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PMT15-02025 i City of Menifee Permit No.: PMT15-02026 29714 HAUN RD, 1k MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 0 7/1 612 01 5 i PERMIT Site Address: 29070 AVENIDA DE LAS FLORES, Parcel Number: 341-142-015 MENIFEE, CA 92587 Constructlon Cost: $800.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION '.. Work: Owner Contractor CAROL PEPPER ALL STAR WATER HEATERS INC 29070AVENIDA DE LAS FLORES 30300 PUERTO VALLARTA WAY MENIFEE, CA 92587 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 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 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 licenser 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 Cis s License Na who builds or improves thereon, and who contracts for the projects with e Exp 3'Oires Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION D CLA ATION ) 1 am exempt from licensors under the Contractors'State License',Law for the O 1 hereby affirm under penalty of perjury one o1 the fallowing declarations: following reason: ''.. I have and will maintain a certificate of consent of I•n ure 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. bullt as an owner-building If It has not been constructed In Its entlrety by licensed — contractors. I understand that a copy of the applicable law, Section 7044 of the IV.- 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:h2p�l/www.lealnfo.ca.govfcalaw.html, permit Is Issued.My workers'compensation Insurance carrier and policy number are: Carrier�lf Property Owner or Authorized Agent Date Expires&%®///S- Policy# /-,/GC S�,P/leg 9 Name of Agent Phone# ❑ By my Signature below, I certify to each of the followlnT 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 ems any persons In any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become �, -� e subject to the workers'compensation provisions of Section 3700 of the Labor property ner Authorized Agent Date Code,I shall forthwith comply with those provisions. � City Business License# 1 Date;7z(,26� Applicant: WARNING: FAILURE TO ECI,L E WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLANIFUL, 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, DYES OCCUPANT HANDLE HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SEQTIQN 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL .LABOR CODE, INTEREST, AND ATTORNEYS FEES ONO 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 ❑NO DISTRICT(SCAQMD) SEE PERMITTING.CHECKLIST FOR OWNER BUI DER D E ri ARATIONS 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 oheekmark(s)I have placed DYES 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 orshe 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 licensors 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sale HAZARDOUS MATERIAL FQEPORTING. compensation, will do( )all of or( ) porting of the work, and the structure Is PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply,to an owner of a property X who, through employees' or personal effort, bulids or Improves the property, provided that the improvements are not intended or offered for sale'If,however, the banding or Improvement Is sold within one year of completion, the Owner- Builder will have the burden of proving that It was not built or improved for the purpose of solo). 4 Menifee DATE I�'rs PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL [Z]RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW ✓ PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Replace existing water heater. Same size and location. PROIECTADDRESS 29070 Avenida De Las Flores '1 ASSESSOR'S PARCEL NUMBER LOT TRACT OWNERNAIVE Carol Pepper ADDRESS 29070 Avenida De Las Flores PHONE 951-723-2424 EMAIL APPLICANTNAME . Slerra:.Sprague ADDRESS 30300 Puerta Vallarta PHONE 951-301-0067 EMAIL allstar.sierra@gmail.com CONTRACTOWSNAME Sierra Sprague OWNERSUILDER7 OYES�ONO BUSINESS NAME All Star Water Heaters ADDRESS 30300 Puerta Vallarta Way PHONE 951301-0067 EMAIL allstar.sierra@gmail.com CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36 VALUATION$ 800.00 SQ FT LSQFT APPLICANT'S SIGNATURE DATE .S i e DEPARTMENT DISTRIBUTION CITY OF MFNIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP _A INVOICE PAID:AMOUNT " AMOUNT1. 0 CASH CHECKN O CREDIT CARD_ VISA/MC PLAN CHECK FEES PAID AMOUNT 0 CASH O CHECK It C CREDIT CARD VISA{Mc OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER _ O YES O NO City of Me.nifee Buiidirg&Safety OLportment 297.14 tloun Rd. 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