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PMT14-02418 1f I i City of Menifee Permit No.: PMT14-02418 29714 HAUN RD. Type: Residential Plumbing !-' MENIFEE, CA 92586 li MENIFEE Date Issued: 09/09/2014 1 PERMIT u Site Address: 28060 GARDENA DR, MENIFEE, CA Parcel Number: 336-230-027 92586 Construction Cost: $800.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION Work: Owner Contractor DARREN DROUILLARD ALL STAR WATER HEATERS INC 28060 GARDENA 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 Phone: 9513454083 Fee Description (Qtyt Amount I$1 esl ag/,ali ate eat -0^ 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 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_i'ermit_Template.rpt Page 1 of 1 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 Clas License No. who builds or improves thereon, and who contracts for the projects with a Expires O Signatur licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLAkATION ❑ I am exempt from licensure under the Contractors'Stale 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 action 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http'//www.leoinfo.ca.gov calaw html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier4eo /lL6r7 Property Owner or Authorized Agent Date Expires?//S Policy ❑ 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 emolov any persons in any manner so as to become subject to the //l workers' compensation laws of California, and agree that if I should become �y�,�y� tea]`/�S✓/_/�_ subject to the workers'compensation provisions of Section 3700 of the Labor property Own orAu rized Agent Date Code,I shall forthwith comply with those provisions. City Business License#��,5 Date;� Applicant; WARNING: FAILURE TO SE UR 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, ❑YES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES if-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 ONO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS 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 DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable items)(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, 0 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 ZlyES 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($500).) CODE SECTION IONMAT 25505RIAL I�EP533,AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED AGENT not intended or offered for sale.(Section 7044, Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). �,uTY yr AVIFNvFE : PI Cu W. Fengil Np' 29714 Haun Road Dale D�� �TS Menifee, CA 92586 q�$ Phone: (951)672-6777 Amount k AmbunP Fax:(951 )679-3843 Cka - Building Combination Permit To Be Completed By Ap licant Legal Description: Planning Ease, F. t. RI' R Property Address: 26060 Gardena Dr. Assessors Parcel Number 336230027 Prolectrrenant Name: Unit 0 '.. Floor k' Name: Darren Drouillard Phone No. 951-723-0444 Fax No Property Address- Owner Same fls job Unit Number ! Zip Code 92636 Emait Address: LL��fi�a.r, sierra R�mar'�<om ,' Name: Sierra Sprague Phone No Fax No. 951-345-4Q83 Applicant Address: 30300 Puerto Vallarta Unit Number Zip Dade 92584 Email Address- i Name: Phone No All Star Water heaters 951 345.40S3 Fax No. Contractor Address. 30300 Puerto Vallarta City Sl late Zip.Coe Men[fee � Code 92584 ontractor s City Boorty c Contractor 5 City Slate,of C�ajligo�rtia Licenzn No CIa55Pmafinn C 36 Number or Squares: V l 4 Square Fmiage Description of work: Replace existing water heater,Same size and location. Bost of Work:$ 800.00 Applicants Slgnalure I Date: To Be Cq ew By City Staff Only - Indicate As R-Received or NIA-Not Applicable 5 Comoleles sets of fully dlmensume4 drawn to sale plans which include: 1 set of documents which Include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only) ❑ Plot I Site Plan -❑ Root Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'6 x 11) ❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Stmetural Calculations ❑ Single Line diagram for elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report Residential Class Cogs: Indicate New Construction Allera(ion' Addition' MeanslMel7de Work Type Repair Retrdllt' Revisionlc Existing Pegnil' Requtieaa YES NO Proposed Building Use(s): Existing Building Use(s) P Buildings- N Units; q Stories' Will the Building Have a Basement? Y of N Bldg.Code Occupancy Group Indicate Indlcalc it YES:of NO Indicafe all Geodech.IHaz-Zone At Project Sprinkleran Completion: Construction Ih2t apply Coastal Zone Type(s): C Of O yES or NO Noise Zone Renuired? Listed on Historic Resources Inventor CITY PLANNING STAFF ONLY APPROVALS: Costal Ceramics Arch.Review.Board Landnm4 Comm. Planning Comm.Zoning Administrator Fee Exempt Gily Prnjedl Elea Vehicle Charger Land+,ark Seisnnc Retrofit snrec.m Case my 016urlApprwar Expedite Project(s): Child-Care City Project Green Building Lpndmark Allowable Housing For Start Use Only 9widmg Safo v Parmd Specrahsl City olanrnng I t rnl Gnninpenn_q r Admur l:ansprinauon Momt Rpm Cumrol THANK YOU FOR HELPING US CREATE A BEl TER COMMUNITY