PMT14-02171 i
City of Menifee Permit No.: PMT14-02171
29714 HAUN RD. Type: Residential Plumbing
C' CE MENIFEE, CA 92586
MENIFEE Date Issued: 08/20/2014
PERMIT
Site Address: 26156 BIRKDALE RD, MENIFEE, CA Parcel Number: 337-410-080
92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
SUSAN BURIN ALL STAR WATER HEATERS INC
26156 BIRKDALE ROAD 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92586 MENIFEE, CA 92584
Applicant Phone: 9513454083
ALL STAR WATER HEATERS INC License Number: 812894
30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584
Phone: 9513454083
Fee Description Qtv Amount f$1
Building Permit Issuance 1 27.00
G E 0
$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_Templatexii 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 properly 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 li
License Class C„ License No. P'/� / who builds or improves thereon, and who contracts for the projects with a
Expires DIz eZ Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLAR ION
❑ 1 am exempt from ticensure under the Contractors'Stale License Law for the
❑ 1 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 b this permit, cannot legally sell a structure that I have
permit is issued. P Y P 9 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
I 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:http:llwww leginfo ca gov/calaw html.
permit is issued.My workers'compensation Insurance carrier and policy number are:
Carrier 44
ai✓ �: �r �dnaAa.ny
Property caner or Authorize gent Date
Expires s(��/�t / % Policy# '�/(,/'/�//gJp ;'�
Name of Agent Phone# [I 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 Code,I shall forthwith comply with those provisions. P Y ner9 Authorized Agent Date
City Business License
Date; u�,2d Applicant;
WARNING: FAILURE TO SECURIC 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, AYES OCCUPANT HANDLEA 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
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address pNO 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 reasons)indicated below by the checkmark(s)I have placed AYES 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, ONO 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 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
El 1, 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 Menifee
Building Dept PI CH Nn Permit Nt
29714 Haun Road Menifee, CA 92586 AUG 18 1014 Dale Dale
Phone: (951)672-6777 Alnnunt Amnum'
Fax:(951)679-3843 Received Y Ck v tim
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case F L Rt R-.
Property Address 26156 Birkdale Rd. Assessors Parcel Number: 337410080
ProjecVTenant Name: Unit it Floor#
Name: Susan Burin Phone No 951-246.4170 Fax No
Property Address Unit Number Zip Code
Owner Same as job 92584a
Email-Address
Name: Sierra Sprague Phone No Fax Nu
951-345-4083
Applicant Address: 30300 Puerto Vallarta Unit Number Zip Code
92584
Email Address: //
CL��ynr.f7Ptra.@ ylai . lan7
Name: All Star Water Heaters Phone No 951-345-4083 Fax No
Conaador Address: 30300 Puerto Vallarta Cdy Menifee Slate CA Zip Code 92584
OnlfaC.tOYS City r1B n28B IC.enBa O Comrsixor a uny SIatP.or8pjifpj a License No Classification: C 36
Number of Squares. l ZZtt{{Yy
Square Footage
Description of Work: Replace existing water heater.Same size and location. cost of work:3 800.00
Applicants Signature Date
To N completeu ey ity Staff Only
Indicate As R-Racelved or N/A-Not Applicable
5 Corrati sets of fully dimensioned.dram to sale plans which Include: I set of documents which=ude
❑ Title Sheet ❑ Elevations [) Electrical Plan ❑ Gee TechlSoils Report(on cd only)
❑ Plot I Site Plan ❑ Root Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Ys x 11)
❑ ❑ Structural Calculations
Foundation Plan ❑ Cross Section [] Plumbing plan
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing plan 8 Delalls ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Gonslructio Alteration Addition' Meonsimetheds
Work Type. Repair' Retrofit' Revision to Existing Permit Required? YES NO
Proposed Building Use(s): Existing Building Uses)
#Buildings: it Units: #Stories Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate II YES or NO Indicate all FNoise
az Zone
At Project Sprinklered that apply: e
Completion: Construction
Type(s): C or o YES of NO Required? storic Resources Inventor
CITY PLANNING STAFF ONLY
APPROVALS. Costal Commiss Arch.Review Board I Landmarl, Cumni I Planning Comm.Zoning Administrator
Fee Exempt City Project I JElec Vehicle Charger LanrlM+ark Seismir,Retrofit ecial(:ass Bme
_ onx iel Approval
Expedite Project(s): Child Cara City Project Green Building Landmark Affordable Housing
For Staff Use Only
auadingfSamr: Perm(SPeoahsl city Plamm..9 (ire E191oP n9 f •' Admn• lwnsl ..anon Moml Renl CO V01
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY