PMT16-02982 City of Menifee Permit No.: PMT16-02982
29714 HAUN RD. Type: Residential Plumbing
<;�CCFj:A—> MENIFEE. CA 92586 Date Issued: 09/0812016
MENIFEE
P E R M I T
Site Address: 31145 ENSEMBLE DR, MENIFEE, CA Parcel Number: 360-560-008
92584 Construction cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Contractor
Owner ALL STAR WATER HEATERS INC
RUSSELTAVENNER 30300 PUERTO VALLARTA WAY
31145 ENSEMBLE DRIVE MENIFEE,CA 92584
MENIFEE, CA 92584
Applicant Phone:9513010067
LAREA MILLER License Number:812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE,CA 92584
Fee Descriptlon City Amount($1
1 83.00
Residential Water Heater 27.00
Building Permit Issuance 1
GREEN FEE 1 1.00
1 4.15
General Plan Maintenance Fee-Plumbing
$115.15
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 commencedA(ithin six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
Page I of I
AA_BIdg_Perrnit.Temp1ate.rpt
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractods)pursuant to the Contractors State License Law).
Chapter9(commencing With section 7000)of Division 3 of the Business and ci I am exempt from licensure under the Contractoes State Utcense Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C-2,t , i ense No. By my signature below I acknowledge that,except for my pemonal residence
Expiresa-24 _IQ 'Signature in which I must have resided for at least one year priorto completion of
Q - improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as a n owner-builder if it has not been constructed in its entirety by
a I hereby affirm under penalty of perjury one of the following declarations:I licensed contonactors.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 website:
by Section 370D of the Labor Code,for the performance of work for which www.leginfo.ca.gcv1calaw.htmI.
this permit Is issued.
Date
Policy# PROPERTY OWNER OR AUTHORIZED AGENT
VI have and Will maintain worker's compensation insurance,as required by
Aection 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 workees compensation insurance a rrier and policy owner or authorized to act on the property owner's behalf I have read this
numberare: 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 Xr building construction.I authorize representatives of this city or county to
Policy# C_LJq00 1VTcp,e, ii 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 OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall 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 I t handle hazardous material or a
shall fio I mply wit h those provision - Will the applicant or future building occupan
S�Date mixture containing a hazardous material equal to or greater that the
Applica I amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS riYes ciNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TOONE 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 forguidellnes
CONSTRUCTION LENDING AGENCY oYes oNo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be winhin 1000 feet of th e
lending agency for the performance of the work which this permit is Issued outer boundary of a school?
(Section 3097 Civil Code) ciYes ciNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Sectlion 25505 and 25534 concerning
Contractoes License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed nextto the applicable item(s)(Section 7032.5 ciYes u 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 EPARENOVATI N,REPAIR AND PAINTING IRRP)
License Law(Chapter 9(commeneing 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 Ileged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certffled firms and comply with
an Applicant for a permit subjects th e applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managerswho do the paint-di5turbing work themselves or through their
o 1,as owner of the property,or my employee with wages as their sale employees.For more information a bout EP9s Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eva.gov/`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 Contractoes State License Law does not apply to an owner of a ci An EPA Lead-Safe Certified Renovator wifli be responsible for this Imiject
property who,through employeesor personal effort,builds or improves the
property provided that the improvements am not intended or offered for Certified Firm Name:
sale.if,however,the building or improvement is sold within one year of Firm Certifitnition No.:
completion,the Owner-Builder will have the burden of proving that it was a No EPA Lead-Safe Certified Firm Is required forthis project because:
not built or improved for the purpose of sale.
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contnactor's State License Law does not apply to an owner of a If your project does not comply With EPA RRP role please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMiT/PLAN CHECK APPLICATION
Menifpe
DATE PERMIT/PLAN CHECK NUMBER
TYPE: 0 CON MERCIAL [ZIRESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL 0 MECHAN"ot Monih 8
0 MEW [,/�LUMBING ORE-ROOF-NUMBEROFSQUARES ..-[3uliding& Safety Dept.
DESCRIPTION OF WO X Replace existing water heater. Same size and I Owe 2416
PROJECTADDRESS 31145 ensemblepv?,, qaovA ---RABoe4vbd
ASSESSOR'S PARCEL UMBER 2(gn LOT TRACT
OWNER NAME rui sell tavenner
ADDRESS 31145 msemble
PHONE 951-32g-5892 EMAIL
APPU NTNAME _LaRea Miller
ADDRESS 30300 Puerta Vallarta
PHONE 951-301w 067 EMAIL alistar.sierra@gmall.com
cowmcrowswm LaReaMiller OQWNERBUILDR OYES2NO
BUSINESSNAME A Star Water Heaters
ADDRESS 30309 1 luerta Vallarta Way
PHONE 951-301 0067 EMAIL alistar.slerra@gmail.com
CONTRACTOR'S NUMBER 812894 UCENSE CLASSIFICATION C36
VALUATION$ 80 OC' F7 — L SO FT
APPLICANT'S SIGN R DATE
CnT0FMEN1FEEBUSINMUQ0QtNuM�,
DEPARTMENT D1STRI8UTI
BUILDINW6 P�NNWG EER 6 FIRE REEN SMIP
INVOICE �x .1 PAIDAMOUNT .19::; jo� OcHECKM
AMOUNT
PLAN CHECK FE PAID AMOUNT OCHEMN Oaarrmo Y&VMC
1 0 CASH �ARPFn LErTFR 0 YE:S0 NO
OWNER BUILDER VERII 0 YES 0 NO DLNUMBER
City of Menj,ee Building&safety Depoftment 29714 Houn Rd.Menifeg,CA.92s86 9-51-672-6777
www,cityc1menffea.us tnspect;on Request LinegSI-246-6213
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