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PMT16-04004 City of Menifee Permit No.: PMT16-04004 29714 HAUN RD. Type: Pool/Spa-Residential <A-CC1E-Cj-Q.' MENIFEE,CA 92586 MENIFEE Date Issued: 12107/2016 P E R M I T Site Address: 25728 BUFFALO CIR, MENIFEE, CA Parcel Number: 358-502-017 92584 Construction Cost: $50,000.00 Existing Use: Proposed Use: Description of INGROUND SPOOL 264 SO FT, 130 L FT GAS LINE FOR BBC &FIREPIT&50 L FT ELECTRICAL Work: LINE FOR BBC Owner Contractor LEONARD GREENLEE PATRON LANDSCAPE CONSTRUCTION 25728 BUFFALO CIR 632 E SHAVER STREET MENIFEE, CA 92584 SAN JACINTO, CA 92583 Applicant Phone:9514908226 DA License Number.917722 PATRON LANDSCAPE CONSTRUCTION 632 E SHAVER STREET SAN JACINTO, CA 92583 Fee Description QtV Amount Receptacle, Switch,Outlet&Fixture 1 116.00 Swimming Pool/In-Ground Spa 1 467.00 Plumbing Fixtures and Vents,fixtures 1 116.00 Building Permit Issuance 1 27.00 GREENFEE 1 2.00 SMIP RESIDENTIAL 1 7.00 General Plan Maintenance Fee-Electrical 1 29.15 $764.15 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 carded 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 Bidg_Permt-Ternplate.rpt Page I 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 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapterg(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Class bm' ense By my signature below I acknowledge that,except for my personal residence Expires C'130 4�k Signature Inwhich 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 COMPENSATION 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 website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. www.leginfo.ca.goy/calaw.htmi. Policy# 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 worker's compensation insurance carrier and policy owner or authorized to act an the property owner's behalf.I have read this numberare- application and the Information I have provided is correct.I agree to comply C 6?Xc—/ '—Z'_4f "/Z 4-&4� with all applicable city and county ordinances and state laws relating to I El :2 building construction.I authorize representatives of this city or county to 7 enter the above identified property for inspection purposes. Policy# Pvivc �-��'?5 pirias A�l f, (Thissection need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHOR17ED AGENT a I certify that in the performance of the work for which this permit is issued, CITY BUSINE 3 1 shall not employ any persons in any manner so as to become subject to the SS UCENSE# 0 worker's compensation laws of California,and agree that if I should become H.AZARDOUS MATERIAL DECLARATION subject to*worker's comperysation provisions of Section 3700 of the Labor Code,I shall 110 th ply"those provisions. Will the applicant or future building occupant handle hazardous material or a Applicamt� P Date mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? E VJ91R WARNING:FAILURE TO SEC KER'S COMPENSATION COVERAGE IS oYes oNo 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 TOONE 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 forguidelines CONSTRUCTION LENDING AGENCY ci Yes a 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 th e lending 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 SCACLMD 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 materl I re ing. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 o N9," Business and Professions Code).Any city or county that requires a permit to- 91's's A-f Date /)-7 construct,alter,improve,demolish or repair any structure,pricurto its ��DPERTY 0 ERIOR 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 Continictor's State EPA REM ZN,REPAIR AND PAINTING(RRP 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 most work that disturbs paint in a pre-1978 and 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 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 workthemselves cirthrough their o 1,as ownerof the property,ormy employee With wages astheirsole employees.For more Information about EPA's Renovation Program visit: compensation,will do I )all of or I I portion of the work,and the structure is www.epa.goy/lead or contact the National Lead Information center at not intended or offered for sale.(Section 7044,Business and Professions 1-SOG-424-LEAD(5323). Code,The Contractor's 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 em ployeee or persona I effort,builds or im proves 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. o No EPA Lead-Safe Certified Firm Is required for this 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 FIRP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION lddk�...Menifee hb�— DATE PERMIT/PLAN CHECK NUMBER O%p q- TYPE: OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJEcrADDRESS c2S7.)8 13j�1�6qlo eacle ASSESSOR'S PARCEL NUMBER �559 -fjbq�-bQ LOT TRACT OWNERNIAME Z eolvl9le) 2/9E CA/k�(F ADDRESS -),57�kg ;:?L�fF41b (!�tCl? PHONE E M A I L f�14PZe4 A 4�&Ll 1-14 APPLICANT NAME �WL18 el IUq,�7(f rJ ADDRESS PHONE EMAIL CONTRACTOR'S NAME A27,-?a1v ��7�vc7-iwv OWNERBUILDER? OYES,4�1\10 BUSINESS NAME ADDRESS 63D (�c '04 (f�'j PHONE Cj�-f- L/IjO - (� EMAIL CONTRACTOR'SSTATE LIC NUMBER q)'IT3 '�- LICENSE CLASSIFICATION VALUATION$ 501 oaz,e� �Q FT LSQFT APPLICANT'SSIGNAT'UREAO�lf Z4" DATE DEPARTMENT DISTRIBUTION SMIP CITYOFMENI MBER BUILDING PLANNING ENGINEERING FIRE GREEN MgMI INVOICE 11(.Cf.145 PAIDAMOUNT LAOU NT OCASH 0CHEOK# OCREDITCARD VISA/MC M PLAN CHECK FEES PAID AMOUNT 0 CASH OCHECK# 0 CREDIT CARD VISAIMC OW BU NEERILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofimenifee.LIS Inspection Request Line 951-246-6213 ------N DATE(MMMONM) I�MJCP' CERTIFICATE OF LIABILITY INSURANCE 1012412016 THIS CERTIFFcATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the poticy(les),nast be cl. If S ATION IS WAIVED,subject to the terms and conditions of the policy,certain POIiCiO5 may require an ando Ent. A stc("ro"ni-onthIscerti e does not confer rights to the certificate holder in lieu of such enclorsement(l). r -- PRODUCER CONT T Pay hex Insurance Agency Inc NAME- 7EUlf� . PAYCHEX INSURANCE AGENCY,INC. PHO FAX 150 SAWGRASS DRIVE fAICNqEn\lg� 877-266-6850 %q7Pt/)o/ I(Alc Nct, 585-389-7426 ROCHESTER,NY 14620 E-MAIL '---Qerts@paycheX ADDRESS. INSURER(S)AFFORDING COVERAGE NAIC S INSURED INSURER A.' Wesco Insurance Company 25011 PATRON GROUP INC(A CORP) INSURER 8: PATRON LANDSCAPE CONSTRUCTION 632 E SHAVER STREET INSURER C: SAN JACINTO.CA 92583 INSURER 0.' ba_ t41— INSURER I-' INSURER F.- COVERAGES CERTIFiCA NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE ISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.N OTMTHSTANOING ANY REQUIREMENT,TE OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INS RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMIT SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL EIR OLICY NUMBER POLICY EFF POLICYEXP LIMITS LTR INSR�WUID IP JMMMDNYYY) IMMUNYYY) GENERAL LIABILITY 10� I - EAC-IOCCURRENCE 3 COMMERCIAL GENERAL LIABILITY 0 OL"U a'4 14%� R s E::1tAs!S-MADEE�CUR NED Sale(An'orm Perso.) s PFRSO MAL 9 MV WURY GENERALAGGREGME $ GEITL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COLIPAOPAGG �D I'MIC' =PROJEM=I-OC 0 r- AUTOMOBILE LIABILITY COM MY AUTO (E..=INGLE LINT BODILY INJURY 4LOWI� SCHEOULEO (Per pwaon) AMOS AMOS SODILYINJURY (Per accident) FROPEffTYOAIAAGE (Pwuddedt) —a.—L-11 —R EACH OCCURRENCE EXCESS LIAB C�ms-;mrE AGGREGATE S DED I I RETENTION 5 $ WORKERS COMPEMATIONAND WWC3235957 1011512016 1011512017 X1 10'.' A JIMPLOTRAW URINUFFY 1.000.000.00 MYPROPR1ETOR?PMTNG�9CU7IVE EL DISEASE EA EMPLOYEe S 1,000,000.00 ��y NIA E.L.DISEASE POLICY UNIT 3 1.000.000.00 9,as.des.l... OFAQRIPTI,OF QPWRAIMIN, RECEIVED DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Mach ACORD 401.Additional Remarks Schedule,It more space 1.required) OCT 2 4 2016 State License Number. 917722 WORK COMP UNIT CERTIFICATE HOLDER CANCELLATION Contractors State License Board SHOULD ANY OF THE MOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PO Box 26000 DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY Sacramento,CA 95626 PROVISIONS,Burr FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR UMILIV OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2010105) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AB-Incorr bus name and entity )8/ - 4 10 0 13 39 / - 8 // 21 Li