PMT14-02170 City of Menifee Permit No.: PMT14-02170
29714 Type: Residential Plumbing
MENIFEEEE,, CA 92586 C 92 i
ci�wk" i, MENIFEE Date Issued: 08/20/2014
PERMIT
Site Address: 28634 MISSION DR, MENIFEE, CA 92584 Parcel Number: 372-061-035
Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
COLETTE VON DURING ALL STAR WATER HEATERS INC
28634 MISSION DRIVE 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584 MENIFEE, CA 92584
Applicant Phone: 9513010067
SIERRA SPRAGUE License Number: 812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584
Phone: 9513454083
Fee Description QtV Amount l$)
esld iat to 'eat r 83 0
Building Permit Issuance 1 27.00
G E
$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 building 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
License Class G�..i License No. E_P who builds or improves thereon, and who contracts for the projects with a
Expires 2 Signature licensed contractor(s)pursuant to the Contractors State License Law). 1
1
WORKERS'COMPENSATION DECLA ION
❑ lam exempt from licensors 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 im improvements covered b this permit, cannot legally sell a structure that have
permit is issued. P Y P g Y
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
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:tUp://www.leginfo.c@,Qov/calaw.htm[,
permit is Issued.My workers'compensation insurance carrier and policy number are:
Carrie y Property Owner orAufhorrzAgent Date
Expires Policy Peliey#
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 state laws relating to building
construction.I authorize representatives of this city or 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 employ 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 a nAuthorized Agent Date
Code,I shall forthwith comply with those provisions. erg,Gy�
Date; z
City Business License# ®� ✓v��
L 1/ Applicant;
WARNING: FAILURE TO SiWORKERS' 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 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
I hereby affirm under penally 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 ❑YES 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 �&ES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensors 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, 4� ,�
who, through employees' or personal effort, builds or improves the properly,
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).
(]ITY IO MENIFEE City of Menifee
Building Dept PI CI•'Nn Fnrmil No
29714 Haun Road y-
Dzfe Dale:
Menifee, CA 92586 46 18 2014 g
Phone' (951)672-6777 Amount Amount CID
Fax:(951 )679-3843
ReCeiVe # Ck#
Building Combination Pernl`it
To Be Completed By Applicant
Legal Description Pia�unif Case- F L RI R-
Properly Address: Assessor S parcel Number: 372061035
28634 Mission Dr.
Projecllienanl Name --
Unit U Floor#
Name Colette Von During Phone No. 951-679-3298 Fax Nn
Properly Address'
Owner Same as job Unit Number Zip Code 92584
Email Address
Name: Sierra Sprague Phone No. fax No
951-3454083
Applicant Address:
30300 Puerto Valletta Unit Number Zip Code 92584
Email Address:
(,r;��SFar.Serra®' MaW'/.ca
Hama' All Star Water Heaters Phone No 951-345-4083 Fax No
Canvanor Address. 30300 Puerto Vallarta City Menifee SlaleCA Zip Code 92584
Contractor aCity Sudanese License N,, Contmclor's City Slate of BC'ji(p9'li,License NO Classlficaligrr C 36
Number of Squares .ZSS 4
Square Footage
Description of Work: Replace existing water heater.Same;size and location. Cost of Work: 800.00
Applicant s Signature Date
To Be Completed By Cur Staff only O 7
Indicate As R•Rera(ved or NIA-Not ApplirAble
5 Comoleles sets of fully dimensioned.drawn to sale plans which include: I set of documents which include
❑ Title Sheet ❑ Elevations ❑ EIF.Sdrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on E Y:x it)
C] Foundation Plan ❑ Cross Section ❑ Structural Calculations
❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code Indicate New Construction Alteration' Addition' Meanshvetheds
Work Type: Repair' Li Retrolit' Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s)-
#Buildings- #Units ,—stories Will the Building Have a Basement?
Y of N
Bldg,Code Occupancy Group Indicate Indicated Indicate all Gen-tech.Haz Zone
At Project Spnnklered 'YES or NO
Completion: Construction � that apply Coastal Zone
Type(sl: C of 0 (:,YES o/NO Noise Zone
Ragolred9 Listed on Historic Resources Inventor
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review board LandmarV Comm Planning Comm.Zoning Administrator
Fee Exampl City Project Elec.Vehicle Charoer Larrin+ark Seismic Retrofit sped cna+ aid,
_ O(prldlA )rptpl
Expetlite.Project(s): Child Care City Project Green Bni�ding Landmark A9ordable Housing
For Slan Use Only
i Butldmg.Salelr i Pennd$per.lallst City Planning I tit:[ngrtrt±,enna I Ad� Ird.mg;
R C
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY