PMT16-03265 City of Menifee Permit No.: PMT1 6-03265
29714 HAUN RD. Type: Pool/Spa-Residential
<A-CCEILA—> MENIFEE, CA 92586
SMI- MENIFEE Date Issued: 10/0512016
P E R M I T
Site Address: 31616 NORTHFIELD, MENIFEE, CA Parcel Number: 358-234-022
92584 Construction Cost: $30,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 800 SQ FT,290 L FT GAS LINE FOR FUTURE USE
Work:
Owner Contractor
KELLY WHITTEMORE
31616 NORTHFIELD LN
MENIFEE,CA 92584
Applicant License Number.
KELLY WHITTEMORE
31616 NORTHFIELD LN
MENIFEE, CA 925B4
Phone:9513173382
Fee Description 9tX Amount($
Swimming Poollin-Ground Spa 1 467.00
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 23.35
$645.15
The issuance ofthis permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing buillding 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.
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property who builds or improves thereon,and wh 3 contracts
LICENSED DECLARATION with a licensed contractor(s)pursuant to the ConZcton stat ns wf.�
I
rl hereby affirm under penalty of perjury that I am under provisions of
ti. Chapter9(commencing with section 7GOO)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!s in full force and effect. the following reason:
License Class Ulcense 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
Improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S QgMPENSATION DECLARATION have built as an owner-builder if It has not been constructed in its entirety by
,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 requestwhen
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.leginfoA. ov w.htmI.
this permit is issued.
Policy# VJ4 Date /0
PRdl`ERTYbWNER OR AUTHORIZED AGENT
u I have and will maintain worker's compensation insurance,as required by
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 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 buildingpn km.I authorize representatives of this city or county to
r Hred prope
Policy If Expires e er e or spection purposes.
(This section need not to be completed is the permit is for one-hundred r Date
0 1
dollars($100)or less P k6FE-RrivowN ER OR�AUHORQEDArGENT
a I certify that in the performance of the work for which this permit is issued,
Ishalinotemplo any persons in any manner so as to become subject to the CITI BUSINESS LICENSE#
workees compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ri Yes o No
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 COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST;AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY u 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
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) uYes allo
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 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 item(s)(Section 7031.5 oYes ci 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 OWNE R 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 IRRPI
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 mostwork that disturbs paint in a pre-1978
and the basis for the alleged exemption.Anyviolation of Section 7031.5 by residence or childcare facilityto 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 J$500). managers who do the paint-disturbing work themselves or through their
a 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ci An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. a No EPA Lead-Safe Certified Firm is required for this project because:
0 1,as owner of the property am exclusively contracting With licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
,�Menlfee
DATE PERM IT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ORESIDENTIAL 0MULTI-FAMILY OMOBILEHOME jVfOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION C)DEMOUTION OELECTRICAL OMECHANICAL
�PNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK _ wBnt 4
1 2?
PROJECT ADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT If,
OWNER NAME 60(1!1 k)k%4, 4-^O�r
ADDRESS ? I � /(a -A)w j1kt6,aJ
PHONE 9V-317-3-3 02- — EMAIL J::�cif an7
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? )�ES 0 NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 31�avd> z) L SQ FT
APPIL TE ZV
JMF�FFUSEONLY
DEPARTMENT DISTRIBUTION q7— SMIP IV I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEr Q
I — W —
NVOI,CE PAID AMOUNT
NT PL
AMOUNT K115 I I 1 0 CASH 0 CHECK 0 0 CREDIT CARD VISA/MC
PLAN CHECK FEES I PAID AMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARO VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Allenfee, CA 92586 951-672-6777
www,cityofmenifee.Lis Inspection Request Line 951-246-5213
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