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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