PMT14-03265 City of Menifee Permit No.: PMT14-03265
_ 29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Plumbing
s� eswM " MENIFEE Date Issued: 12/16/2014
PERMIT
Site Address: 27361 PROMINENCE RD, MENIFEE, CA Parcel Number: 335-453-028
92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of - REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
MARILYN COOPER ALL STAR WATER HEATERS INC
27361 PROMINENCE 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92586 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 Q_yt Amount
Resltletstial Water Heater tim 63 00
Building Permit Issuance 1 27.00
GREEN FEE,
$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_Bldg_Permil Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I ar0 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 / Signature licensed contractor(s)pursuant to the Contractors State License Law),
WORKERS'COMPENSATIONDECLAR TION
❑ I am exempt from licensors 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
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/calaw html,
permit Is issued.My workers'compensation insurance carrier and policy number are:
Carrier��� Property Owner or Authorized Agent Date
Expires ZZ"Z/5 Policy#,ZC CC�d
y 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-
❑ I 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 became subject to the
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 O ev hcrized Agent Date
Code, I shall forthwith comply with those provisions.
City Business License#
Date; Z / / _ Applicant; �+^^C..
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
($900,000), 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 []YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT (SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
1 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 items)(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 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, SECTION 25505, 25533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORYING.
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 Cade;
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).
CITY OF ♦vaE 7IFEE PI CK Nn Pnrmil No
29714 Haun Road
:
Menifee, CA 9258�''ICity of Menifee Date Dale.
Phone: (951)672Vfiding & Safety Dept. Amtlunl Amount
oa
Fax:(951)679-3843 DEC 1 1 2014 Ck# ck i
Building Combination lq@tved
To Be Completed By Applicant
Legal Deslxiption Planning Case F L Rt R
Property Address: 27361 Prominence Rd. Assessor s Parcel Number:
ProjecVTenent Name: Unit# 5 Floor#
Name: Marilyn Cooper Phone No 951-301-0547 Fax No
Property gtltlress Unit Number ZipCode
Owner Same as job 92588
Email Address:
Name: Sierra Sprague Phone No 951-3454083 Fax No
Applicant Address: Unit Number Zip Code 30300 Puerto Vallarta p 92584
Email Address:
Name: All Star Water Heaters Phone No 951.3454083 Fax No
Conhaclor Address: 30300 Puerto Vallarts City Menifee SteteCA zip code 92584
ontrector s by Business License No contractors City State o18AIi18o�i�a License No Classification C 36
Number of Squares: 11
Square Footage
Description of Work: Replace existing Water beater.Same size and location. Cost of Work:S 800.00
Applicant s Signature
Date:
To 19a aced Ry atilt only
Indicate As R-Recalved a NIA-Not Applirable
5 Cgmpleles sell,of fully dimensioned,drawn to sale plans which include: I set of documents which include
❑ Title Sheet ❑ Elevations 0 Electrical Plan ❑ Goo TechlSoils Report(on cd only)
❑ Plot f Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 0%x 11)
❑ 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 1 ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration. Addition, Means/Methods
Work Type. Repair' Retrofit* Revision to Existing Permit' Requiree? YES NO
Proposed Building Use(s): Existing Building Uses)
#Buildings: #Units: #Stories, Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate it YE5 or NO Indieste all Geodech Hat Zone
At Project Construction Spnnkl¢r0 thal apply: Coastal zone
Completion Type(s): C of o Noise Zone
Raquiredo YES or NO
Listed on Historic Resources Inventor
CITY PLANNING STAFF ONLY
APPROVALS. Costal Commiss Arch.Review Board I I Landma6 Comm I Planning Comm.Zoning Administrator
Fee Exempt City Project I lElec Vehicle Cbergerl Landmark Seismic,Relro01 on coal .a.oraide
Expedite Project(s): Child Care City Project Green Building Landmark Alrornable Housing
For Staff Use Only
emldmq/Saiety I Pi,m,l brwh ',sl Uy ulannmq I (.,T ,,p nn,xq Admm imnfiMnanen(rtpmi Renl Control
THANK YOU FOR HELPING US CREATE A BEl TER COMMUNITY
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