PMT14-02498 1
City of Menifee Permit No.: PMT14-02498
29714 HAUN RD.
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Type: Residential Plumbing MENIFEE, CA 92586 9
MENIFEE Date Issued: 09/17/2014
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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
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$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
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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