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PMT17-03043 City of Menifee Permit No.: PMT17-03043 29714 HAUN RD. "-ACCEL/k? MENIFEE, CA 92586 Type: Pool/Spa-Residential ' - MENIFEE Date Issued: 08/28/2017 PERMIT Site Address: 30707 LAJOEST, MENIFEE, CA 92584 Parcel Number: 360-434-008 Construction Cost: $34,250.00 Existing Use: Proposed Use: Description of INGROUND 375 SQ FT SHOT-CRETE SWIMMING POOL&SPA Work: Owner Contractor MICHAEL MITSUYASU J L BLODGETT POOL CONSTRUCTION 30707 LAJOE ST 40035 SAN IGNACIO RD MENIFEE,CA 92584 HEMET, CA 92544 Applicant Phone:9513777327 JERRY BLODGETT License Number:498542 J L BLODGETT POOL CONSTRUCTION 40035 SAN IGNACIO RD HEMET, CA 92544 Fee Description Oft Amount ISI Swimming Pool/In-Ground Spa 1 467.00 Building Permit Issuance 1 27.00 GREEN FEE 1 2.00 SMIP RESIDENTIAL 1 5.00 General Plan Maintenance Fee-Electrical 1 23.35 $524.35 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 staled,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_Bldg_Permit_Templatexpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who 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 contractor(s)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 Contractors State License Law for Professions Code and my license is in full force an ffect.cU7 Z the following reason: License Class (2 S 3 Uc se o. O5 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 ORKER'S COMPENSATION DECIARAT N have built as an owner-builder if it has not been constructed in its entirety by ❑I hereby affirm under penalty of p jury 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 by Section 3700 of the Labor Code,for the performance of work for which this application is submitted or at the following webske: this permit is issued. `^1 www.leginfo.ca.gov/calaw.html. Policy# ,, Date ^ RHV PROPERTY OWNER OR AUTHORIZED AGENT ❑I have and will maintain workers compensaton insurance,as required by 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 workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: r/ J application and the information I have provided is correct.I agree to comply Carrier S�!T �tti O/ with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to olicy#�Q�d��) Expires O'��r /,7, ' enterthe above Identified propertyfor inspection purposes. (This section need not to be completed is the permit is for one-hundred 'Y �L�rrdd Darte.&FZ2S J� dollars($100)or less ROPERTY OWNER OR AUTITORIZED AGENT ❑I certify that in the performance of the work for which this permit is issued, �� I shall not emolov 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 subjectto the r re s compensation provisions of Section 3700 of the Labor Code,Ishal rth thcomplywit t eprovisions. Will the applicant or future building occupant handle hazardous material or Applicant d Date , 17 mixture containing a hazardous material equal to orgreater thatthe amounts�pec fled on the Hazardous Materials Information Guide? WARNING• AILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ci UNLAW L,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the Intended use of the building by the applicant or future building AND C IL 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(SC construction or See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideCoast Airu CONSTRUCTION LENDING AGENCY ❑Yes .9 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 bo nd y of a school? (Section 3097 Civil Code) ❑Yes oIq 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 checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 h ardo e o terlal repord d° Business and Professions Code).Any city or county that requires a permit to Date f construct,alter,improve,demolish or repair any structure,prior to its PR NER OR AUT O ED 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 Contractors State EP RENOVATION REPAIR AND PAINTING RRP License Law(Chapter 9(commencing with Section 7000)of Division 3 of the he 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.Anyviolation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with an Appllcantfor 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 ❑1,as owner of the property,or my employee with wages as their sale 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.gov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-BOG-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 forthis 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: ❑1,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. BUILDING PERMIT/PLAN CHECK APPLICATION Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL X RESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN SUBTYPE: O ADDITION C%ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL 0oL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK LV 1 -91 PROJECiADDRE55 ,��-�� E `P2G$4ASSESSOR'S PARCEL NUMBER � �" 9-71 0M LOT $' TRACT Ab Ct 1- , OWNER NAME ADDRESS E' PHONE �� -,ja,3 " ,'j oCe2� EMAIL APPLICANT NAME ADDRESS Q PHONE 9 ��7�� ]�a? 7 EMAIL CONTRACTOR'S NAME `OWNER BUILDER? O YES O BUSINESS NAME S ADDRESS J gaSyS� PHONE 5!2 2- 73a] EMAIL , d CONTRACTOR'S STATE LIC NUMBER -�i`a- LICENSE CLASSIFICATION e23 VALUATION$ SO FT L SQ FT APPLICANT'S SIGNATURE � DATE DEPARTMENT DISfRIBUTIO 7CASH CITY OF MEEIIFEEIB 51y5E�SS ICENSE NUMBER BUILDING PLANNING EN INEERING FIRE GREEN © VINVOICE PAID AMOUNTAMOUNT # C%CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT # %CREDIT CARD VISA/MC OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO