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