PMT17-01055 City of Menifee Permit No.: PMT17-01055
29714 HAUN RD. Type: Pool/Spa-Residential
�CCEL/-> MENIFEE, CA92586
MENIFEE Date Issued: 04/1112017
PERMIT
Site Address: 29551 BAREFOOT CIR, MENIFEE, CA Parcel Number: 333-560-055
92585 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA,485 SF
Work:
Owner Contractor
TONY GRAHAM ALOHA POOL&DESIGN INC
29551 BAREFOOT CIRCLE 41083 SANDALWOOD CIRCLE STE I
MENIFEE,CA 92585 MURRIETA, CA 92562
Applicant Phone: 9514539728
MARK KLINGSPOON License Number: 965927
ALOHA POOL&DESIGN INC
41083 SANDALWOOD CIRCLE STE I
MURRIETA, CA 92562
Fee Description O_yt Amount IS)
Swimming Pool/In-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 builiding 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_eldg_Permit Template.rpt Page 1 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 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of 91visfon 3 of the Business and a I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full forcand effect. the following reason:
License Class fe No. _ -L-5` 17- 7 By my signature below l 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 DECLARAT104 have built as an owner-builder if it has not been constructed in its entirety by
a I hereby affirm under penalty of perjuv 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.eov/calaw.html.
Policy# Date
a 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 y 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 wrier or authorized to act on the property,owner's behalf.I have read this
number are: application anp the information I have provided is correct.I agree to comply
Carrier withallappli ble city and county ordinances and state laws relating to
building cons ruction.)authorize representatives of this city or county to
Policy# Expires enter the ab ve identified property for inspection purposes. .
(This section need not to be completed is the permit is for one-hundred —
dollars($100)or less •-
��bate
PROPER !WNER OR AUTHORIZED AGENT
certify that in the performance of the work for which this permit is issued,
Ishallnotemolov 11teh
persons in any manner so as to become subject to the CITY BUS IS LICENSE#
worker's compensn laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the war compensation provisions of Section 3700 of the tabor
Code,)shall fr]rth comply with those provisions. 9 Will the applicant orfsture building occupant handle hazardous material ora
Applicant Date I 2 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAA IRE TO SECURE WORKER'S COMPENSATION COVERAGE IS D Yes zkNo
UNLAWFUL,MD SHALLSUBIECT 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
IN SECTIODITION N
3 THE COSTLAB OF OR CODE,INTERDAMADATrOGES AS ROVIDEDS Coast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATFORNEYS FEES forguid�7l,Ines
CONSTRUCTION LENDING AGENCY ❑Yes fdTio
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) ❑Yes 6fmo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklis.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health Safety Code,Section 25505 and 25534 concerning
hazard us mter! Ireporting.
_
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes us m`
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 PROPERTYOW�IER OR AUTHORIZED AGE'
issuance,also requires the applicant for the permit to file a signed statement 11 !!
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVAYlON,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 700D)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)orthat 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
a 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.eoa.zov/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 a An EPA Lead-Safe Certified Renovator will be responsible for this project
property wh'o,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. D No EPA Lead-Safe Certified Firm is required forthls project because:
a I,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.
BLI I LDING & SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DATE 4111, PERMIT/PLAN CHECK NUMBERPM-1 -01066
TYPE: O COMMERCIAL (YESIDENTIAL O MULTI-FAMILY O MOBILE HOME OOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK �7Ji9"L-
PROJECTADDRESS Z �S� = !OD7! eifrg-- - "1
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME (� ICitYofMenifeo
DI JQ;
ADDRESS Zq5-,. YAPR 11201?
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PHONE e1q-5-i9 YLr��7,, EMAIL ,,p
APPLICANT NAME o rip �. &ij Received
ADDRESS
PHONE EMAIL
n
CONTRACTOR'S NAME - 1 Z b OWNER BUILDER? O YES ONO
BUSINESS NAME
ADDRESS 7
PHONE S - � Sj-C� � �EyTMAIL
CONTRACTOR'S
SSTTATTE.LICNLIMBER '3! "' LICENSE CLASSIFICATION
VALUATION$ D SQ FT MCA L SQ FT
APPLICANT'S SIGNATURE DATE l�
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE !ffG PAID AMOUNT
AMOUNT ,S OCASH OCHECKH 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Nlenifee Building&Safety Department 29714 Haut) Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 9,51-246-6213
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