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