PMT18-01713 City of Menifee Permit No.: PMT18-01713
29714 HAUN RD. Type: Pool/Spa-Residential
EL/? MENIFEE,CA 92586
°oe�Wk—' MENIFEE Date Issued: 04/17/2018
PERMIT
Site Address: 28942 GOLDEN DAWN DR,MENIFEE, Parcel Number: 372-352-022
CA 92584 Construction Cost: $50,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA,468 SF,WITH 3 POOL LIGHTS AND 1 SPA LIGHT,ADDITIONAL U/G GAS
Work: LINE FOR FIRE PIT
Owner Contractor
MARK&ROXANNE HODGES POSEIDON POOL AND SPA CONSTRUCTION INC
28942 GOLDEN DAWN DRIVE 48415 PECHANGA RD
MENIFEE,CA 92584 BLDG H STE 804
Applicant Phone:9512862198
JILL FRENCH License Number: 1008129
POSEIDON POOL AND SPA CONSTRUCTION INC
48415 PECHANGA RD
TEMECULA,CA 92592
Fee Description O_yt Amount($1
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 7.00
General Plan Maintenance Fee-Building 1 5.80
General Plan Maintenance Fee-Electrical 1 23.35
$648.15
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 Bldg_Peenk_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I herebyaffirm under with a licensed contractors)pursuant to the Contractors State License Law).
penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 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 force and effect. the following reason:
License Class.(:Sf./ ,[-fz'� License No. ,�/IfI�./.-7� B m signature below I acknowledge that,except for m��,, y y 'g g p y personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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,for the performance of work for which w, ,.Ieeinfo.ca.Rov/calaw.html.
this permit is issued.
Policy 0 Date
o 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 a 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 owner's behalf.I have read this
number are: application and the information 1 have provided is correct.I agree to comply
Carrier �� � „� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Polity p 9s1"7/�� Expires { 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
a 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 q
workers compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code, shall forthwith c�omlply with tho provisions. r Will the applicant or future building occupant handle hazardous material or a
App1 Date ) )d mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide.
WAR�NIN��'I FAILURE,TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes a 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
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air quality Management District(SCAOMO)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes D No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 2000 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 a No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAOMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
Californiaealth al Safety Cade,Section 25505 and 25530 concerning
Contractor h
s License Law for the reason(s)Indicated below by the
hazardous material reporting.
checkmark(s)I have placed next to the applicable Rem(s)(Section 7033.5 oyes D 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
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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
o I,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.epa.gov/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 70",Business and Professions 1-80D-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o 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:
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7D44,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 & SAFETY PERMIT/PLAN CHECK APPLICATION
I -
Menifee
19�ftk,
DATE: o%ZghF PERMIT/PLAN CHECK NUMBER - on
TYPE: OCOMMERCIAL O RESIDENTIAL O MULTI-FAMILY MOBILE HOME ;KPOOL/SPA O SIGN
SUBTYPE: �,Oc ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
p NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DE,SCnnRIPTION OF WORK
V S 'rr I s+S
L
PROJECTADDRESS 2894�g ae%pn �vcin �n"(le ZIP ty Of Menifee
ASSESSOR'S PARCEL NUMBER 3�Z3�iZO7J_ LOT TRACT Building Dept.
OWNER NAME tjrk j F�V_a_nn&_ APR 1 7 2018
ADDRESS 925
PHONE EMAIL Received
APPLICANT NAME
ADDRESS y
PHONE EMAIL r�
CONTRACTOR'S NAME OWNER BUILDER? O YES XNO
BUSINESS NAME nG.
ADDRESS
PHONE
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION Cool, cog
VALUATION$ SO,FT uU12) L SQ FT
APPLICANT'S SIGNATU DATE /fr
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNWG ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE SMIP - GREEN —
PLAN CHECK FEE INVOICE TOTAL ^�
OWNER BUILDER VERIFIED YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777
www.cityofimenifee.us