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PMT18-05268 City of Menifee Permit No.: PMT18-05268 AR AV 29714 HAUN RD. I MENIFEE, CA 92586 Type: Pool/Spa-Residential MENIFEE MENIFEE Date Issued: 10/3012018 PERMIT Site Address: 25695 MOUNTAIN SPRINGS ST, Parcel Number: 339-450-033 MENIFEE, CA 92584 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of IN-GROUND POOUSPA 505 SQ. FT. Work: Owner Contractor JOE AND KELLY CONNELL ALOHA POOL& DESIGN INC 25695 MOUNTAIN SPRINGS ST 41083 SANDALWOOD CIRCLE STE I MENIFEE, CA 92584 MURRIETA, CA 92562 Applicant Phone: 9514539728 MARK KLINGSPORN License Number: 965927 41083 SANDALWOOD CIRCLE STE I MURRIETA, CA 92562 Phone: 9514539728 Fee Description Qty Amount($► 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 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 I hereby affirm under penalty of perjury that 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of ivision 3 of the 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 'ce 'e No. G5�lZ - � � 7 By my signature below I acknowledge that,except for my personal residence Expires Z�� Signature - in which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legallysell a structure that I WORKER'S COMPENSATION DECLARAT O/ have built as an owner-builder if it has not been constructed in its entirety by ❑I hereby affirm under penalty of perjuNj 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 rww,leginfo.ca.eov/cala�v.litml. this permit is issued. Policy# 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 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 policy owner or authorized to act on the property owner's behalf.I have read this number are: application an the information I have provided is correct.I agree to comply Carrier with all appli ble city and county ordinances and state laws relating to building cons ruction.I authorize representatives of this city or county to Policy# Expires enter the ab ve identified property for inspection purposes.- l (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERT� WNER OR AUTHORIZED AGENT \94 certify that in the performance of the work for which this permit is issued, r( I shall not emolov a.�persons in any manner so as to become subject to the CITY BUS(ry SS LICENSE# workers compensa on laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the wor rs compensation provisions of Section 3700 of the Labor Code,I shall forth ith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing 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 IS o Yes p.No UNLAWFUL,MD 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 Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 37D6 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guid Ines CONSTRUCTION LENDING AGENCY ❑Yes 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 "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.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health 9 Safety Code,Section 25505 and 25534 concerning hazard us m tenal reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes Jo // Business and Professions Code).Any city or county that requires a permit to 11 Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OW ER OR AUTHORIZED AGENT issuance,also requires the applicant for the permit to file a signed statement 1 �/ that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVAU6N,REPAIR AND PAINTING(RRP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of the v 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 it Section of not o residence or childcare facility to be RRP-certified firms and comply with than 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 1,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.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.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: ❑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. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE DATE: � � PERMIT/PLAN CHECK NUMBER 0 GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES TYPE: COMMERCIAL RESIDENTIAL MULTI-FAMILY MOBILE HOME OOL/SPA SIGN SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL MECHANICAL NEW PLUMBING RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS YES __ ' PROJECT ADDRESS ZIP ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME ADDRESS S�Z S / .//� V cl•t/ "� �.i��r'�(L `5� ' PHONE EMAIL APPLICANT NAME C..�fll ADDRESS PHONE EMAIL 1' CONTRACTOR'S NAME OWNER BUILDER? YES kWO BUSINESS NAME ADDRESS ✓%1Ql�c�2r3- f/!I'� �iL �p �'7� �Z PHONE �� EMAIL CONTRACTOR'S STATE LIC NUMBER �l 7 LICENSE CLASSIFICATION v•J� VALUATION $ j a!7� SQ FT s5 L SQ FT APPLICANT'S SIGNATURE DATE OTYSTAFFUSEONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE RM INVOICE TOTAL 5_z_Z GREEN SMIP OWNER BUILDER VERIFIED YES .--. NO DRIVERS LICENSE# NOTARIZED LETTER YES `:::: NO City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 www.cityofmenifee.us EIVIF�-