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PMT15-00971 City of Menifee Permit No.: PMT15-00971 29714 HAUN RD. Type: Residential Plumbing 'WCCE.L A—> MENIFEE, CA 92586 MENIFEE Date Issued: 04/17/2015 PERMIT Site Address: 28778 BROADSTONE WAY, MENIFEE, Parcel Number: 340-123-006 CA 92584 Construction Cost: $800.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION Work: Owner Contractor MICHAEL ANNA ALL STAR WATER HEATERS INC 28778BROADSTONE WAY 30300PUERTO 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 Oft Amount($1 R,e'10(y ltial Wat5-7 2f�H 2'erw.,, m vtl-ls�;w�uaew a'as¢ a "1 83. p] 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 building 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 it 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 License No.q/ ,P?� 9 s�._ 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 DECL RATION ❑ I am exempt from Iicensure 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' for by By my signature below I acknowledge that, except for my personal residence In compensation, Issued by the Director of Industrial Relations as provided Section 3700 of the Labor Code, for the performance of world for which this which I must have resided for at least one year prior to completion of permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have Policy# built as an owner-building if It has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the 4�1.. 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:htl :/www.a info.ca. ov/calaw.html. permit is Issued.My workers'compensation insurance carrier and policy number are: Carrier l✓�i� roperty Owner or Aul orize Agent Expires M Policy# Date, �/�/.'1�P//y/o��� Name of Agent Phone# eBy my Signature below, I certify to each of the following: I am the property 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 emploany persons in any manner so as to become subject to the --�1 workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall f rthwith comply with those provisions. _ Property wn� r Authorized Agent Date Date; / Applicant; City Business License WARNING: FAILURE TO SE RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL HAZARDOUS MATERIAL DECLARATION 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, EYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES r.W'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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT ENO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS GUIDE LINES 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 DYES 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 (Chapter9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL Section 7000)of Division 3 of the Business and Professions Code)or that he or RYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Iicensure 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 FIND 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 HAZARDQUS MATERIAL REPOR1 ING. compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER W 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). City of Menifee Building Dept BUILDING SAFETY PER%flT/PLAN CHECK APPLICATION fk Menifee DATE 4 PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL [?]RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA O SIGN SUBTYPE: O ADDITIO O ALTERATION O DEMOLITION 0 ELECTRICAL O MECHANICAL O NEW ✓ LUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Replace existing water heater. Same size and location. PROJECTADDRESS 28778 Broadstt}o_ne Way , ASSESSOR'S PARCEL NUMBER ��[X7`UIJIV LOT TRACT OWNER NAME Michael Anna ADDRESS 28778 Broadstone Way PHONE 951-679-7805 EMAIL _. _.. APPucANTNAME Sierra Sprague ADDRESS 30300 Puerta Vallarta PHONE 951-301-0067 EMAIL alistar.sierra@qmail.com CONTRACTOR'SNAME Sierra Sprague OWNER BUILDERS OYES O BUSINESS NAME All Star Water Heaters ADDRESS 30300 Puerta Vallarta Way PHONE 951-301-0067 EMAIL allstar.sierra@gmail.com CONTRACTOR'S STATE LIC NUMBER 812894 UCENSE CLASSIFICATION C36 VALUATIONS 800.00 SQ FT LSQFT APPLICANTS SIGNATURE DEPART MENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING Fine GREEN SMIPINVOICE AMOUNT PAID AMOUNT 1 r O�H OCNEa# OCREDITCARD VIWMC PLAN CHECK FEES PAID AMOUNT 1 0CASH 0CHECK# OCREDITCARD w5A/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City pfMenifee Building&Safety Oeparrment 29784 Naun Rd.Arlenifee,CFI 92586 951-672-6777 www.cityojmenifee.us Inspection Request Line 951-246-6213 e 340 v At lie N N n c m 3 N C 0 O N m a N = N 4 cv w fi _ E o E w w ao _ co N a s c a = N O -O N e�is i y 9 m a r 3 0 0] � U Q M "' w a C a a E - N N v g x a A N m � W � # a � N Q w •# a '� e w c a E o 1%1 o 'p a N ❑ ❑ N O F N Z a C v E= � u ti ~ L ` d E E N a .o w E E ` •d 14 c: c o o> ,° � E y 3 C i L �y �• N M N A a D 0 6 to • D C ... a C - N E W •r N N a C S ~ a D M a W C v m2 A L d u C E 1p E �i v `o # m G # w u a v N e''m W a� = E Li A a a c E $ o c a E w � y o 0, o N 0 cN Q a m a U. a y o E 'E^ Qi VI O W2 = E y vEi 3 io # SNy � VI N C.0 d O :�1 Vl pCr E c s' a 10 E 12 a $ o ° c e °c E c y « Z cn g O w 2 cEa c a W F- o F Q" N C9 u m a N 3 c e - yo o�Lv y S 3 Z $ N 'c W2gs w W t� u41 N jy g _ WO 0 .- LL Z W 'Z L d G �-1 fti rtf W �.. 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