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PMT14-02829 City of Menifee Permit No.: PMT14-02829 29714 Type: Residential Plumbing l'GG�i.-A MENIFEE, CA 92586 C' 92 9 MENIFEE Date Issued: 10/23/2014 PERMIT Site Address: 29166 QUAIL BLUFF RD, MENIFEE, CA Parcel Number: 339-472-002 92584 Construction Cost: $800.00 Existing Use: Proposed Use: Description of WATER HEATER REPLACEMENT, SAME SIZE AND LOCATION Work: Owner Contractor ERIC KURTZ ALL STAR WATER HEATERS INC 29166 QUAIL BLUFF ROAD 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 QQt rr Amount f$1 �Reslge''i i F,Wa a V. m �r. 83'_ 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 Class Cf�, License N /r?`dv who builds or improves thereon, and who contracts for the projects with a Expires�(� Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ 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. Policy# built as an owner-building if it has not been constructed in Its entirety by licensed y contractors. I understand that a copy of the applicable law, Section 7044 of the Q71' 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,//www.leginfo.ca.gov/ca aw htm1. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier�CE Property Owner or Authorized Agent Date Expires zie///6 Policy#',�� 5/,GO9G,�A ❑ By my Signature below, I certify to each of the fallowing: 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 a -. subject to the workers'compensation provisions of Section 3700 of the Labor Property Owne r A4#1 prized Agent Date Cade,I shall forthwith comply with those provisions. City Business License# Date; Applicant; WARNING: FAILURE TO SECU 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, ❑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 FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS 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 [-]YES 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 Cade)or that he or DYES 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 fitEPORTING. compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED 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). Fy�erm�,i�l No Menifee 29714 Haun Road Building &f Safety Dept. Dale Menifee, CA 92586 Wo 1 13 _N Phone: (951)672-6777 OCT 2 3 2014 Amount Amount, 02- Fax:(951 )679-3843 ck# Ilk ck.# Received -- -- Building Combination Permit To Be Com feted By Applicant Legal Description: Planning Case F. L Rt R Property Address: 29166 Quail Bluff Rd. Assessor-s Parcel Number: 339-472-"@ adz 2 Project/Tenant Name' Unit# Floor#: Name: Eric Kurtz Phone No. g18 454-8642 Fax No Properly Address Unit Numher to Cnd e Owner Same as job 92584 Email gdtlress: Name: Phone No.Sierra Sprague 951-345-4083 Fax No Applicant Address: 30300 Puerto Vallarta Unit Number Zip Code 92584 Email Address: Name: All Star Water Heaters Phone No 951-345-4083 Fax No. Contractor Address: 30300 Puerto Vallarta City Slate Zip Code Menifee CA 92584 Contractor's C it usiness License n. ConUactor's City State of California License No Classification' L S 812894 C 36 Number of Squares: Square Footage Description of Work: Replace existing water beater. Same size and location. Cost of Work:S 800.00 Applicants Signature Date: /0/ // TO Be V0_M_p1_ete_d8_y_r1ty Staff Only - Indicate As R-Received or N/A-Not Applicable 5 Comotetes sets of fully dimensioned drawn to sale plans which include. 1 set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y x it) ❑ Foundation Plan ❑ Cross Section ❑ Structural Calculations ❑ Plumbing Plan ❑ 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 Existing P 1MIr 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 if Indicate all Geo-tech. Haz.Zone At Project Sprinkleretl YES or 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 Landrna4 Comm. Planning Comm.Zoning Administrator Fee Exempt City Pmjecl Elec.Vehicle Charger Landmark Seismic.Retrofit special Case-emg O(LcialA royal Expedite Project(s): Child Care City Project Green I'll filing Landmarki Affordable Housma For Staff Use Only Building,Snler; I Permit Specialist I City Planning Admim Irarsportallon Mpmt Renl Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY