PMT14-02748 i
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City of Menifee Permit No.: PMT14-02748
.�r� '�-y, Type: Residential Plumbing
29714 HAUN RD. T
"} 60EL..7Y MENIFEE, CA 92586 11
MENIFEE Date Issued: 10/16/2014
1
PERMIT
Site Address: 30900 GREEN BRANCH ST, MENIFEE, Parcel Number: 360-451-035
CA 92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
MATTHEW HARRIS ALL STAR WATER HEATERS INC
30900 GREEN BRANCH STREET 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
Fee Description nY Amount i$1
Building Permit Issuance 1 27.00
RE
$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 slated, 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
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City Of Menifee
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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. who builds or improves thereon, and who contracts for the projects with a
Expires 3o Signature licensed contractor(s)pursuant to the Contractors State License Law),
WORKERS'COMPENSATION DECIL TION
❑ 1 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 b this permit, cannot legally sell a structure that have
permit is issued. P Y P 9 Y
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
6�!r- 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:http:l/wwm,leginfo.ca.gov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier, P/-i ta_h Property Owner or Authorized Agent Date
Expires Fz�,z C Policy
Name of Agent Phone# ❑ BY my Signature below, I certify to each of the following: I am the property
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-
0 1 certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes.
shall not any persons in any manner so to become subject to the
compensation
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 Own A
Code, I shall forthwith comply with those provisions. P Y rA� rized Agent
Date
Date; Applicant; City Business License#
WARNING: FAILURE TO SECUR W 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 ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑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
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
❑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 reasons)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, ❑NO 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 ❑,1'ES 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($500).) CODE SECTION 25505 25533 AND 25534 CONCERNING
El 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f}EPORI'ING,
compensation, will do ( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement Is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
PI Ch Nn F'nrmit_No
City of Menif e �$
29714 Haun Road Building & Safety pt. Dale:
Menifee, CA 92586 1
Phone: (951)672-6777 OCT 14 &?i r,ount Amount:
Fax:(951 )679-3843 Ck# Ck tf
ReceiVAd _
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case, F: L RI_ R
Property Address: 30900 Green Branch St. Assessors Parcel Number
360451035
Project/Tenant Name: Unit k Floor#:
Name: Matthew Harris Phone No Fax No
951-246-3733
Properly Address
Owner Same as job unit Numher Zip Code 92584
Email Address—
Na-me: Sierra Sprague Phone No. Fax No
951-345-4083
Applicant Address: 30300 Puerto Vallarta Unit Number Zip Code
_ 92584
Email Address:
Name: All Star Water Heaters Phone No 951-345-4083 Faz No
Contractor Address: 30300 Puerto Vallarta City Menifee Slate CA Zip Code 92584
Contractors City Business License No. Contractor's City State ot8plllp�gia License No ClassifiratioI C 36
Number of Squares: 12ri 4
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 Completed By City Staff Only -
Indicate As R-Received or N/A-Not Applicable
5 Comdletes sets of fully dimensioned,drawn to sale plans which include: I set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot I Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y x 11)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' Means(Methods
Work Type. Repair' Retrofit' Revision to Ezisting Peflllil' Requlrea7 YES NO
Proposed Building Use(s): Existing Building Use(s)
#Buildings: #Units: #Stories- Will the$ullding Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate if YES or NO Indicale all Geo-tech.Haz-Zone
At Project Construction Sprinklered That apply: Coastal Zone
Completion: Type(s): Colo Noise Zone
Required? yES a NO
Listed on Historic Resources Inventor
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landman! Comm. Planning Comm.Zoning Administrator
Fee Exempt City Project Elec.Vehicle Charger Lanabliark Seismic Retrofit ,.,W case Bide
d@<ea1A naval
Expedite Projeci(s): Child Care City Project Green Building Landmark Affordable Hcusinq
For Staff Use Only ---'� — -
Buddin ;Sale: Permit Specialist City Plamm�g Gsd C�ninaenng F-�':'.L:.Adm r lrancppr a n M m Rent C n of
THANK YOU FOR HELPING US CREATE A REITE R C OMMUNITY