PMT14-01066 City of Menifee Permit No.: PMT14-01066
29714 HAUN RD. Type: Residential Plumbing
't iCCELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 0 610 9/2 01 4
PERMIT
Site Address: 25498 DORVAL CT, MENIFEE, CA 92584 Parcel Number: 339-190-003
Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
DALE POWERS ALL STAR WATER HEATERS INC
25498 DORVAL COURT 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584 MENIFEE, CA 92584
Applicant Phone: 9513010067
ALL STAR WATER HEATERS INC License Number: 812894
30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584
Fee Description Qtty Amount f$1
Building Permit Issuance �1 ' 27.00
$111.00
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 staled, 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
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class�'. .�i/ License No. �2112a!z who builds or improves thereon, and who contracts for the projects with a
Expires 51/_ �y Signature _ licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARA ION
❑ I am exempt from licensure under the Contractors'State License Law for the
I hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have
Policy# built as an owner-building if It has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this - submitted or at the following Web site:httc'//www loginfo ca aov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires Policy#
Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property
owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
�. I certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes.
shall not emolov any persons in any manner so as to become subject to the S /
workers'compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor property Own r or A1411horized Agent Date
Code, I shall forthwith comply with those provisions.
City Business License#
Date; J 1�1 Applicant; c
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES. UP TO.ONE HUNDRED THOUSAND DOLLARS _ W__LLL THE_AP—PLI_CANT OR—F❑1T_URE—BUILDING —
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
_ Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address [I NO FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s) (Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
or repair any structure, prior to its 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 Contractor's State License Law(Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensors and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZAdDOUS MATERIAL REPORTING,
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZEDAGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
PI cti rar: Pn,nr.t No
29714 Haun Road Build City of afety Dept. Dale Pair l Menifee LA o tw
Menifee, CA 92586
Phone: (951)672-6777 MAY 0 8 2014 Armnnt Alnonm
Fax:(951)679-3843 R Ck ck n
Building Combination P� dived
To Be Completed By Applicant
Legal Description Planning Case F- L RI R
Properly Address 25498 Dorval Ct Assessor.;Parcel NNnohe,
339190003
Project/Tenam Name Ural a
Floor N
Name: Dale Powers Phone No g51-679-5041 Far No
Property real Same as job Unit Numher Zip Code Owner
92584
Email—Address
Name' Phnne No
Robert Block 95I-34.5-4083 Fax No
Applicant Address: 30300 Puerto Vallarm Lhul Number Zip Cod¢
92584
Email Atltlress
Name
All Star Water Heaters Pn°"`No 951-345-0083 Fax No
Contractor Address. 30300 Puerto Vallarta City Menifee State CA Zip Code 92584
ontractor's .ity uameSs ieerlSP. No ContractrIt City �
Glattolf 'r„pL mn rnr°Nn
$Iz Classification (.3b
Number of Squares'. [)4
Square Footage
Description or Work Replace existing water heater.Same size and location. Cosl of Work.S QUO
Applicant's Signature Dale j-/O p. 00
To Be Completed 8 City 81afF Only
Indicate As R-Received or NIA-Not Appur.able
S CemOurfes sets of fully dimensioned,drawn to sale plans which include. I set of documents whim include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo TechlSoils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'A x 11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for etec services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sowed Report-Residential
Class Code Indicate New Construction Alteration' Addition' Means/Melnrds
Work Type: Repair' Retrohl• Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Usels)
N Buildings' 0 Units I N Stories Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indite(:it YES or NO
At Project Indicate Indicate all Gen-tech_Haz Zone
Completion:
Construction Sprinklomd I[in apply Coastal Zone
Type(s): C Of O YES or NO Noise Zone
Renrured'+ Listed on Historic Resources Inventor
CITY PLANNING STAFF ONLY
APPROVALS. Costa[Commiss Arch.Review Board Landivai$ Condit I Plannmg Comm.Zoning Administrator
Fee Exempt Cry Project Elec Vehicle Charger Landmark Seisnur,Retrofit Srenni case Bin,
Expedite Projects) Child Care y Prnle _ OautalApproval C ce 8fq
Landmark Aliordable Houma
For Staff Use Only --- -- — —
Bullding.Sale r _ "and Speualisl.__ I (.it lardig _-(.rn.Cnoineenna --__---tnmm I;ansnonaUon Mgmt .,_- Renl Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY