PMT14-03266 City of Menifee Permit No.: PMT14-03266
_ 29714 HAUN RD,
MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 1211612014
PERMIT
Site Address: 26074 VERDE GRANDE CT, MENIFEE, Parcel Number: 337-410-023
CA 92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
LEONARD JACOBSON ALL STAR WATER HEATERS INC
26074 VERDE GRANDE COURT 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 Qtv Amount
gitesidentia Water Heater r ry 1 _ _ F ti' 83.04
Building Permit Issuance 1 27.00
'GREEN,FEEw.,t
$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 Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I and 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 11� — License No. F%ggp who builds or improves thereon, and who contracts for the projects with a
Expires_Q (,L_ 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. 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
P5- 1 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.loq!nLo,ca.gov/calaw.html.
permit Is issued.My workers'compensation insurance carrier and policy number are:
Carriel'z ' / . Property Owner or Authorized Agent Date
Expires e-ZS Policy
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. 1 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-
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 /J
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 erg uthorized Agent Date
Code, I shall forthwith comply with those provisions.
City Business License# _
Date; / / Applicant; � •C.
WARNING: FAILURE TO SECU 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
($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 ❑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
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 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 []YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from icensure 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 sale HAZARDOUS MATERIAL REPORT 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).
(X y OF jr`ENIFEE PICK Nn.'.— Fn.mit No
29714 Haun Road City of Menifee _ Caq
Buildiny & Safet Dep t. Dale Date
Menifee, CA 92586 la I tt I ILA
Phone: (951)672-6777 DEC 1 1 2014 Amount Amount
Fax:(951)679-3843
Cs ri CkY
Received _
Building Combination Permit
To Be Completed 8 Applicant
Legal Description: Planning Case• F L RI R:
Property Address: 26074 Verde Grande Ct. Assessor s Parcel Number:
Project/tenant Name: Unit x Floor p 3
Name: Leonard Jacobson Phone No 626-688-8932 Fax No
Property Address' Unit Number Zip Gode
Owner Same as job p 92686
Email Address:
Name: Sierra Sprague Phone Nn Fax No
951-345-40g3
Applicant Address: Unit Number Zip Code
30300 Puerto Vallarta p 92584
Email Address:
Name: A8 Star Water Heaters Phone No 951-345-4083 Fax No
Contractor Address: 30300 Puerto Vellarta City Menifee State CA Zip Code 92584
Contractors City Business License No
ConOaclor's City state oftllZ�oY9ia License No Classification C 36
Number of Squares: tl ZS 9
Square Footage
Description of work: Replace existing water heater.Same size and location. Cost of work:S 800.00
Applicants Signature
Date:41 /.?//,1 /
lell To go Completed By city slag Only
Indicate As R-Received or N/A-Not Applicable
5 Compietes sets of fully dimensioned,drawn to sale plans which include: t set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo TechlSoils Report(on cd only)
❑ Plot f Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
❑ Foundation Plan ❑ Cross Section ❑ plumbing Plan ❑ Struclural Calculations
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shorting Plan ❑ Sound Report-Residential
Class Cade: Indicate New Construction Alteration' I Addition' Meanstetethoda
Work Type: Repair' Retrofit' Redsbn to Existing Permit Required? YES NO
Proposed Building Use(s): Existing Building Uses)
'N Buildings, If Units: p Stories' Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate If yE5 or NO Indicate all Geo-tech Haz Zone
At Proles Construction spdnkleren that apply: Coastal Zone
Completion:
Type(s): C 0f O YES or NO Noise Zone
Requbee? Listed on Historic Resources Inventor
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm Planning Comm lZoning Administrator
Fee Exempt City Project Elea Vehicle Charger Landc+ark Seismir,Relroft Spe-ue Case'aldg
Oflu.wl Approval
Expedite Prraject(s)- Chiltl Cara City Project Gmen Building Landmark Ano,dable Housing
For Staff Use Only -
Buddmg:saki" _I Perms Spaneksl City Planning Cr,r.Enalneenrw Admn Uanziwnayo'i Momt Rent Caniro!
THANK YOU FOR HELPING US CREATE A BE77ER COMMUNITY
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