PMT16-02759 City of Menifee Permit No.: PMT16-02759
29714 HAUN RD. Type: Residential Plumbing
c��CCFECA—> MENIFEE, CA 92586
MENIFEE Date Issued: D812412016
P E R M I T
Site Address: 25129 SPRINGBROOK WAY, MENIFEE, Parcel Number: 339-431-003
CA 92594 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER,SAME SIZE AND LOCATION
Work:
Owner Contractor
NANCY HARRIS ALL STAR WATER HEATERS ING
25129 SPRINGBROOK WAY 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584 MENIFEE,CA 925B4
Applicant Phone:9513010067
LAREA MILLER License Number:812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE,CA 92584
Fee Description City Amount($)
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 4.15
$116.16
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of ernors 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 BldgPermit—Template.rpt Page 1 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 a in under Provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the follonviing reason:
License Class C 1-21( 1 License No. 4 By my signature below I acknowledge that,except for my personal residence
Expires 21-2 Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKEWS COMPENSATION DECLARATION have built as a n owner-builder if it has not been constructed in its entirety by
o I hereby affirrin under pena Ity of perjury one of the following decla nations: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 worker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following welosite:
by Section 3700 of the La bor Code,for the performance of work for which
this permit is issued. www.IegInFo.ca.Rov/calaw.htmI.
Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date
Z' I have and will maintain worker's compensation insurance,as required by
ection 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I a in the property
this permit is issued.My workees compensation insurance carrier and policy owner or authorized to act on the property ownees behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives ofthis city or county to
Policy# C_0<2 I 5pve' Ii — 19 enter the above identified property for inspection purposes.
(This section need not to be com pleted is the permit is for one-hu mired Date
dollars($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT
n I certify that in the performance of the work for which this permit is issued,
I sha 11 not employ 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 shalj��I it�'�Ply wl"In those provistions. Will the applicant or future building occupant handle hazardous material or a
Date mixture containing a hazardous material equal to or greater that the
Applica J:iJ7
amounts specified onthe Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ciYes oNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVI L F]NES UP TO ONE HUNDRED THOUSAND DOLLARS($10D,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 for guidelines
CONSTRUCTION LENDING AGEN ciYes; oNo
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) uYes oNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQVID
permitting checklist.I understand my requirements under the State of
I hereby affirm 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 placed next to the applicable item(s)(Section 7031.5 ciYes a No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,priarto 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 Contra clues State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 a lleged exemption.Any violation of Section 7031.5 by residence or childca re facility to be RRP-certified firms and comply with
a n Applicant for a permit subjects the applica nt 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 themselves or through their
ci 1,as owner of the property,or my employee with wages as their sole em ployees.For more information about EPA's Renovation Progra in visit:
compensation,will do I I all of or I I portion of the work,and the structure is www.epa.goy/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 o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through em ployees!or personal effort,builds or im proves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold Within one year of Firm Certification No.:
completion,the Owner-Builder will have the bu rden of proving that it was
not built or improved for the purpose of sa le. o No EPA Lead-Safe Certified Firm is required for this PrOjEct because:
o 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 your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
DATE !>
A" PERM IT/PLAN CHECK NUMBER
TYPE: ()COMMERCIAL FZ]RESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION 0DEMOUTION OELECTRICAL OMECHANICAL
ONEW R]PLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WOR� Replace existing water heater. Same size and location.
City of Man fee
-DY-11sling-&-Safe y Dept.
PROJECTADDRESS 25129 springbrook way 00emLA AUG 2 3--1016
ASSESSOR'S PARCEL NUMBER j!m-Lk2Pl-Qz LOT TRACT
O.WNERNAIME narcyharris Recei-- d
ADDRESS 25129springbrookway
PH13NE 951-447:.19826 EMAIL
APPLICANT NAME RaRea Miller
ADDRESS 30300 luertaVallarta
PHONE 951-301-OD67 EMAIL allstar.sierra@gmail.com
CONTRACTOWSINIAM , LaReaMiller OWPLERSUILD�R? 0YESZ1100
BUSINESSNAME All Star Water Heaters
ADDRESS 30300 uertaVallartaWay
PHONE 951-301-0,067 EMAIL allstar.sierra@gmall.com
CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION$ 8OOjOO SQ FT L SO FT
—mm 0 'R—5 561
APPLICANT'S SIGNATUREZV:�—� E
DEPARTMENT DI$TAIBUT101i CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I -
:INVOICE PAID AMOUNI 0 CASH 0 CHECK# OCREDITCARD VISAIMC
'VOICE
":MO U N=TC
A �%,)-
PLAN CHECK FEES' PAID AMOUNT 0 CASH OCHECK# 0 CREDIT C�ARD VIS�A/N'Cl
OWNER BUILDER VERIN D 0 YES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
Cityof&,jenif, eStlildii,,g&SofetyDepaltrnent29714 flounRd. Mernfee, CA92586 951. 672-6777
www.JtyofmenI`ee.u5 inspection Request Line 9SI 246-6,7-13
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