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PMT16-04081 City of Menifee Permit No. PMT16-04081 29714 HAUN RD. Type: Pool/Spa-Residential '1;kCCELA—> MENIFEE, CA 92586 MENIFEE Date Issued: 12113/2016 P E R M I T Site Address: 29574 WAGON GREEK LN, MENIFEE, CA Parcel Number: 339-414-015 92584 Construction Cost: $18,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA,640 SF Work: Owner Contractor EDWARD&TONI SKANE 29574 WAGON CREEK LANE MENIFEE, CA 92584 Applicant License Number EDWARD&TONI SKANE 29574 WAGON CREEK LANE MENIFEE, CA 92584 Phone:9099574676 Fee Descriotion Qtv Amount($ Swimming Pool/In-Ground Spa 1 467.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 3.00 General Plan Maintenance Fee-Electrical 23.35 $521.35 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 bulliding 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 BldgPermit-Ternplate.rpt Page 1 of I 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 License 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 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 th, pplication I i ed or at the following website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. XeRinl A5.SVI n 7w.html. Policy# gy] A Z ITIV- -Date t Ole c I have and will maintain worker's compensation insurance,as required by PROPERTY O%kOrk OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which ci 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 Carrier with all applicab e city and county ordinances and state laws relating to i'dingconstru ' n. authorize representatives of this city or county to rt a I Policy# Expires te he bo yidfled property for inspection purposes. (This section need not to be completed is the permit is for one-hundred i I`I I . �KIAI V Date /c,-//, dollars($100)or less PR5PrRTyF0WT4I71RO_RAUT ORIZEDAGENT o 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 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 Applicant Date mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes ci 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 ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY oYes oNo 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) ci Yes ci No OWNER BUILDER DECLARATIONS I have mad the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements underthe 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 Business and Professions Code).Any city or county that requires a permit to oYes o No 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 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 most work that ifisturbs 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-certffled 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 o 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.epagoy/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 70",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. o No EPA Lead-Safe Certified Firm is required forthis project because: as owner of the property am exclusively contracting with licensed tractors 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 "Wenifee DATE 2 PERMIT/PLAIN CHECK NUMBEAvu Ge TYPE* 0 COMMERCIAL )<�RESIDENTIAL 0MULTI-FAMILY OMOBILE-HDME V0OL/!P)qflA9V09V I jul�,w - SUBTYPE: OADDITION 0ALTERATION ODEMOLITION OELECTRICAL OMPCUHANICAL ONEW OPLUMBING 0- RE-ROOF-NUMBER OF SQUARES IDIEC DESCRIPTION OF WORK !lea PROJECTADDRESS ASSESSOR'S PARCEL NUMBER 44-01 LOT TRACT OWNER NAME Cl 4 yud , L�a A)� 241 ADDRESS ')_q 10101)d 0 f r- laAle UhL(�:If Ch ?:25 PHONE q0q- q5r�-4106 EMAIL gmail bw APPLICANT NAME r� A� v ZkA 'I S V=a AR ADDRESS PHONE EMAIL '�ZIES 0 NO CONTRACTOR'S NAME OWNER BUILDER? BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ SO FF-� LAD L SO,FT APPIL 4 DATE CITY STAFF USE ONLY DEPARrMENT D15TRIBLFTIUN C17Y OF MENIFEE BUSINESS LICENSE NUMBER SMIP BUILDING PLANNING ENGINEERING FIRE GREEN S IP INVOIC I; E �V�..abj AMOUNT PAID AMOUNT 1 0 CASH OCHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building&Sofety Department 29714 Houn Rd. I'vienifee, CA 92586 951-672-6777 www.cityofmenifee.us Inspection Request Line 951-24f5-5213