PMT16-03785 City of Menifee Permit No.: PMT16-03785
29714 HAUN RD. Type: Pool/Spa-Residential
<XCC1EUA-> MENIFEE, CA92586
MENIFEE Date Issued: 11123120116
P E R M I T
Site Address: 31585 NORTH FIELD LN,MENIFEE, CA Parcel Number: 358-231-004
92584 Construction Cost: $25.000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 845 SQ FT
Work:
Owner Contractor
RICH QUESEDA ALOHA POOL&DESIGN
31585 NORTH FIELD LN 41083 SANDALWOOD CIRCLE STE I
MENIFEE,CA 92584 MURRIETA, CA 92562
Applicant Phone: 9514539728
MARK KLINGSPORN License Number:965927
ALOHA POOL&DESIGN
41083 SANDALWOOD CIRCLE STE I
MURRIETA, CA 92562
Fee Description Qtv Amount 4$)
Swimming PooVin-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 buillding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as othervAse stated,a permit for wristruction 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.B[dg_Perrnit—Template.rpt Page 1 of 1
CITY OF IVIENIFEE
PU J)e_CL�ARATJL3N Property who builds or improves thereon,and who Contracts for the pmjects
_i:JeEiZSir;Q PD
with a licensed comfgCtOT(S)pursuant to the Contractors State Ucense Law).
I hereby affirm under penalty of perjury that I am under provisions of
Ch.pt-r9(commencing with section 7000)of . . 3 f he Business and a I am exempt from licensure under the Contractor's State License I for
vision 0 the Bush L,
ct
Professions Code and my license is in full for and 14ect- the following reason:
License Class zlc_ 17) JLice e No. By my signature below I acknowledge that,except for my personal residence
Expires T/Z Signature in which I must have resided for at least one year prior to completion of
�Tl improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATI have built as an owner-builder if it has not been constructed in its entirety by
a 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 availaple 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
this permit is issued. www.Ieglnfic.ca.gov/caIaw.htm 1.
Policy It Date
o 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 workees compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: lication nd the Into tion I have provided is correct.I agree to comply
a pp1h a 'c
Carrier wit Ilapp able di�a2da,ountv ordinances and state laws relating to
building conitruction.I authorize representatives of this city or county to
Policy# Expires enter the abkve identified property for inspecti.on purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less &
ed, PROPERTY0 NER OR AUTHORIZED AGENT I
)Wcertffy that in th performance of the work for which this permit is lou
I shall not 4employ y persons in any manner so as to become subject to the CITYBUSINES UCENSE# cy7:iI051
worker's comperis I on laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wor t es compensation provisions of Section 3700.of the Labor
Code,I shall fort y wit those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FA RITO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o
St ES
UNLAWFUL,A SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI 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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY a Yes c(W
I hereby affirrin that under the penalty of perjury there is a construction Will the proposed building or rodi ifled facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary,of,school?
(Section 3097 Civil Code) a Yes �Po
OWNER BUILDER DECLARATIONS I have mad the Hazardous M; rial Information Guide and the SCAQMD
in
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I unders nd my requirements under the State of
at _5
Contractor's License Law for the reason(s)Indicated below by the California Health&Safety Co Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting
Business and Professions Code).Any city or county that requires a permit to oYes No Date
—y i —
construct,alter,improve,demolish or repair any structure,prior to its iROPE9TY OWN ER OR AU I I 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 Contractor's State EPA RENOVATION,REPAIR D PAINTING[RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,RepalAnd Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is"empt from Ecensure
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certifiecl firms and comply with
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
u 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPXs Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.Rov/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 u 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 havethe burden of provingthat itwas
not builtor improved forthe purpose of sale. o No EPA Lead-Safe Certified Firm is required forthis project because:
o 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION -Boom
en ee
Ad_�Nkb,0�
DATE PERMIT/PLAN CHECK NUMBER
TYPE-. OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME $dPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
O- NEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 4tq?Z
PROJECTADDRESS "'J
ASSESSOR'S PARCEL NUMBER LOT TRACT A 9(0-51P
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANTNAME /7t4-j0,tL_ IL
ADDRESS I I
PHONE EMAIL
CONTRACTOR'S NAME A-Z-0 OWNER qUILDER? 0 YES
BUSINESS NAME
ADDRESS *'_3 -5/+ 4 C4 yz-, Trz;:_ 7—
PHONE W/ -Ll!�3 - EMAIL
CONTRACTOR ssTATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT L SQ FT
DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION LI I Y uF mtNIFEE 13USINESS LICENSE NUMBER
r-ft.
BUILDING PLANNING ENGINEERIN-G FIRE GREEN ' log SMIP 14"
INVOICE PAID AMOUNT
AMOUNT 1 1 � 0 CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES I PAID AMOUNT I I OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No CIL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.citVofmenifee.us Inspection Request Line 951-246-6213
..........
Oil
17�