PMT18-03518 City of Menifee Permit No.: PMT18-03518
1*1*40 29714 HAUN RD. Type: Residential Plumbing
MENIFEE,CA 92586
MENIFEE MENIFEE Date Issued: 07/16/2018
PERMIT
Site Address: 30165 NIGHT PASSAGE PL, MENIFEE, Parcel Number: 358-501-006
CA 92586 Construction Cost: $1,000.00
Existing Use: Proposed Use:
Description of INSTALL U/G ELEC LINE AND 220A POWER SUPPLY FOR ABOVE GROUND SPA, U/G GAS LINE
Work: FOR FIRE PIT, U/G GAS&U/G ELEC LINE FOR FUTURE BBQ AND FUTURE POOL EQUIPMENT
Owner Contractor
COLE YOUNG A CUT ABOVE CONSTRUCTION POOLS&
30165 NIGHT PASSAGE PLACE LANDSCAPE INC
MENIFEE, CA 92586 26025 NEWPORT ROAD#A533
Applicant Phone: 9512447754
CHRIS YOUNG License Number:672202
A CUT ABOVE CONSTRUCTION POOLS&LANDSCAPE INC
26025 NEWPORT ROAD#A533
MENIFEE, CA 92584
Fee Description City Amount(S)
Receptacle, Switch, Outlet& Fixture 1 116.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 5.80
General Plan Maintenance Fee-Electrical 1 5.80
$271.60
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 for the projects
1 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 7(100)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 — 5� pseF -"Zy Z' By my signature below l acknowledge that,except for my personal residence
Expires ZJ Signature J In which l must have resided forat 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
o 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 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 www.Ieginfo.ca.gcy/caIaw.huni.permit is issued.
Policy g Date
o I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o 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 polity owner or authorized to act on the property owners behalf.I have read this
numberare: r application and the information I have provided is correct.I agree to comply
Carrier ( 1L -ri with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Po11cyll Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the perms is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o 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
subject to the workers5ompensation provisions aF Section 3700 of the Labor
Cade,(shall forthwit,ro prywitht evisioniof Will the applicant or Future building occupant handle hazardous material or
Applicant I ate 2 1 6 mixture containing a hazardous material equal to or greater that the
amountUpecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE KER'S MPENSATION COVERAGE IS o Yes No
UNLAWFUL,AND SHALL SUBIE PLOYER 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 applicant
modification from South
IN SECTION ON TO
06 OF
LABOR CODE,INTERTION,DAMAGESASPRNEYS FEES
FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 37060E THE LABOR CODE,INTEREST,ANO ATTORNEYS FEES farguidelines
CONSTRUCTION LENDING AGENCY crYes �{No
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 00
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.1 understand my requirements under the State of
California Health&Safety Cade,Section 25505 and 25534 concerning
Contractors License law for the reason(s)indicated below by the hazardous m lair repo ' g.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Byes _
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 PROPE NER OR A NT
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 REP RAN PAINTI G RRP
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repa lilting(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-certlfred firms and comply with
an Applicant Fora 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
D 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.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 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.II,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-guilder 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:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Cade: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
G�VrC,!E? , /ou'.,1 6 - A at],(' Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER 1 —�
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL QWESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SP C N .
fee
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION KELECTRICAL O MECHAIBORding Dept.
, NEW A PLUMBING O RE-ROOF NUMBER
OF SQUARES
DESCRIPTION OF WORK FAI, Self
Received
-
OCCUPANCY GROUP CONSTRUCTION TYPEn SPRINKLERS
O YES YNO
PROJECT ADDRESS J�--1 V5� &Jq I(jO� Imo % V ZIP
ASSESSOR'S PARCEL NUMBER � E01-( n V LOT TRACT
OWNER NAME
ADDRESS / ( �Q 4l y ( l�.�s � l-.
IIq.�
PHONE (O EMAIL
APPLICANT NAME CGI S v�b
ADDRESS
PHONE , EMAIL
CONTRACTOR'S NAME (i(� �VvL OWNER BUILDER? OYES yr
NO
BUSINESS NAM.EE n /1
ADDRESS
PHONE 9I0-Z`�y` ( (�y EMAIL
CONTRACTOR'S STATE LIC NUMBER (q�r'zU LICENSE CLASSIFICATION C'
VALUATION$ OOD S T LSQFT �—
APPLICANT'S SIGNATURE DATE 7 /'"
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEP DIBY: 116
,^ CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE �l/\
INVOICE TOTAL k. 0 GREEN SMIP
OWNER BUILDER VERIFIED O YES 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.cit)(ofmenifee.us
NIF