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PMT16-04529 City of Menifee Permit No.. PMT16-04529 29714 HAUN RD. Type: Pool/Spa-Residential <^—CCCI/? MENIFEE,CA 92586 MENIFEE Date Issued: 12/29/2016 PERMIT Site Address: 29275 COOL CREEK DR, MENIFEE, CA Parcel Number: 338-192-028 92586 Construction Cost: $18,000.00 Existing Use: Proposed Use: Description of INGROUND GUNITE POOL ONLY,200 SF Work: Owner Contractor LAURA WESTHOVEN LANCON PLUS 29275 COOL CREEK DRIVE 33157 KENNEDY COURT MENIFEE,CA 92586 TEMECULA, CA 92592 Applicant Phone:7605944638 MATT ORTWEIN License Number: 886118 LANCON PLUS 33157 KENNEDY COURT TEMECULA, CA 92592 Fee Description Oft( 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 1 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 builiding operations being cared 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. Page 1 of 1 AA_Bld9 Permit_Template.rpt CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of d Chapter9(commencing with section 7000)of Division 3 of the Business an ❑I am exempt from licensure under the Contractors State License Law for Professions Code and my license Is in full force and effect. the following reason: License Class !i'>�.� Licen E � j( By my signature below I acknowledge that,except for my personal residence Expires iro 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 ❑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 workers 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 www leginfo ca gov/calaw.html. this permit is issued. Date Policy# PROPERTY OWNER OR AUTHORIZED AGENT ❑I have and will maintain workers compensation insurance,as required by B sign below I certify to each of the following:I am the property section 3700 of the Labor Code,for the performance of the work for which Y m Y 8 this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners 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 building construction.I authorize representatives of this city or county to Policy# Expires enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for ome hundreci Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT ❑I certify,that in the performance of the work for which this permit is issued, CITY BUSINESS LICENSE# I shall not employ any persons in any manner so as to become subject to the workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the work rs pensation provisions of Section 3700 of the Labor Will the applicant or future building occupant handle hazardous material or a Code,I shall j ly with those provisions. mixture containing a hazardous material equal to orgreaterthat the Applicant amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS D 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)7 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY o Yes ❑No I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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) o Yes o No 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 Contractors 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 ❑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 EPA RENOVATION REPAIR AND PAINTING IRRP) that he or she is licensed pursuant to the provisions of the Contractors State 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($500). managers who do the paint-disturbing work themselves or through their ❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a D An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was D No EPA Lead-Safe Certified Firm is required for this project because: not built or improved for the purpose of sale. ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. APPLICATION BUILDING & SAFETY PERMIT/PLAN CHECK 2 IF Menifee i DATE PERMIT/PLAN CHECK NUMBE TYPE: O COMMERCIAL yd RESIDENTIAL O MULTI-FAMILY O MOBILE HOME OL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION C DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROIECTADDRESS 7S CAB �. �112A\t'�8 ZSY ASSESSOR'S PARCEL NUMBER 2,?R 1qo�'�$ LOT TRACT Cit of M OWNER NAME t4mrA Safety Dep , ADDRESS Z&z7S C:OoI Gtt2� 47r+ "^' . c1v5 a DEC 29 2016 PHONE Xl UL— EMAIL Rec APPLICANT NAME ADDRESS PHONE EMAIL OWNER BUILDER? O YES,00 CONTRACTOR'S NAME A �S BUSINESS NAME„rl PUS ADDRESS 'Olbiti � ` COLS a2�Z PHONE �lrU-4J'�1� �{LS�sd EMAIL CONTRACTOR'S STATE LIC NUMBER CrS3 LICENSE CLASSIFICATION VALUATION$ f dU0 SOFT sir LSQFT 124 Z f APPLICANT'S SIGNATURE DATE -' - CITY OF MENIFEE BUSINESS LICENSE NUMBER DEPARTMENT DISTRIBUTION BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE . PAID AMOUNT �� OCASH OCHECKB OCREDITCARD VISA/MC AMOUNT PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 Ft a 4 f , ,rJ L f