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PMT14-02419 1 I City of Menifee Permit No.: PMT14-02419 _ 29714 HAUN RD. i, MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 09/09/2014 PERMIT Site Address: 29747 ROCK CANYON RD, MENIFEE, CA Parcel Number: 340-461-019 92584 Construction Cost: $800.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION Work: Owner Contractor TRACY ADLER ALL STAR WATER HEATERS INC 29747 ROCK CANYON ROAD 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 ON Amount($1 e i e la r� e e fit. 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 Manifee.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 l City Of Menifee LICENSED DECLARATION 1 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,6' �z who builds or improves thereon, and who contracts for the projects with a Expires Si natur TG p 9 licensed contractors pursuant to the Contractors -.9� ( )P tors State License Law), WORKERS'COMPENSATION DECLA ATION ❑ I am exempt from Iicensure under the Contractors'State 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 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 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:hftp://wm.leoinfo,ca.gov/calaw,html. permit is issued.My workers compensation insurance carrier and policy number are: Property Owner or Aut orized Agent Carrier iyJ/eVi lR/7 Date Expires �'/i �S Policy#�'/n//, ❑ 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- El I certify that y the performance of the work for which this permit is issued,I identified properly for the inspection purposes. employ not emov any persons in any manner so 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 Ow orA rized Agent Date Code,I shall forthwith comply with those provisions. Date; �� Applicant; City Business License# �,.��l —t f—�-z-�- 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, OYES 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 F%C 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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address P'-N0 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 checkmark(s)I have placed OYES 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, MO 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 VYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Iicensure 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING El1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f EPORIING. compensation,will do ( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property who, through employees' or personal effort, builds or Improves the property, provided that the improvements are not intended or offered for sale. If,however, the building or improvement Is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). Ci TY OF M E 1'Af Q F E E PI Ce Nn- .�._ Cermil N, 29714 Haun Road Date Dale OR Menifee, CA 92586 Phone: (951)672-6777 Amount Amnnm co Fax:(951)679-3843 C1,a Gkn � Building Combination Permit To Be Completed By Applicant Legal Description Planning Case' F! L RF R Property Address: 29747 Rock Canyon Rd. Assessors Parcel Number: 340461019 Proje V enam Name: Unit N Floor#' Name: Tracy Adler Phone No, 562.381.4725 Fax No Property Address P Unit Number Zi Corte Owner Same as job 92584 Email Adtlressl Name: Sierra Sprague Phone No 951-345-4083 Fax No. Applicant Address- 30300 Puerto Vallarta Unit Number '... Zip Code 92584 Email Address: Ai//S r s/QrI'a ma.,lrarll Name. All Star Water Heaters Phone No 951-345 4083 Fax No. contractor Address: 30300 Puerto Vallarta City Menifee SlateCA Zip code 92584 ontracf- It t teensy o. Contractor's City State ofa,ii 041A License No laasigcalich C.36 Number of Squares: Z Square Footage Description of Work Replace existing water heater.Same size and location. Cost of Work:S 800.00 Applicant's Signature (Sale. 9 � /dIl To Fe Co; Q eted By City$Gff Only I Indicate As R-Received or N/A-Not Applicable I b Comiiletes sets of fully dimensioned,drawn to sole plans which include: I set of documents which include ❑ Title Sheet ❑ Elevations d Electrical Plan ❑ Goo Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ THle 24 Energy(on 8%x 11) ❑ 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: Intlieate New Construction Alteration' Addition' MeansfMelhods- WorkType Repair' Retrofit' Reylsion to Existing Peonil' Required? YES NO Proposed Building Use(s): Existing Building Use(s), 1!Buildings' tl Units: 4 Stories' Will the Building Have a Basement? Y of N Bldg.Code Occupancy Group Indicate Indicate if YES or NO Indicate all Geo-lechJJ.Haz..Zone At Project Sprinklered that a Completion: Construction PP Y' coastal Zone Type(s): C 01 o YES or NO Noise Zone Required? Listed on Historic Resources Inventor CITY PLANNING STAFF ONLY APPROVALS: Costal commiss Arch.Review Boartl Landmark Convtl. Planning Comm Zoning Administrator Fee Exempt City Project Elect.Vehicle Charger Landmark Baisrnic Retrofit Srcrlal casealaq Oflu,al Au meal Expedite Project(s): Child Care City Project Green 8(lilding Lb)idniarkl I Almidable Hcusino For Staff Use Only BinIding1Sale!v I Permit SPeclmist I Cit,Plsmmng Crvn Emceermg L""n Admen irnngprynaoon r omt Point Control THANK YOU FOR HELPING US CREATE A SET'T'F.'R COMMUNITY