PMT18-02686 City of Menifee Permit No.: PMT18-02686
29714 HAUN RD.
br MENIFEE,CA 92586 Type: Pool/Spa-Residential
MENIFEE MENIFEE Date Issued: 06104/2018
PERMIT
Site Address: 28170 RUSTLING WIND CIR, MENIFEE, Parcel Number: 333-601-006
CA 92585 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUD POOL& SPA 570 SQ FT, 15 L FT GAS LINE FOR FIRE PIT
Work:
Owner Contractor
DAN WALKER ALOHA POOL& DESIGN INC
28170 RUSTLING WIND CIR 41083 SANDALWOOD CIRCLE STE I
MENIFEE, CA 92585 MURRIETA,CA 92562
Applicant Phone: 9514539728
MARK KLINGSPORN License Number:965927
ALOHA POOL&DESIGN INC
41083 SANDALWOOD CIRCLE STE I
MURRIETA,CA 92562
Fee Description PV Amount!$)
Swimming Pool/In-Ground Spa 1 467.00
Plumbing Fixtures and Vents, fixtures 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee- Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 23.35
$644.15
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_Permit_Template.rpt 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 ggqqrvis)on 3 of the Business and D 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 'fS3 'ce eNo. -76-5-SZ7 By my signature below l acknowledge that,except for my personal residence
Expires Z- Signature I in which I must have resided for at least one year priorto completion of
WORKER'S COMPENSATION DECLARA71 improvements covered by this permit I cannot legallysell a structure that I
have built as an owner-builder If It has not been constructed in its entirety by
o 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 wvnv.leeinfo.ca.aav/calasv.latml.
this permit is issued.
Policy N 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 9'�y my signature below I certify to each of the fallovring:I am the property
this permit is issued.My worker's compensation insurance carrier and policy o�caner or authorized to act on the property owner's behalf.I have read this
number are: application anO the information I have provided is correct.I agree to comply
Carrier with all appl ble city and county ordinances and state laws relating to
building cons ruction.)authorize representatives of this city or county to
Policy p Expires enter the ab,ve identified property for inspection purposes. .
i
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPER �WNER OR AUTHORIZED AGENT
�7 certify that in the performance of the work for which this permit is issued,
t shall not emolov an�persons in any manner so as to become subject to the CITY BUS S LICENSE N
worker's compensa on lawsof California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wor is compensation provisions of Section 3700 of the Labor
Code,)shall firth ith comply with those provisions. ++77 Will the applicant or future building occupant handle hazardous material ora
Applicant Date L mixture ton[aining a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAIL RE TO SECURE WORKER'S COMPENSATION COVERAGE LS D Yes dNo
UNLAWFUL,AfiD SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES Will the intended use ofthe budding bythe appficantor 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(SC lion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo guld Coast
A Ines
CONSTRUCTION LENDING AGENCY o Yes to
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) o Yes "o
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.1 understand my requirements underthe State of
Contractor's License Law for the reason(s)indicated below by the California Health 15afety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazard us m ter! I reporting.
Business and Professions Code).Any city or county that requires a permit to Dyes us
i
construct,alter,improve,demolish or repair any structure,prior to its r�' Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY DWP'R OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPARENOVA O4 REPAIRANDPAINTING(RRP)
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 pre ctices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
o1,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 i I portion of the work,and the structure is www.eoa.eav/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-ROD-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a D 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. o No EPA Lead-Safe Certified Firm is required for this pmject because:
D 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: `XI PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION C DEMOUTION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK /5�FJD
PROJECTADDRESS 255-j-20 ZIP 5'e_s7r4/-
ASSESSOR'S PARCEL NUMBER LOT IOa- TRACT D
OWNER NAME
ADDRESS
PHONE 7�9-7L�=p�„ g Z EMAIL 1
APPLICANT NAME �I'�j�.�_ LEI A/(o 5 Oe;n�>✓
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME e-_ OWNER BUILDER? O YES
BUSINESS NAME {,
ADDRESS �Op I�I'lrvYr9oa C.c Zl�
PHONE r72-r- EMAIL
CONTRACTOR'S STATE LIC NUMBER 6592-7 LICENSE CLASSIFICATION
VALUATION$ Zs&2 SO FT / 70 L SO FT
L��ANT'S SIGNATURE 72: DATE
DEPARTMENT DISTRIBUTION ACCEPTED BY: CI IT OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICETOTAL GREEN ' SMIP
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
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