PMT15-02024 City of Menifee Permit No.: PMT15-02024
29714 HAUN RD.
L t MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 07/16/2015
i
1
PERMIT
Site Address: 26095 WAVERLY DR, MENIFEE, CA Parcel Number: 338-021-004
92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
DEBBIE BARR ALL STAR WATER HEATERS INC
29065 WAVERLY DRIVE 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 ,City Amount
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 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
1
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of (he property an exclusively contracting with Ilcenset �I
Chapter 9(commencing with.section 7000),of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professiom
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 propert)
License Clogs License No Improvesprojects with E
Expires . Signature who builds tr ct thereon, and who contracts for the ro w)
WORKERS'COMPENSATION D CLA ATION - licensed contractors pursuant to the Contractors State License La
❑ 1 am exempt from licensure under the Contractors'State License Law for the
O I hereby affirm under penalty of perjury one of the fallowing declarations; following reason:
I have and will maintain a certificate of consent of 121f.insure for workers' By my signature below I acknowledge that, except for my personal residence it
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 thispermit Improvements covered by this permit, I cannot legally sell a structure.that I have
Policy9 Issued built as an owner�bullding 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 Cade, for the performance of the work for which this submitted or at the following Web site:bgnYUwww.leglnfo.ca.gov/calaw.html.
permit Is Issued.My workers'compensation Insurance carrier and policy number are:
Carrier Property Owner orAuthorizedgen
Date
Expires�"�y Policy#X��
Name of Agent Phone# D 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 041 be completed If the permit Is for application and the Information I have provided Is correct. I agree Ito 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:; 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
workers' compensation laws of California, and agree that If I should become -7 S
- subject to the workers'compensation provisions of Section 3700 of the Labor property ner Autfiorizod Agent Date
Code,I shall forthwith comply with those provisions.
City Business License
Date; Applicant;
WARNING: FAILURE TO EC1FE WORKERS' HA2:ARDOUS MATERIAL DECL'A RATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALT,
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, DYES 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 ❑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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
❑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 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 (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 DYES 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 permlt subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING,
compensation, will do( ) all of or( ) porting of the work, and the structure Is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044, Business and Professions Code:
The Contractor's State License Law does not apply,to an owner of a property X
who, through employees' or personal effort, builds or Improves the property,
Provided that the improvements are not intended or offered for sale.If,however,
the building or Improvement Is sold within one year of completion, the Owner-
Bulider will have the burden of proving that 11 was not built or Improved for the
purpose of sale).
RECK APPLICATION
Menifee
DATE �` 5 PERMIT/PLAN CHECK NUMBER �J
TYPE: 0 COMMERCIAL ❑✓ RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION 0 ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
0 NEW ✓ PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace existing Water heater. Same SIZe and location.
PROJECTADDRESS 29065 Waverly Dr. 0057p
ASSESSOR'S PARCEL NUMBER &2$- ow- OvLk LOT. TRACT
OWNER NAME Debbie Barr
ADDRESS 29065 Waverly Dr.
PHONE 951-679-5603 ..EMAIL
APPLICANT NAME Sierra S ra Ue. ..
ADDRESS 30300Puerta Vallarta
PHONE 951-301-0067 EMAIL allStar.Slerra@gmail.com
CONTRACTOR'S NAME Sierra.Sprague OWNERBUILDER? 0 YES 00
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
VALUATION$ 800.00 SQ FT _ _ L SQ Fr
APPLICANT'S SIGNATURE yam�,_.,.�. DATE S S
-:Z
W
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING fIRE 6RE EN SMIP
INVOICE - PAID:AMOUNT
AMOUNT G>CASH 0 CHECK# C)CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH 0 CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER O YES 0 NO
..ww... City of Menifee Building&Safety Department 297.E4 Houn Rd. Menifee, GA 92586 951-672-6777
www.cityof nenife.e.us Oupection Request line 951-246-6213
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