PMT16-03259 City of Menifee Permit No.: PMT16-03269
29714 HAUN RD. Type: PoollSpa-Residential
<A-CCECA-> MENIFEE, CA 92586
MENIFEE Date Issued: 1010412016
P E R M I T
Site Address: 27495 FREEDOM LN, MENIFEE, CA Parcel Number: 360-563-001
92584 Construction Cost: $50,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL AND SPA,340 SF,WITH 12' U/G GAS LINE FOR FUTURE BBQ WITH 3 GF]
Work: OUTLETS
Owner Contractor
IONE OLSEN PATRON LANDSCAPE CONSTRUCTION
27495 FREEDOM LANE 632 E SHAVER STREET
MENIFEE, CA 92584 SAN JACINTO,CA 92583
Applicant Phone: 95114908226
DAVID KINGSTON License Number:917722
PATRON LANDSCAPE CONSTRUCTION
632 E SHAVER STREET
SAN JACINTO, CA 92583
Fee Description City Amount
Swimming Poollin-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
Inspections not specified 116 116.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 7.00
General Plan Maintenance Fee-Electrical 1 23.35
$758.35
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_Pemlt-TempIate.rpt Page 1 of 1
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CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts fo,the prialects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contraictor(s)pursuant to the Contractors State License Law).
Chapter9(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 fame and effect. the following reason:
License Class e'd-1 6 5�5 -License No, By my signature below I acknowledge that,except for my personal residence
ExPiTeS&A�/:20/ Signature I)IPZJ 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
WORKER'S�COMPINSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
ci 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 welasite:
by Section 3700 of the Labor Code,for the performance of work for which www.leglnfo.ca.gov/calaw.html.
this permit is issued.
Policy# Date
ci 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 following:I am the property
this permit is issued.My worker's compensation insura nce carrier a nd policy owner or a uthorized to act on the property owner's beha If.I have read this
n u in bar 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 C- building construction.I authorize representatives of this city or county to
policy# �JO W A 6 6'7.Expires enter the above identified property for inspection purposes.
(Thissection need notto be completed isthe permit isforone-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
u I certify that in the performance of the work for which this permit is issued,
I 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
5ubjectto the worker's compensation provisions of Section 3700 of the Labor
Code,I s with c mplywithth Islons. Will the applicant or future building occupant handle hazardous material or a
,7' 0 prov
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE SECU RKERWS COMPENSATION COVERAGE IS ci Yes o No
U
N MPLO)
UNLAWFULANDSH ULSUBJ 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($1110,000),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(SCAQi See permitting checklist
IN SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES
for guidelines
CONSTRUCTION LENDING AGENCY ci Yes ci 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
[ending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the 5CAQMD
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 25505 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 ltem(s)(Section 7031.5 oYes o No
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 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 IRIRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensur The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
e receiving compensation for most work that disturbs paint in a pre-1978
and the basis forth,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
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
0 1,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 I I all of or I )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 ci An EPA Lead-Safe Certified Renovator will be responsible for this project
Property who,through employees'or personal effort,builds or improves the
pro
Property provided that the improvements am not intended or offered for Certified Firm Name:
If,however,the building or Improvement is sold within one year of Firm Certification No.:
cam
Completion,the Owner-Builder will have the burden of proving that it was
"at
ot built or improved for the purpose of sale. a No EPA Lead-Safe Certified Firm Is required for th Is project because:
ta 1,
,as owner of the property am exclusively contracting with licensed
mractors to construct the project(Section 7D44,Business and Professions
e;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
lee
DATE 10104/2016 PERMrr/PLAN CHECK NUMBER 0- 073-;:�
TYPE: []COMMERCIAL R]RESIDENTIAL j_]MULTI-FAMILY E]MOBILEHOME MPOOL/SPA [:]SIGN
SUBTYPE: DADDITION []ALTERATION []DEMOLITION F]ELECTRICAL []MECHANICAL
[:]NEWE]PLUMBING [-IRE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Swimming Pool,Spa, BBQ Island,Flat Work
PROJECTADDRESS 27495 Freedom Lane,Menifee
ult, "VAQa
ASSESSOR'S PARCEL NUMBER ?Koo-f5U-6-C)C)k LOT 1*ACP &
PROPERTY OWNEWS NAME [one Olsen OCT 0 4 2916
ADDRESS 27495 Freedom Lane, Menifee R
PHONE (951)719-7618 EMAIL C.bIac;k18@Iive�com Mad
APPLICANT NAME David Kingston(Patron Landscape Construction)
ADDRESS 632 E Shaver St.San Jacinto,CA 92583
PHONE (951)544-9539 EMAIL david.patmnoonstruction@outlook.com
CONTRACTOR'S NAME Patron Landscape Construction OWNERBUILDER? [JYESZNO
BUSINESSNAME Patron LandsrapeConstruGtion
ADDRESS 623 E Shaver St,San Jacinto,CA 92583
PHONE (951)490-8226 EMAIL patronoDnstruction@yahoo.Gom
CONTRACTOR'S STATE LIC NUMBER 917722 LICENSE CLASSIFICATION C27 C53
VALUATION $ $50.000.00 SO FT 340 L SO FT
APPLICANT'S SIGNATURE DATE 10/04/2016
DEPARTMENY DISYRIBUTION SMIP MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE
PAID AMOUNT CAS CHECK# CREDIT CARD VISA/MC
AMOUNT jj - IN
PLAN CHECK FEES PAiDAMOUNT -- CASH C�FCHECK# CREDrr CARD VISA/MC
[OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLEITER 0 YES 0 NO
111z
City of Mlenifee Building&Scftty Department 29714 Houn Rd.merifee, G4 92586 951-672-5777
www.citypilmenifee.us inspection Request Line 951-246-6213
OCT 0 4 2016
ROCiSh/ed
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DATE
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