PMT14-02001 i
City of Menifee Permit No.: PMT14-02001 j
29714 HAUN RD. Type: Residential Plumbing
` MENIFEE, CA 92586
MENIFEE Date Issued: 08/04/2014 'd
Fri
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PERMIT
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Site Address: 26495 POTOMAC DR, MENIFEE, CA Parcel Number: 338-243-012 9
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92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
EDNA THOMAS ALL STAR WATER HEATERS INC
26495 POTOMAC DRIVE 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92586 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 f$1
sl a ial; eet �"1e n 83�°
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_Bldg_Permit_Template.rpt Page 1 of 1
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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 nand lmy 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. 9LA2 ,041 who builds or improves thereon and who contracts for the projects with a
p p l h
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ 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: fallowing 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. built as an owner-building if it has not been constructed In its entirety by licensed
Policy# 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:httn,//www.iealnfo.ca.gov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property Owner or Authorized Agent
Carrier �� S, pen Date
Expires � S / ✓ Policy f.411�
Name of Agent Phone# g 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 cityor county to enter the above-
El I certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes.
shall not cemolo ompensation
any persons in any manner so to become subject to the Y
workers'bompensafion laws of California, and agree that if I should become r .ram!
subject to the workers'compensation provisions of Section 3700 of the Labor property Ow r or AlIthorized Agent Date
Code,I shall forthwith comply with those provisions.:
DD City Business License#
Date, o/ Applicant; ax a
WARNING: FAILURE TO SE�Ci 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, EYES 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 EYES 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 checkmarli I have placed EYES 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, E 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 EYES 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 sole HAZARDOUS MATERIAL REPORTING.
compensation, will do ( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED 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).
C-ATI OF 1Vl ElagFEE PI C:I:Nn Pmmil No
City of Menifee T14-e)
29714 Haun Road Building & Safety Dep4. Date -dale.
Menifee, CA 92586 1
Phone: (951)672-6777 AUG 0 1 2014 Amount Amount-
Fax:(951)679-3843 ck# eke
Received
Building Combination Permit
To Be Completed By Applicant
Legal Description: To
Case, F. i L RI� R
Properly Address: 26495 Potomac Dr. Assessor's Parcel Number ^
Projed/Tenant Name• Unit it Floor#' O\do
Name: Thomas Ede Phone No. 951-679-91b4 Fax Nn
Properly Address• Unit Number zip Code
Owner Same.as job p 92586
Email Address'
Name: Sierra ue S ra Phone No F0X No.
Sprague 951-345.4083
Applicant Address: 30300 Puerto Vallarta Unit Number Zip Code 92584
Email Address:
CL��S7R.+. S'i@Iya-� /J7ei.`, fort
Name: All Star Water Heaters Phone No 951-345-4081P Fax No
Contractor Address: 30300 Puerto Vallarm City Menifee State CA Zip Code 92584
fff
ontracr's to City Business License Nn. Contractors City Slate of cm a License Nn Classification C 36
2 Y
Number of Squares:
Square Footage
Descfiptipn of Work: Replace existing water heater.Same size and location. Coot of Work:S 800.00
Applicant's Signature VOW
Date.
To Be Completed By City Staff Only !J
Indicate As R-Received or N/A-Not Applicable
5 Comolelee sell of fully dimensioned,drawn to sale plans which include: I set of documents Wmen mGude,
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Ttlle 24 Energy(oit S Y.x 11)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for else.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan d Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code Indicate New Construction Alteration' Atldition Means/Methods
Work Type:ElRepair' Retrofit' Revision to Existing Permit' Rayuired7 YES NO
Proposed Building Use(s): Existing Building Use(s)
#Buildings' #Units: #Stories Will the BUUding Have a Basement? Y of N
Bldg.Code Occupancy Group Indicate Indicate LEI
of NO Indicate all Gen-tech.Haz.Zono
At Project Sprinkterdd at
a I
Completion: Constm lion pp y Coastal lone
Type(s)': C of O YES or NO Noise ZonF.
Required? Listed on Historic Resources Inventor
CITY PLANNING STAFF ONLY
APPROVALS, Costal Commiss Arch,Review Board Lannmarl Comm. Planning Comm.Zoning Administrator
Fee Exempt City Project Elec.Vehicle Charger Land�wrk Selffniin Relmgl sRerinl axe-airy
6aeialA oraval
Expedite Pmject(s) Child Care City Project Green nuilding Lar{dmark Allamahle blouann
For Staff Use Only
Bullding:Seiely Permit Spe ialist City Planning I uw:Enoihnenng IG".'.'. Admu,. �raneponPt do Mgml R I Co l of
THANK YOU FOR HELPING US CP.EATE A BEITER COMMUNITY