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PMT14-02782 City of Menifee Permit No.: PMT14-02782 29714 HAUN RD. MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 1 0121/2 01 4 PERMIT Site Address: 26785 WORTHY DR, MENIFEE, CA Parcel Number: 331441-017 92585 Construction Cost: $800.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION Work: Owner Contractor BRIAN VARGAS ALL STAR WATER HEATERS INC 26785 WORTHY 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 f3ty Amount($1 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,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be forfeited. AA_eldg_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 Clas,,Zf,4_L License N who builds or improves thereon, and who contracts for the projects with a Expires O Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLA ATION ❑ 1 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 Business and Professions Code,is available upon request when this application is �C have and will maintain workers' compensation insurance, as required submitted or at the following Web site:htto'//www lecinfo ca oov/calaw html. section 3700 of the Labor Code, for the performance of the work for which this s permit is issued.My workers'compensation insurance carrier and policy number are: Property Owner or Authorized Agent Date Carrier/��R Expires F/ ////,r Policy#;e/�`��9/.3i9 ❑ 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- 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 employ any persons in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become AA Z subject to the workers'compensation provisions of Section 3700 of the Labor > Code, I shall forthwith comply with those provisions. Property OwroeroryAorized Agent Date City Business License# Gd�S'Cy�S' Date;- Applicant; WARNING: FAILURE TO S CU 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 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 INFORMATION GUIDE? 1 hereby affirm that under the penalty of perjury there is a construction lending 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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS PRINT NAME: I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the reason(s)indicated below by the checkmark(s)I have placed AYES 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 I HAVE READ THE HAZARDOUS MATERIAL provisions of the Contractor's Slate License Law (Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or AYES 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 Sus ON 25505ATERIAL 25O 3 A D 25534 CONCERNING HAZANDO❑ I, as owner of the property, or my employees with wages as their sole 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; X 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). `A-ATY 0'h 1\�E1'!0F1Li LLi -- PI,Ck Na- Permll No: 29714 Haun Road Date Dal O' 1 Menifee, CA 92586 Phone: (951)672-6777 Amoum Amount Fax:(951)679-3843 Ck# ck# \\\� Building Combination Permit To Be Completed By Applicant - Legal Description: Planning Case' F: L RI- R Property Address: 26785 Worthy Dr. ASee5sof5 Parcel Number: 331441017 ProJecVTenant Name: Unit# Floor#: Name: Brian Vargyas Phone No. 951-445-1675 Fax No Properly Address Owner Same as job Unit Number Zip Code 92585 Email Address Name: Sierra S ra ue Phone W, Fax No. P g 951-345-4053 Applicant Address: 30300 Puerto Vallarta Unit Number Zip Code Email Address: 1 92584 a,lls A,-S/eI/,. ce/re Name: All Star Water Heaters Phone No 951-345-4083 Fax No. Contractor Address: 30300 Puerto Vallarta City Slate Zip Code Menifee CA 92584 ontractor n ny upr� Contractor's City State o181 iig n,a License No Classification: C 36 Number of Squares; C/ l Y Square Footage Description of Work: Replace existing water heater.Same size and location. Cost of work;s 800.00 Applicant's SignatureDale' ' To Be Completed By City Staff Only -Indicate As R-Received or N/A-Not Applicable b Comoletes sets of fully dimensioned,drawn to sale plans which include: I Eel 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%x it) ❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations ❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shorin Plan ❑ Single Line diagram for also.services over 400 AMP 9 ❑ Sound Report-Residential Class Cotle: Indicate New Construction Alteration' Addition' Means/Methods Work Type Repair' Retrofit' Revision to Existing permit' Raquired? YES NO Proposed Building Use(s): Existing Building Use(sp #Buildings: #Units: #Stories Will the Building Have a Basement? Y of N Bldg.Code Occupancy Group Indicate Indicate it Indicate all Geo-tech.Haz Zone At Project Sprinkle'ad YES or NO Completion: Construction Ihat apply: Coastal Zone Typea): C of O YES or NO Noise Zone Requiretl? Listetl on Historic Resources Inventor CITY PLANNING STAFF ONLY APPROVALS: Costal Commiss Arch,Review Board Landntar4 Cumm. Planning Comm.Zoning Administrator Fee Exempt City Project Elec.Vehicle Charger Landmark Seismic,Retrofit pen.case-amy DlLualA royal Expedite Projecl(5): Child Care City Project Green Building Landmark Allordaule Hous"ule For Staff Use Only tf lldtn S f r P r n Span.usl I Oty-mi ng I OvIi[, 9 L, Admit, 1 ....i Mg t Rem I THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY