PMT16-02983 City of Menifee Permit No.: PMT16-02983
29714 HAUN RD. Type: Residential Plumbing
<A—CCIELA> MENIFEE,CA 92586
MENIFEE Date Issued: 09108/2016
P E R M I T
Site Address: 29434 WARM SPRINGS DR, MENIFEE, Parcel Number: 340-274-015
CA 92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
DON MILLER ALL STAR WATER HEATERS INC
29434 WARM SPRINGS DRIVE 30300 PUERTO VALLARTA WAY
MENIFEE,CA 92584 MENIFEE,CA 92584
Applicant Phone:9513010067
LAREA MILLER License Number:812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MEN]FEE,CA 92584
Fee Description Qtv Amount($1
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
$116.15
The issuance of this permit shall not prevent the building official from thereafter requiflng the correction of errors in the plans and
specifications or from preventing builiding operations being carried an 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 Bidg_Permit-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 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
ChapterS(commencing vvith section 7000)of Division 3 of the Business and a I a in exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effe ct. the following reason:
License Class C-)v , License No. By my signature below I acknowledge that,except for my personal residence
Explres.ST��l S-ignature_, 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
WORKER'S COMPENSATION DECLARATION have built as an 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 contractors.I understand that a copy of the applicable law,Section
have and will maintain a certifinte 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 applintion is submitted or at the following website:
by Sectlion 3700 of the Labor Code,for the performance of work for which www.leRInfo.ca.Roy/calaw.htmI.
this permit is issued.
Policy# Date
Yhave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
."Ition 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 m the property
this permit is issued.My worker's compensation insura nce ca rrier and policy owner or authorized to act on the property owner's 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 of this city or county to
Policy# C-LKOO- "Qpues S-I enter the above Identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundmd Date
dollars($:LOD)or less PROPERTY OWNER OR AUTHORIZED AGENT
a I certify that in the performance Of the work for which this permit is Issued,
I shall not employ any persons In any ma nner 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 sh I I In h provisions. Wilithea plicant or future building occupant handle hazardous material ora
all fo lt�.' mp y P
Applica —�fo '- Date mixture containing a hazardous material equal to or greater that the
- - 1�1 amounts specified on the Hazard Ous Materials Informatio n Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 Oyes ONO
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 ON E HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or madlikation from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See perm itfing checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines
CONSTRUCTION LENDING AGENCY ri Yes a No
I hereby affirm that under the penalty of perjury them 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) ayes ONO
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACIMD
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)(SacCion 7031.5 oYes ci 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,a Iso 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 IRRPI
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 RRP-certffied firms and comply with
a n Applicant for a permit subjects the applicant to a civil pena Ity,of not mom required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the propeft or my employee with wages as their sole employees.For more Information about EPA's Renovation Program visit:
compensation,will do( )all of or( 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 Profiessions; 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or persona I effort,builds or improves 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 Cerilification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. a No EPA Lead-Safe Certified Firm is required for this project bemuse:
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.
Mendree
7DATE 7A, PERMIT/PLAN CHECK NUMBERVK"%-Q- ae
TYPE: 0 CON MERCIAL PIRESIDENTtAL o muai-rAmv 0 MOBILE HOME 0 P.00LISPA 0 SIGN
SUBTYPE: 0 ADDITION 0 AITERAMON 0 DEMOLITION 0 ELECTRICAL 0 MECHANICAL
0 NEW F,(]PLUMBING 0 RE-ROOF-NUMBER OFSQUARES
DESCRIPTION OF WO 1K Replace existing water heater. Same size and location.
PROJEcTADDRESS 29434 warm springs dr 0a n%-k
'rM LOT TRACT
ASSESSOR'S PARCEL I UMBER!" -0 Qjf2
OWNE NAME dc i miller city pie
01 Ma"
Builul"WA a
ADDRESS 29434 Narm springs dr - ante
cc%)
PHONE 951-246-2424 EMAIL
APPU NIT NAME LaRea Miller
ADDRESS 30300 Puerta Vallarta
PHONE 951-3011-10067 EMAIL allstar.sierra@gmaii.com
CONTRACTOWSNANj LaReaMiller OVINERBUIDER? OYES 0
BUSINESS NAME A I Star Water Heaters
ADDRE,, 30300 11 uerta Vallarta Way
PHONE 951-301-0067 EMAJIL allstar.siorra@gmaii.com
CONTRACTOWSSTAT:LIC NUMBER 812894 uaNSECLASSIFicKnON C36
VALUATION$ 80C.00 SQFT LSQFT
AppUCANrSSIGNAI ATE 8e .
7
0EPAfqMENT01StfiI8UTI(NW CrnOFMENIFEEBUSINEMSSUCENSE NUMBER
BUILDWO P�NING WGINEERINjGFIRE GREEN SMIP
INVOICE I PAID AMOUNT OCASH OCHECKN OCREMICARD VrAVMK
AMOUNT its .1 C'
PLAN CHECK FEI 5 PAIDANIOUNT 0: OCZ a 0 CREDq
1 0 CASH :H=# OCRAID.Iraw VISA/Mc
OWNER BUILDER VERIF ED 0 YES 0 No DI U11RA.00 NOTARIZEDUETTER 0 YESO NO
city of Mem e Building&Safety Department 29714 Houn Rd.Menifee,CA 92586 951-672-6777
www.citycilmenifee-us Inspection Request Line 951-246-6213
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