PMT16-02758 City of Menifee Permit No.: PMT1 6-02758
29714 HAUN RD. Type: Residential Plumbing
<A-C CZ L MENIFEE,CA 92586
MENIFEE Date Issued 0812412016
P E R M I T
Site Address: 27482 EMBASSY ST, MENIFEE, CA Parcel Number: 335-323-016
92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER,SAME SIZE AND LOCATION
Work:
Owner Contractor
PAMELAWORLEY ALL STAR WATER HEATERS INC
27482 EMBASSY STREET 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92586 MENIFEE, CA 9251541
Applicant Phone:9513010067
LAREA MILLER License Number:812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE,CA 92584
Fee Description City Amount
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 415
$115.16
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 BidgPermit-Ternplaterpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and ri I am exempt from licensure under the Corittactor's State License Law for
Professions Code and my license is In full force and effect. the following reason:
License Class C-2,( � License No. 9 4 By my signature below I acknowledge that except for my personal residence
Expires Sc—2a:4 S-ignature—.. in which I must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder If it has not been constructed in its entirety by
ci I hereby affirm under penalty of perjury one of the fiollowling declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workees 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Inclustrila I Relations as provided for this application Is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.legfinfo.ca.gov/caIaw.html.
this permit is Issued.
Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date
%0 have and will maintain worker's compensation insurance,as required by
/section 3700 of the Labor Code,for the performance of the work for which a By my signature below I certify to each of the following:I am the property
this permit is Issued.My worker's compensation insurance carrier and policy owner or authorized to act an the property ownees behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
wiith all applicable city and county ordinances and state laws relating to
Carrier r� building construction.I authorize representatives of this city or county to
enter the above identified property for inspection purposes.
(This section need not to be completed is the permit Is for one-hundred Date
dollars($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT
a I certify that in the performance of the work for which this permit is issued,
lshallnotempl any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I she] Will the applicant or future building occupant handle hazardous material or a
mpY w Provisions mixture containing a hazardous material equal to or grater that the
P11V
I In t,. in Date
amounts specified on the Hazardous Materials Information Guide?
MLARNING-FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 o Yes ci No
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY a Yes ci No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit Is issued outer boundary of a school?
(Section 3097 Civil Code) Oyu allo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirrn under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)Indicated below by the hazardous material reporting.
checkmark(s)I have pla ced next to the applicable item(s)(Section 7031.5 uYes a No
Business and Professions Code).Any city or county that requires a permit to Date
construct alter,improve,demolish or repair any structure,prior to Its PROPERTY OWNER OR AUTHORIZED AGENT
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 EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRPcertifted firms and comply with
an Applicant for a permit subjects the applicant to a Civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselvesorthrough their
a 1,as owner of the property,or my employee with wages as their sole employees.For more Information about EPA's Renovation Program visit:
compensation,will do( I all of or( )portion of the work,and the structure is www.epa.Roy/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a c;An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
5a le.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder wilil have the burden of proving that it was
not built or improved far the purpose of sale. ci No EPA Lead-Safe Certified Firm is required far this project bemuse:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a if you r project does not com p ly with EPA RRP rule please fill out the RRP
Acknowledgement.
N,31 �g M
f
W; I
DATE PEIRMIT/PLAN CHECK NUMBER
TYPE: OCOMNERCIAL ORESIDENTIAL CIMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE; OADDITION CALTERATION ODEMOLITION OELECTIRICAL OMECHANICAL
0 NEW ELPLUMBING 0 RE-ROOF-NUMBER OF SQUARES--
DESCRIPTION or womi Replace existing water heater. Same size and location.
PROJECTADDRESS 27482 embassy st 0005S-o citv of Menifee
Building & Safety Dip—t ,
ASSESSOR'S PARCEL NUMBER '336- -69b -OkkM LOT TRACT
OWNERNAME parrelaworley AUG 2 3 2016
ADDRESS 27482einbassyst
PHONE 951-679,5567 EMAIL
APPLICANTNAME LaRea Miller
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar.sierra@gmall.com
CONTRAcrowsNAME LaRea Miller OWNEIRBUILD—ER? OYES>940
BUSINESS NAME All 3tar Water Heaters
ADDRESS 30300 P erta Vallarta Way
PHONE 951-301-CO67 EMAIL alistar.slerra@gmail.com
CONTRACTOR'S STATE IIC NUMBER 812894 LICENSE CLASSIFICKnON C36
VALUATION$ 800.00 SQ FT LSQFT
APPLICANT'$SIGNATU
CITY OF MENIFEE BUSINESS LICENSE NUMBER
ING PLANNING EN(INEERING FIR-E GREEN —SMIP
-DEPARTMENTIDISTRIBUTION
INVOICE PAIDAMOUNT
AMOUNT N5,�5 0 CASH 0 CHECK# OCREDITCARD VISVMC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VIWMC
OWNER RUILIDERVERIFIE1 I OYES 0 No DLNUMBER -- — NOTARIZED UETTER 0 YES 0 NO
City of Menife?Building& 5afety Department 29714 Houn Rdj Menifee, CA 92586 951.-67)-0'777
www,city0fn,c,tjjfee.u5 117.spectloo Request Une 95.1-24155-6213
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