Sl-672-6777
www.cityof,menifee.us Inspection Request Line 951-246-6213
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