PMT14-01999 r
u
City of Menifee Permit No.: PMT14-01999
MENIFEE,
EE, C 92 Type: Residential Plumbing
MENIFEE, CA 92586
MENIFEE Date Issued: 0 810412 01 4
PERMIT
Site Address: 28281 HEARTHSIDE DR, MENIFEE, CA Parcel Number: 340-292-056
92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
NORMAN SIMPKINS ALL STAR WATER HEATERS INC
28281 HEARTHSIDE DRIVE 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584 MENIFEE, CA 92584
Applicant Phone: 9513010067
SIERRA SPRAGUE License Number: 812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584
Fee Description Qtv Amount($1
Building Permit Issuance 1 27.00
G BEN FE f i` '
$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_Bldg_Permit Template.rpt Page 1 of 1
I
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 1
License Class License No. who builds or improves thereon, and who contracts for the projects with a
Expires _ Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ 1 am exempt from Iicensure 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, I cannot legally sell a structure that I have
permit is issued.
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
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:hftn,//www.leqlnfo,ca.gov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
�4 Property Owner or Authorized Agent Date
Carrier /Y/1!/j/seJ/ V1 /�.4N _ d.
Expires P// �s / / Policy#f�'.fcPy9G%14X
g 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 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 employ any persons in any manner so as to become subject to the
workers'compensation laws ofCalifornia, and agree that if I should become Ys"e �
subject to the workers'compensation provisions of Section 3700 of the Labor Property Ow p r or@ ithorized Agent Date-/��
Code,I shall forthwith comply with those provisions.:
City-Business License# 77n.3 S'O�S
Date; z 5e l Applicant; "+ - uz u
WARNING: FAILURE TO SEC/Uld 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
($900,000), IN ADDITION TO THE COST OF COMPENSATION, AYES 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
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
❑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 pYES 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, El 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 pYES 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
❑ i, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
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).
CITY OF MEN]IFEE
PI Eh Nrr ,Permit No-
29714 Haun Road City of MenifeerML q`1
Building & Safety Dept, Date- Dal.
Menifee, CA 92586
Phone: (951)672-6777 AUG 0 1 2014 q'"aunt Amount
1
Fax:(951 )679-3843 Ck# Ck#
Building Combination Pe�rAeived
To Be Completed By Applicant
Legal Description: Planning Casa' F L RI R
Property Address: 28281 Hearthslde Dr. Assessor's Parcel Number:
ProjectrTenent Name' Unit# 1 Floor#:
Name: Norman Simpkins Phone No 951-301-983o Fax No
Properly gtltlress p Unit Numher Zip Code
Owner Same as job 92584
Email Address:
Name: Sierra Sprague Phone No Fax No.
951-345-4083
Applicant Address: 30300 Puerto Vallarta Unit Number ?to Code
92584
Email Address f�sj yy�,ra.,-s r�cx'1•coin
Name: Phone No
All Star Water Heaters 951-345-408,3 Fax No.
Contractor Address. 30300 Puerto Vallarta City Menifee State CA Zip Code 92584
ontrnel0r s City uainess rcense n. ....tractor's City Slate of 8La,1894a License NO Ela�sircaltom C 36
Number of Squares; Z
Square Footage
I
Description of.Work: Replace existing water heater.Same size and location. Coil of Work:5 800.00
Applicants Signature '
Date-
To Be Completed By City Staff Only
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned.drawn to sale plans which include. I set of documents whichisclude
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gad Tech/Soils Re on(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ 'Rile 24 Energy(or1 8 y,x 11)
❑ Foundation Plan ❑ Structural Caiculatl'on$
❑ Cross Section ❑ Plumbing Plan
❑ Single Line tliagraT for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: indicate New Construction Alteration'Ed Addilioo'; Means/Methods
Worh Type Repair' Retrofit Revivon toEsisting Perfel' Required? YES NO
Proposed Building Use($): Existing Building Uses)
#Buildings- #Units: #Stories Wilt the Building Havela Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate II YES or NO Indicate all Gen4eim Hez.Zone
At Project Construction Sprinkla
Completion: rtM - foal apply Coastal Zon2
Type(s): C of O YES or NO Noise Zone.
Required? Listed on Historic Resources Inventor
CITY PLANNING STAFF ONLY I
APPROVALS. costatCommi$s. Arch.Review Board I I Landinar4 Comm. Plaminig Comm.Zoning Administrator
Fee Exempt City Project Elea Vehicle Charger Land,ark gchSmw Relrori OQuunl ee. bmN
Expedite Projecfts), Child Care City Project Green Bui45n
g Lanifmark AlrordabierHqusinq
For Staff Use Only
1 ding,-Safr.:g 1- Pans Specialist City Planning Crep arainewing [;✓:'.11 Ammvi l lrampor at on Mom I R mr Convol
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
I