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PMT14-01069 City of Menifee Permit No.: PMT14-01069 29714 HAUN RD. CCCL MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 06/09/2014 PERMIT Site Address: 28833 HILLSIDE DR, MENIFEE, CA 92584 Parcel Number: 372-244-004 Construction Cost: $800.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER. SAME SIZE AND LOCATION Work: Owner Contractor MICHAEL HAMPTON ALL STAR WATER HEATERS INC 28833 HILLSIDE DRIVE 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 Ply Amount �f,$1 �ateraH�euete..,�....,a,.,.da-v'is`�aiut._. .x�'i�".�.� i y�r��.�,rt�� Isrs:..Ev v....Mv..��_�.ua.A.w�.-:.� .�,.,�BJ•Vvs+ Building Permit Issuance 1 27.00 ,� .�ti.au..�Ls,.S..-�a..._uu..�,:T.La.➢�t.vv.......au.....�i .,.zvu..,U.zws ,� ems._ sm.c,...a..c.-ua.,�a,,..�a--�.�.isr.�::,p $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 slated,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_Permlt_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 _License No., who builds or improves thereon, and who contracts for the projects with a Expires Signature licensed contractors)pursuant to the Contractors State License Law), WORKERS'COMPENSATION DECLAR ION ❑ I am exempt from icensure 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 improvements covered by this permit, cannot legally sell a structure that have permit is issued.0 built as an owner-building if it has not been constructed in its entiretyb licensed Policy# �,.,x 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:htto://www.leginfo.ca.gov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Property Owner or Authorized Agent Carrier Date Expires Policy# ❑ By my Signature below, I certify to each of the following: I am the property Name of Agent Phone# 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 slate laws relating to building construction.I authorize representatives of this city or county to enter the above- ' 1 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 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 orA- horized Agent Date Code,I shall forthwith comply with those provisions. City Business License# Date; Applicant; WARNING: FAILURE TO SECURE /ORKERS' 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, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA DAMAGES--AS-.PROYIDEO—FOR.IN .SECTION.3.706 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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address O 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 reasons)indicated below by the checkmark(s)I have placed OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable items) (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 licensure 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 sale HAZARDOUS MATERIAL htEPORI ING. 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). �J0 ll, N h�'l- M Ex\l8�'E LL� Pick Nr ur.nnn N,--- City of Menifee 29714 Haun Road Building & Safety Dept Dale Dalr, Menifee, CA 92586 151211A Phone: (951)672-6777 MAY 0 8 2014 Aenntlol Amount Fax:(951 )679.3843 Cxn c:kif Received _.-- Building Combination Permit To Be Completed By Applicant Legal Description Planning Case F L RI R Property Address 28833 Hillside Dr. Assesso,v Parcel Number 372244004 Project/Tedanl Name Unit 0 Floot 4 Name Michael Hampton Phone No 951-816.7596 Pax Nn Properly Address' Unit Number Zip Code owner, Same as job 92584 Email Address Name- Sierra Sprague Phone No. 951-345-4083 Fax No. Apeicanl Address. 30300 Puerto Vallarta Unit Number Zip Cody. 92584 Email Address Name All Star Water Heaters Pltnne No 951-345-4083 Fax No Contractor Address. 30300 Puerto Vallarta Clly Menifee State CA Zip Code 92584 .ontrectnr's .ity Lsnmss .irense n Conimcint's Cut,filar"01812894�i Llrens.i.Nn classification O 36 Nud i of Sduares Sguare Pootage Descnplion of Work Replace existing water heater.Same size and location. Cost of Work S 800.00 Applicant Signature pale To 8e Completer]By City Staff Only Indicate As R-Reretved or NIA-Not Applirahle. S Comaleles Sets of fully dimensioned dravin to sale plans which include I set of documents whicn include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gep TechlSoils Report(an ed only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y:x 11) ❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations ❑ Single.Line diagram for elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential Class Code Indicate New Construction Alteration' Addition' MeanslMeihods Work Type Repair' Retrofit' Revision to Existing Permit' Regmredl YES NO Proposed Building Use(s). Existing Building Uselsf 1f Buildings b Units- d Stories' Will the Building Have a Basement? V of N Bldg. Code Occupancy Group Indicate iIndlcntn if O Ind®ale all Geo-tech Haz Zone At Project SpdnMered YES or N Ihm a tI Coastal Zone Completion' Construction Pf y Type(s): C m O Noise Zone Re mred7 YFS on NO n I_Isled on Historic Resources Imenlnt CITY PLANNING STAFF ONLY APPROVALS. Costal Commies Arch.Review Board11 Lend n.arF Cun vn. Pla nnmg Comm.Zonino Administrator Fee Exempt City Ptnlecl Elec Vehicle Charger Lnl:n•�nrx 5eiv nu'.kepMll (An is ::se amg llf, iA:P 1pl.1.1" -1 1j Expedite Projecl(s) Child Care Clly Pmlact Green R-Tiding Landmark Allomattle Noulldll -et T For Slaa Use Only T --Building;Uidn" I Permd Specialyd C, rn-oinpnnnn I Adinty T ransportation rAdmi Rent Control THANK YOU FOR HELPING US CREATE A BE 11 ER COMMUNITY