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PMT14-02498 1 City of Menifee Permit No.: PMT14-02498 29714 HAUN RD. � Type: Residential Plumbing MENIFEE, CA 92586 9 MENIFEE Date Issued: 09/17/2014 i 1{ I PE R M I T Site Address: 29207 DESERT HILLS DR, MENIFEE, CA Parcel Number: 338-051-015 92585 Construction Cost: $800.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION Work: Owner Contractor SHY CARNEY ALL STAR WATER HEATERS INC 29207 DESERT HILLS DRIVE 30300 PUERTO VALLARTA WAY MENIFEE, CA 92585 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 t3ty Amount 1$1 - Building Permit Issuance 1 27.00 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 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 Templatexpt 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 Class �3y License No. 40/.? who builds or improves thereon, and who contracts for the projects with a Expires Z60e Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARA ION ❑ I am exempt from licensure 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 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 shave and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is ection 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http,//www.leglofo.ca.ciov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Property Owner or Authorized Agent Date Carrier�i1Qf•ia...� ,/ Expires .P,// �i Policy#MiVGCf ��3f ❑ 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 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 workers' compensation laws of California, and agree that if I should become s subject to the workers' compensation provisions of Section 3700 of the Labor Property Ow r or m orized Agent Date Code, I shall forthwith comply with those provisions. Date; Applicant; City Business License# 7,? o/S � WARNING: FAILURE TO SECLfItE 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 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 QkNO 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 1�,,NO DISTRICT (SCAQMD) SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS 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 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, 6ZNO 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 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).) HODS SECTION 25505RIAL f�E 5533ORI, AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole G. 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). ICATY OF MENII~EE City of Menifee PICKN,, Fnrmil No Building Dept 29714 Haun Road Date parr t; S S Menifee, CA 92586 SEP 17 2014 Amount a Phone: (951)672-6777 Amo mt Fax:(951)679-3843 Receive If Ck# \ Building Combination Permit To Be Completed By Applicant Legal Description: Planning Case F L Rt R Property Address: 29207 Desert Hills Rd. Assessor s Parcel Number: 338051015 Project/Tenant Name' Unit Floor#: Name: Shy Carney Phone No 951-723-8300 Fax No Property Atltlress- Owner Same as job Unit Number Zip Code 92585 Email Address. Name: Sierra Sprague Phone No Fax No 951345 4083 Applicant mailAddr Ad 30300 Puerto Vallarta lint Number Zip Code 92584 Email Adtlres � / Name: All Star Water Heaters Phone No 951-345-4083 Fax No Contractor Address: 30300 Puerto Vallarta C'ty Menifee State CA Zip Code 92584 contractor's ry uam ss n Conlraclor a City Slate of A fBot a License No Classification C 36 Number of Squares: 11 99 Square Footage Description of work: Replace existing water beater.Same size and location. Cost of work:S 800.00 Applicant's Signature Date- To be Corn~By city SO only Indicate As R-Recelved or N/A-Not Applicable b Completes sets of fully dimensioned.drawn to sale plans which include: 1 set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on ed only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on s Y:x ll) ❑ Foundation Plan ❑ Cross Section ❑ Structural Calculations ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP ❑ Flow Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration' Addition' Means/Methods Work Type. Repair' Retrofit' Revision to Eusiing Pemdl' 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 indicate it indicate all Geo-tech Hat Zone At Project Sprinklered YES w NO Completion: Construction that apply: Coastal Zone Type(s): C Of O YES or NO Noise Zone Required? Listed on Historic Resources Inventor CITY PLANNING STAFF ONLY APPROVALS: Costal Commiss Arch.Review Board LandtnaO Comm I Planning Comm.Zoning Administrator Fee Exempt City Project I JEJec; Vehicle Chargerl I Land,,ark Seismic,Retrofit sr,er'al case Bmq Onmial Approval Expedite Proiecl(s): Child Care City Project Green Building Landmark ARomabie Housino For Staff Use Only Buddm2,5afe!y Permd Specv,kxl I C.ty 'lamm.q lnc G einnemg + ndmn. t,ansyjnahgn Mpmt Rom Cunvol THANK YOU FOR HELPING US CREATE A BEl 7ER COMMUNITY