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PMT15-00972 I City of Menifee Permit No.: PMT16-00972 29714 HAUN RD. ' bCEL�,rnr.' MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 04/17/2016 PERMIT Site Address: 26878 CHINA DR, MENIFEE, CA 92585 Parcel Number: 331-410-051 Construction Cost: $800.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION Work: Owner Contractor PAUL MATSUMOTO ALL STAR WATER HEATERS INC 26878 CHINA DRIVE 30300 PUERTO VALLARTA WAY MENIFEE, CA 92585 MENIFEE, CA 92584 Applicant Phone: 9513010067 SIERRA SPRAGUE License Number: 812894 ALL STAR WATER HEATERS INC 30300 PUERTO VALLARTA WAY MENIFEE, CA 92584 Fee Description Otv Amount l$) Residental Wate a Heater � � � 1_ �e 83�00 j Building Permit Issuance 1y �27.00 77 _1 00�d $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 I 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 N full force and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class License No.�'/ ,P,;�fl f� 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 ATION ❑ 1 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' By my signature below I acknowled a that, except for m compensation,issued by the Director of Industrial Relations as provided for by 9 P y personal residence in Section 3700 of the Labor Code, for the performance of wort)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 .®- 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 Ieginfo ca cov/calaw htm1. permit is issued.My workers'compensation Insurance carrier and policy number are: Carrier�� Property Owner or Aul orize Agent Date Expires /%s 1,�/�'/,'y��9/ar Policy Name of Agent Phone# 9BY 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 ofthe work for which this permit is issued, identified property for the inspection purposes, shall not any persons in anyy manner so as to become subject to the compensation 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 shall f rthwith comply with those provisions. Property wne rAuthorized Agent Date Date; / Applicant; City Business License WARNING: FAILURE TO SEG64E 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 OR A DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES tlR�O 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 APPLICANTOR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT VJ NO 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 []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, q 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 KYES 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 ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than ($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING El1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING. compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER QJR 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 . alli }'I!VLadd e DATE PERMIT/PLAN CHECK NUMBER2m,-57- noena TYPE: O COMMERCIAL ZIRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLTTION O ELECTRICAL O MECHANICAL O NEW ✓ LUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Replace existing water heater. Same size and location. PROJECTADDRESS 26878 China Dr. ASSESSOR'S PARCEL NUMBER n- 440-Q551 LOT TRACT OWNER NAME Paul Matsumoto ADDRESS 26878 China Dr. PHONE 951-679-7497 EMAIL _ APPUCANTNAME Sierra Sprague ADDRESS 30300 Puerta Vallarta PHONE 951-301-0067 EMAIL alistar.slerra@gmail.com CONTRACTOR'S NAME Sierra Sprague OWNER aUILDER4 OYES xN0 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 LICENSE CLASSIFICATION C36 VALUATIONS 800.00 SQ FT L SQ FT APPLICANT'S SIGNATURE DATEUSE ONLY -f DEPARTMENT DISTRIBUTION CnYOE MENIFEE BUSINESS GCENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE pgID-AMOUNT AMOUNT 0CASH OCHECKA OCREDITCARD VIWIAC PLAN CHECK FEES PAID AMOUNT 0CASH OCHECKB OCREOITCARD VISVNIC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Deportment 29714 Naun Rd,Menifee,CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 o Y UJ C W rl ~ C ; N r v O 'o r = a 'c 3 c A v 10 E w'— f� (gym g 7 rl 3 3 c. 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