PMT16-03227 City of Menifee Permit No.: PMT16-03227
29714 HAUN RD. Type: Pool/Spa-Residential
<A-CCr=LA—> MENIFEE, CA 92586
MENIFEE Date Issued: 09/30/2016
P E R M I T
Site Address: 29140 GOOSENECK TR, MENIFEE, CA Parcel Number: 364-240-013
92584 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL 350 SO FT
Work:
Owner Contractor
SCOTTBRUNSON A CUT ABOVE CONSTRUCTION POOLS&
29140 GOOSENECK TR LANDSCAPEINC
MENIFEE, CA 92584 26025 NEVVPORT ROAD#A533
Applicant Phone: 8007007754
CHRIS YOUNG License Number:672202
A CUT ABOVE CONSTRUCTION POOLS&LANDSCAPE INC
26025 NEVVPORT ROAD#A533
MENIFEE, CA 92584
Fee Description QtV 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 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 BidgPemit Template.rpt Page 1 of I
CITY OF MENIFEE
LICENSED DECLARA71ON 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 contratitor(s)pursuant to the Contractors State License Law).
Chapterf)(commencing With section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is In full force antLeffect. the following reason:
n—C:,
Licens Clasj Ic No. By my signature below I acknowledge that,except for my personal residence
Expire:l�� I Signature in which I 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
V DECLARATION 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 ofthe following declarations:I licensed contractors.I understand that a copy ofthe 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 subm tried or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit Is issued. www.IeRInfo.ca.aov/calaw.htmI.
Policy# Date
a I have and Will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 ofthe Labor Code,for the performance ofthe work for which a By my signature below I certify to each of the following:I am the property
this permit is issued.My workees 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 permiths fo;one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
ct I certify that in the performance ofthe work for which this permit is issued,
Ishallnotermil any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# n to
worker's ccurl-Rnsation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subje.tto hew rk scom ensa_Un provisions of Section 3700 of the Labor
Code,I s all to ith comp provisions. Will the applicant or future building occupant handle hazardous material or a
A ic mixture containing a hazardous material equal to or greater that the
pp11I a 1`7 Date amounts specified on the Hazardous Materials Information Guide?
WARN[r�-FAIL SE UREWORKE S COMPENSATION COVERAGE 15 0yes
JEC EM
S LS JECTANE LOYER TO CRIMINAL PENALTIES
UNLAWFUL,AND HAL TAN Ii Will the 71 ,,ded use ofthe 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 Qua lity Ma nagement District(SCAQM D)?See Perm itting checklist
IN SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCrION LENDING AGENCY 0 Yes �A`o
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be Within 1000 feet ofthe
lending agency for the performance ofthe work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) a Yes �No
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 C I f I h.5ple cle,Section 25505 and 25534 concerning
Contractor's Ucense Law for the reason(s)indicated below by the h:zi a=us m tel repo_09
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 -F F(� :�W (�-- -/6
Business and Professions Code).Any city of county that requires a permit to
construct,alter,improve,demolish or repair any structure,prior to its PRbZERTYOWfiIEX6F U R EDAGENT
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 Contractoes State i �IIRAND AINTINGIRRP)
License Law(Chapter 9(commencing With Section 7000)of Division 3 of the The EPA Renovation,RIO&at dainting(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 a pplica nt to a cWil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves orthrough their
o 1,as owner afthe propertV0 or my employee with wages as theirsole employees.For more information about EPA!s Renovation Program visit:
compensation,will do( )allofor( )portion ofthe 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 ofa a 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 yea r 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. a No EPA Lead-Safe Certified Firm is required for this project because:
cr 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 a pply to an owner of a If your project does not comply with EPA RAP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
....-Menifee
DATE -�,O-Ao PERM IT/PLAN CHECK NUMBER FkmtoeO4159�0
TYPE: OCOMMERCIAL PESIDENTIAL CMULTI-FAMILY COMOBILEHOME )—CPOOL/SPA OSIGN
SUBTYPE: OADDITION C)ALTERATION ODEMOUTION XELEcrRICAL 'OMECHANICAL
ONEW gPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK'
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 5�4-,-;240 -013 LOT E57 TRACT '304,;L;,- I
OWNER NAME 75��/V�1)tj I f)cmi—
ADDRESS 6xwswd&-� Y7�1,kz�,
P H 0 N E EMAIL
APPLICANT NAME cgaf-�
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? QYES 9)qo
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER -Z,-ZfJ e�— LICENSE CLASSIFICATION
VALUATION$ SC)t FT SSD LSQFT
APPLICANTS SIGNATURE L (2Zt3 DATE C�-�
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION LI1YUkMtN11 BUNNEbS UCLN5E NUMBER
BUILDING PLANNING ENGINEERING FIRE I GRE'EN SMIP
INVOICE I t,5n.;3 931 PAID AMOUNT
AMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH ()CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213