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PMT17-03887 City of Menifee Permit No.: PMT17-03887 29714 HAUN RD. Type: Pool/Spa -Residential A /74. MENIFEE,CA 92586 MENIFEE Date Issued: 10/31/2017 PERMIT Site Address: 29607 PLEASANT PASEO CV, MENIFEE, Parcel Number: 333-560-011 CA 92585 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA,465 SO FT Work: Owner Contractor JESS KIEBACH ALOHA POOL&DESIGN INC 29607 PLEASANT PASEO 41083 SANDALWOOD CIRCLE STE I MENIFEE, CA 92585 MURRIETA,CA 92562 Applicant Phone:9514539728 MARK KLINGSPORN License Number:965927 ALOHA POOL&DESIGN INC 41083 SANDALWOOD CIRCLE STE I MURRIETA, CA 92562 Fee Description O0t Amount t51 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 issuanceof this permit shall not prevent the building official from thereafter requiting the correction of errors in the plans and specifications or from preventing builiding operations being carded 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_Bldg_Pernit_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 perjurythat I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of ivision 3 ofthe Business and o I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full forc�and effect. the following reason: License Class 4f5— 'ce e No. `I�S'rZ 7 By my signature below 1 acknowledge that,except for my personal residence Expires Signature in which l 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 DECLARATIQ have built as an owner-builder If it has not been constructed in its entirety by o l 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 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 this permit is issued. www.leeinfo.m.aov/calaw.html. Policy# Date D 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 _Py my signature below I certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policyowner or authorized to act on the property owners behalf.I have read this number are: application anil the information I have provided is correct.I agree to comply with all appli ble city and county ordinances and state laws relating to Carrier building cons ruction.I 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 —y PROPER WNER OR AUTHORIZED AGENT `N'"certify that in the performance of the work for which this permit is issued, ' rI 1 shall not emolova persons in any manner so as to become subject to the CITY BUslry S LICENSE# workers compensa on laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to thewor rs compensation provisions of Section 3700 of the Labor Code,I shall firth ith comply with those provisions. �7 Will the applicant or future building occupant handle hazardous material ora Applicant Date Z 7 mixture containing a hazardous material equal to orgreater that the amountr specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes "o UNLAWFUL,; VD SHALL SUBIECTAN 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(SCAQM modification permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldastA,7,1��Toes CONSTRUCTION LENDING AGENCY oyes t o 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 C No OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD 1 hereby affirm under penalty of perjury that I am exempt from the permitting checklis 1 understand my requirements underthe State of California Health safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the I hazard us m teri I reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes �tTlo ! Businessand Professions Code).Any city or county that requires a permit to �; Date construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OW�tR 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 Contractors State EPA RENOVA�ON,REPAIR AND PAINTING IRRP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of the v Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors 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($500). managers who do the paint-disturbing work themselves or through their ❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323). Code,The Contractors State License Law does not apply to an owner of o An EPA Lead-Safe Certified Renovator will be responsible for this project property wh'o,through employees'or personal effort,builds or improves the property provided that the improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because: o I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. APPLICATIONBUILDING&SAFETY PtRMltl/.PLAN CHECK . DATE: (O 3 PERMIT/PLAN CHECK NUMBER 1_C>5f5 TYPE: O COMMERCIAL O RESIDENTIAL . MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS Z /60'] AL ,J 7 ZIP V,S2 Sy ASSESSOR'S PARCEL NUMBER ✓ j j LOT TRACT OWNER NAME le-,' f G ADDRESS 7j 607 .- PHONE �.��-f�O,�D EMAIL APPLICANT NAME �» ADDRESS PHONE EMAIL CONTRACTOR'S NAME G'Q(v-A /�I'.L� ( D i� /l6 OWNER BUILDER? O YES BUSINESS NAME ADDRESS �j PHONE Z S'3 'f 7Z p EMAIL CONTRACTOR'S STATE LIC NUMBER !u$' Tim LICENSE CLASSIFICATIONG VALUATION$ ZS ��0' SO FT L SO FT APPLICANT'S SIGNATURE -DATE l� CITY STAFF USE ONLY ` DEPARTMENT DISTRIBUTION / ACCEPTED BY / � CITY OF MENIFEE BUSINESS LICENSE NUMBER v BUILDING PLANNING ENGINEERING FIRE PERMIT FEE ��S SMIP GREEN L CHECK FEE INVOICETOTAL BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO 7 iajlC,U ) i:r. "1. 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