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PMT14-01068 City of Menifee Permit No.: PMT14-01068 29714 HAUN RD. CC`E1..l MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 05/09/2014 PERMIT Site Address: 26205 BLUEBELL ST, MENIFEE, CA Parcel Number: 335-426-030 92586 Construction Cost: $800.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION Work: Owner Contractor WENDY OSBURNE ALL STAR WATER HEATERS INC 26205 BLUEBELL STREET 30300 PUERTO VALLARTA WAY MENIFEE, CA 92586 MENIFEE, CA 92584 Applicant Phone: 9513010067 ALL STAR WATER HEATERS INC License Number: 812894 30300 PUERTO VALLARTA WAY MENIFEE, CA 92584 Fee Description OltY Amount is Water Heat r a fir'„ > c44 ,a x i.1� r w<-0r r 83 00 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 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_eldg_Permit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION 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. Cade:The Contractor's License Law does not apply to an owner of a property License Class-Cs- ,--License No. who builds or improves thereon, and who contracts for the projects with a Expires 2LIZ,711y Signature � _ -, licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARAOIN ❑ I am exempt from Iicensure under the Contractors'State License Law for the l�I hereby affirm under penally 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 improvements covered by this permit, I cannot legally sell a structure that I have permit is issued.L built as an owner-building if it has not been constructed in its entirety by licensed Policy# z. �h contractors. I understand that a copy of the applicable law, Section 7044 of the ❑ I 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:htti)://www.leainfo.ca.gov/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 stale laws relating to building construction.I authorize representatives of this city or county to enter the above- r4 I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes, shall not eri any persons in any manner so as to become subject to the workers'compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Property Owner or Auf horized Agent Date / CityBusiness License# Date; � y �� Applicant; 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 WILL THE APPLICANT OR FUTURE BUILDING ($100,000), IN ADDITION TO THE COST OF COMPENSATION, ❑YES 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO 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 AYES 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 Stale 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 AYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Iicensure 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 ❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL AEPORIING. compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT 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 C6 Nr. Cnnnit Np City of Menifee 29714 Haun Roaguilding & Safety Dept. - Dale Dalr 11 ,, Menifee, 1) 92586 MAY 0 8 2014 Amount Amounl `Vl Phone: (951)672-6777 _ Fax;(951)679-3843 Ck: C:k' Received _ Building Combination Permit To Be Completed By Applicant Legal Description. Planning Cast- F L R1 R' Property Address 26205 Bluebell St. Assessor s Parcel Number 335426030 Project/Tenant Name Unit# Floor# Name' Wendy Osburne Pgnnrr Nu 951.303-4794 Fax Nn Properly Atldress' Unil Number Zip Corte Owner Same as jots 92586 Email Address Namc: Sierra Sprague Phone No 951-345.4083 Fax No Applicant Address 30300 Puerto Vallarta Unit Number Zip Code 92584 Email Address Name' All Star Water Beaters Phone No 951-345-4083 Fax No Contractor Address. 30300 Puerto Vallarta City Menifee State CA ZrpCode 92584 .onlra[Inr'v .ity usrness .¢;arise o Gonlraclnr e Coy Sratr nl81j S94n lncrn=.i•Nn classi oil C 3G Number of Squares Y Square Footage Description nl Work' Replace existing water heater.Same size and location. Cost of Work S 800.00 Applicants Signature O Date sloelly To Be Completed By Illy Stair Only Indicate As R Received or NIA-Not Applicable S Cumuli Sens of fully dimensioned drawn to sale plans which include I set of documents which mdude ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo TechlSoils Report(on cd only) ❑ Plot/Srte Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 9 Y>x 11) ❑ Foundation Plan Cross Section❑ El Structural Calculations Founda ❑ Plumbing Plan ❑ Single Line diagram for elec services over 400 AMP ❑ Floor Plan ❑ Structural Training Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential Class Code Indicate New Construction Alteration' Addition' MnansinAethads Work Type: Repair' Ll Revotn• Rer!sion to Existing Pennif Requited', YES NO Proposed Building Use(s): Existing Building Use(sl' #Buildings' #Units: #Slnries' Will the Building Have.a Basemenlo Y of N all Code Occupancy Group Indicate lodmatc if YES or NO Indicate all Geo-tech Haa Zone At Project Construction Sprinklered ih21 apply Coastal Zone Completion Type(s)' C of O YES or NO Norse Zone Require,, bsted on Historic Resources Inventor CITY PLANNING STAFF ONO APPROVALS. Costal Commiss Arch.Review Board L andn art Co nm Plano rig Comm.Zoning Administrator Fee Exempt City Project Elec Vehicle Charger l �•w i, Snsnnr ReimIrl pp il^ Expedite Projects) Chiltl Core Cliy Prnjerl f r e_C.rid nn _ Landmark Allc prime lieusnri For Stall Use Only Building brp,,. Permrl Specialist dv plumnng C-r:u G�rnnenpn4 IL:neponahon MAoml Rene Coniml THANK YOU FOR HELPING US CRFATE A BE'ITFR COMMUNITY