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PMT15-01174 City of Menifee Permit No.: PMT15-01174 29714 HAUN RD. Type: Residential Plumbing .1...A.' MENIFEE, CA 92586 MENIFEE Datelssued: 05/07/2015 PERMIT Site Address: 26127 GOLDENWOOD ST, MENIFEE, CA Parcel Number: 335423-028 92586 Construction Cost: $800.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION Work: Owner Contractor MARIA PARKER ALL STAR WATER HEATERS INC 26127 GOLDENWOOD STREET 30300 PUERTO VALLARTA WAY MENIFEE, CA 92586 MENIFEE, CA 92584 Applicant Phone: 9513010067 SIERRA SPRAGUE License Number: 812894 ALL STAR WATER HEATERS INC 30300 PUERTO VALLARTA WAY MENIFEE, CA 92584 Fee Description QtV Amount I$) Building Permit Issuance 1 27.00 v- �GRE7=NaFEeE?,�a,,.u.r:af $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 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.,g"[� ? 7�_ who builds or improves thereon, and who contracts for the projects with a Expires 0 Signature 44904 licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DEC KRATION ❑ 1 am exempt from licensure under the Contractors'Slate 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 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 qi!�, 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:htto�//www.leginfo.ca.gov/`calaw.html. permit is issued. My workers'compensation insurance carrier and policy number are: Carrier/7 C..� Property Owner or Authorized Agent Date Expires4///Z f Policy# Name of Agent Phone# ❑ By 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- El I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes. shall not ample any persons in any manner so to became subject to the compensation �/( S workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Prope wn rAuthorized Agent .Date Code, I shall forthwith comply with those provisions, .S S a5� City Business License Date; Applicant; /2pP� WARNING: FAILURE TO SEC REtiI 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, AYES OCCUPANT HANDLE HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES PNO 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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT qi,,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, IqNO 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 ZIyES 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 ($500).) CODE SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f EPORI ING, compensation, will do ( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED AGENT not intended or offered for sale.(Section 7044, Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If,however, the building or Improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). BUILDING & SAFETY `. APPLICATION Menifee DATE PERMIT/PLAN CHECK NUMBER — TYPE: O COMMERCIAL ✓ RESIDENTIAL O MULTI•FAMILY O MOBILE HOME 0 POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW ✓ LUMBING 0 RE-ROOF-NUMBER OFSQUARES DESCRIPTION OF WORK Replace existing water heater. Same size and location. 26127 Goldend St. city D PROlECTADDRESS woo IIdIn & S etyty Dept. ASSESSOR'S PARCEL NUMBER 335-423-028 LOT TRACT mAy 0 2015 OWNERNAME Maria Parker ADDRESS 26127 Goldenwood St. Rece ived PHONE 951-679-7845 EMAIL APPLICANT NAME Sierra Sprague ADDRESS 30300 Puerta Vallarta ...,........_.- PHONE 951-301-0067 EMAIL allstar.sierra@gmail.com CONTRACTORS NAME Sierra Sprague OWNER BUILDERd 0 YESg NO BUSINESS NAME All Star Water Heaters ADDRESS 30300 Puerta Vallarta Way PHONE 951-301-0067 EMAIL ailstar.sierra@gmaii.com CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36 VALUATION$ 800.00 SQ FT L SQ FT APPLICANT'S SIGNATURE DATE S DEPARTMENT DISTRIBUTION v CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP /. INVOICE PAID AMOUNT 11 0 AMOUNT I , O[A$H O CHECK# CREDIT CARD VISAING PLAN CHECK FEES I PAIDAMOUNT 0CASH 0 CHECK# OCREDITCARD VLSAIMC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 NaunRd. Menifee,CA 92586 951-672-6777 www.cityofinenifee_us Inspection Request tine 951-246-6213 p N s o S A AMy 2 ' oo 'N � a 'om ms v 3 m n o W w a 3 tCn y•.S m M �i 0 A �ni o m a p c ry mry a M. 3 w � Z 0 °O*, Q 3 r m q m o m 3 mc o T a p 'o m m a m x 3, z mx w N S KKy. E 3 ° 'aO a3n y —I - f ro z =« � N �c n o j J � N a N a Ll A n 3O N N O m £ c o m 3 c r G ^ x v � '° o _, p yam � .. .� m r$ a r. m � •n � - 2 w a a o =0 ._� .. a m .1. O .ar CL (� A 2 00 D^ v H fL N y Oo 0 a o _ 3 m v $ ° o w T o n N v '� x •T+ 3 �+ a `D a `+ m -170 ET C 8 Ll G 00 A F w o. a a W, w _. 3 m O N m to O m a 3 a F y fe N OTC W -y m` ro : �• C N yp oOq ' 3 'n N a y y a a a a � i1 � � In O. � •^ K � N � � N A � A N m a rtrrl •b �1'C�15- O 1114 OAF P Q? V Ot 61 psue,CD 9�aTyyCD a + 2- a CD to ro a ro Y co m ¢ 3? , Ea w CNJ7 N 3 t a s ,* a. AZ Z ro a ro -3 CT rofo 00 r m a N a a N R' 5 am p. ry�ry w : as jai tlro 3: c a � co4 � �, w ip � ro CL CL -4 e, o' m b °0 3, 3 a'To igr u 1 o :. i 'M C addor Lai I i