PMT14-02499 I
i
City of Menifee Permit No.: PMT14-02499
MENIFEE,
EE, C 92 Type: Residential Plumbing
MENIFEE, CA 92586 '.
MENIFEE Date Issued: 09/17/2014
PERMIT
Site Address: 28605 MIDSUMMER LN, MENIFEE, CA Parcel Number: 364-213-022
92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
BRANDI DAVIS ALL STAR WATER HEATERS INC
28605 MIDSUMMER LANE 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 OQt Amount I$1
a
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 Menifee.Except as otherwise stated, a permit for construction under which no work Is commenced within six
months after issuance,orwhere the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA 61dg_Permit 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 Class� License No. P'raR9>r who builds or improves thereon, and who contracts for the projects with a
Expires Z40 y 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 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
echave and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
tion 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto://www lecinfo ca cov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Agent
Carrier�fi�n Property Owner or Authorized t Date
Expires Zl e /.S Policy#��GCf�;7®91o3A
❑ 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 ofCalifornia, and agree that if I should become
Labor � �
subject to the workers'compensation
sation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Property Ow r orho6orized Agent Date
Date; Wzz Applicant; s City Business License
WARNING: FAILURE TO SEC E 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
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES (1&`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
3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE
APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
l&,NO 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 DYES 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, gNO 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).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation, will ( )all of or ( ) porting of the work, and the structure PROPER OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044, Business and Professions Code;
The Contractor's Slate License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the properly,
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 MENIFEtbity of Menifee -- -
PI ChNn Permit No
Building Dept �.t1
29714 Haun Road Dale Dale:
Menifee, CA 92586 S 7 i
Phone: (951)672-6777 Amount Amnunf
Fax:(951)679-3843 k# Ck#I, �
Receive
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case• F L RI R
Property Address 28605 Midsummer Ln Assessor s Parcel Number: 364213022
ProjecUTenanl Name Unit If Floor#:
Name: Brandt Davis Phone No Fax No
Property 951-679 9676
p y Address Unit Number
Owner Same as job Zip Code 92584
Email Address
Name: Sierra Sprague Phone.No. Fax No
931-343-4083
Applicant Address:
30300 Puerto Vallarta Unit Number Zip Code 92384
Email Address' `
Name: Phone No
All Star Water Heaters 931-343-4083 Fax No
Conlractor Address: 30300 Puerto Vallarto City Menlfee State CA I Zip Code 92384
omracr°r a City Business License No CoNrector s Clly State ork'jrjZi{947a License No Classification C 36
Number of Squares:
Square Footage
Description of work: Replace existing water heater.Same size and location. Cost of work:S 800.00
Applicant Signature Dale:
,iFJI_
To M COITPNLld By City S1a1F Only
Indicate As R-Recelved or N/A-Not Applicable
5 Correlates sets of fully dimensioned drawn to sale plans which include: I set of documents which Include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on cd only)
❑ Plot I Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 9%x 11)
❑ Structural Calculations
Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑
❑ Single Line diagram for elec services over 400 AMP
❑ Floor Plan ❑ Structuml Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' MeansfMemods
Work Type. Repair' Retrofil• Revision to Existing Permit IRequired? YES NO
Proposed Building Usefs): Existing Building Usels)
#Buildings: If Units: #Stories Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate if YES or NO ;hat
allHI
Geodech.Haz Zone
At Project Construction Sprinktered that apply: Coastal Zone
Completion:
Type(s): Colo YES NO NO Noise Zone
Requiredl iifed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS. Costal Commiss Arch Review Board Landmark Cunim Planning Comm Zoning Atlministralor
Fee Exempt City Project I jElec Vehicle Charger Landmark Seismic.RetroAt spensi case:Bldg
Offuwl ,,i
Expedite Projects} Child Care Cily Project Green Building Landmark Affordable Housing
For Stan Use Only
Building:5alely Permit Specii Cdy olanrnnij 0,!Emminnennq I1.�'' Admix Irenspnnakon Momi Rein C(udrel
THANK YOU FOR HELPING US CREATE A BE17 ER COMMUNITY