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PMT17-01849 City of Menifee Permit No.: PMT17-01849 29714 HAUN RD. <ACCELA--' MENIFEE, CA 92586 Type: Pool/Spa-Residential "'°`"" ;.Fl A- MENIFEE Date Issued: 06/1212017 PERMIT Site Address: 26373 ADELINA DR, MENIFEE, CA 92584 Parcel Number: 360-612-001 Construction Cost: $30,000.00 Existing Use: Proposed Use: Description of IN GROUND POOL, 569 SO FT-ELECTRICAL ONLY. ONE LIGHT IN SWIMMING POOL. Work: Owner Contractor BRIAN CRAYK PETERSON POOLS 26373 ADELINA 31715 CORTE ROSARIO MENIFEE;CA 92584 TEMECULA, CA 92592 Applicant Phone:9516998407 SCOTT PETERSON License Number:842241 PETERSON POOLS 31715 CORTE ROSARIO TEMECULA, CA 92592 Fee Description Oty Amount 1$1 Swimming Pool/In-Ground Spa 1 467.00 Building Permit Issuance 1 27.00 GREEN FEE 1 2.00 SMIP RESIDENTIAL 1 4.00 General Plan Maintenance Fee-Electrical 1 23.35 $523.35 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_Bidg_Permit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION propertywho builds or improves thereon,and who contracts forthe projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and ❑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 tf 53 License No. By my signature below I acknowledge that,except for my personal residence Expires :7/ 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 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,forthe performance of work for which www.leainfo.ca:eov/calaw.h[ml. this permit is issued. Polity If Date ❑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 ❑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 y� �� with all applicable city and county ordinances and state laws relating to /� building construction.I authorize representatives of this city or county to Policy# 4t1u&G-740 Expires �`I/� enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred 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, I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# workers compensation laws of California,and agree that if I should become . HAZARDOUS MATERIAL DECLARATION subject to the workers co ensation provisions of Section 3700 of the Labor Code,I shall forthwit 1 t ose 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 specs ed on the Hazardous Materials Information Guide? WARNIN :FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes po 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)7See permitting checklist - IN SECTION3706OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES-- - - -- -- -- - - - - -- --- — for guideline CONSTRUCTION LENDING AGENCY ❑Yes 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 bound of a school? (Section 3097 Civil Code) ❑Yes Vo ry OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements underthe State of I hereby affirm under penalty of perjurythat I am exempt from the Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning hazardous m checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 � ❑No - Business and Professions Code).Any city or county that requires a permitto aterial re // 7/Date f`� 7or1 construct,alter,improve,demolish or repair any structure,priorto its PROPERTY16WNER OR AUTHORIZED AGENT issuance,also requires the applicant forthe permitto file a signed statement that he or she is licensed pursuant to the provisions of the Contractors 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 disturbs paint in a pre-1978 and the basis forthe alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to he RRP-certlfied 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 or through their ❑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.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 ❑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. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑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. I Menifee AMOS DATE PERMIT/PLAN CHECK NUMBERTg I-J-O l b 4 ol TYPE: O COMMERCIAL WESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ()ELECTRICAL O MECHANICAL ,*NEW OPLUMBING ORE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK �Cc/IW'WnIJ� QzA PROJECTADDRESS �((1J 1.J L�I� 1 Wr clz ASSESSOR'S PARCEL NUMBER %�CQ O• `2 LOT 2, TRACT 305 OWNER NAME ��//p�� 6'ICAA ADDRESS 743 61LQ/` l PHONE -N'- '19 0 n EMAIL APPLICANT NAME /'� /!lj' � ADDRESS 3 7 t5 (,a-IC-y�\ PHONE J l ��—• ��I�,IJ. EMAIL CONTRACTOR'S NAME ..�C.c/l(l� � OWNER BUILDER? O YES 4140 BUSINESS NAME ADDRESS ,,3l1i��G('^�e SaflJ '.a�'+I�[c✓�C �, �� PHONE 96d-2,J 'G�(� — EMAIL Z-6ns.N Vi <9 ku CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ SO, !FT 6"\ L SO FT APPLICANT'S SIGNATURE DATE G � DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING WNNING ENGINEERING FIRE GREEN SMIP INVOIC r PAIDAMOUNT AMOUNT -.J Q CASH O CHECK& O CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH OCHECK# 0CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O C(tY �eP gu City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-Uz-�i�72017 www.cityofinenifee.us inspection Request Line 951-245-6213 p N Fteceive�