PMT16-03045 City of Menifee Permit No.: PMT16-03046
29714 HAUN RD. Type: Residential Plumbing
'CACCFELA-� MENIFEE, CA 92586
MENIFEE Date Issued: 09/1512016
P E R M I T
Site Address: 27580 GROSSE POINT DR, MENIFEE, Parcel Number: 335-241-018
CA 92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Descriptlon of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Omer Contractor
JIM CARDER ALL STAR WATER HEATERS INC
27580 GROSSE POINT DRIVE 30300 PUERTO VALLARTA WAY
MENIFEE,CA 92586 MENIFEE, CA 92584
Applicant Phone:9513010067
LAREA MILLER License Number.812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE,CA 92584
Fee Description Oty Amount($
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
$115.16
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of enrors in the plans and
specifications or from preventing builicling 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.
AABIdg_Perrnit-Ternp1ate.rpt Page I of I
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).
Chapter9(commencing With section 7000)of Division 3 of the Business and a 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 following reason:
License Class C r2lt I License No. a1g: it By my signature below I acknowledge that,"cept for my personal residence
ExpiresSV_2i:l_1(1P 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
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constnicted 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 certificate of consent of self-insure forworker'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 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.IeRinfo.u.goy/calaw.html.
Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date
VI have and will maintain worker's compensation insurance,as required by
hection 3700 of the Labor Code,for the performance of the work for which u 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 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 A-r building construction.I authorize representatives of this City or county to
Policy#jg 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
ci I certify that in the performance of the work for which this permit is issued,
Ishallnotemp] 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 shall fo t1p mply provisions. Will the applicant or future building occupant handle hazardous material or a
!!4p"Itll mixture containing a hazardous material equal to orgmater that the
Appllcant,/_-=e��t Date amounts specified on the Hazardous Materials Information Guide?
3A fARNING.FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o No
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 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 for guidelines
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 Within 1000 feet of the
lending agency for th e 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 SCAQMD
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
Contractoes License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the a pplicable item(s)(Section 7031.5 aYes ci No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,im prove,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 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 exem ptilon.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certlfied firms and comply with
an Applim nt 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 tbemselves or through their
o 1,as owner of the property,or my employee with wages as their sale em ployees.For more information about EPA's RenowtiDn Program visit:
compensation,Will do( I all of or( )portion of the work,and the structure is www.epa.goy/fead or contact the National Lead Informatitin 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 ci 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;
sale.If,however,the building or improvement is sold within one year of Firm Certification 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:
a 1,as owner of the property a in exclusively contracting with licensed
contractors to construct the project(Section 70411,Business a nd Professions
Code:The Contractor's State License Law does not apply to an owner of a if your pmject does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAf ETY P1 RMIT/PLAtJ "-,HFCK OPLICAT1,01\1
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMN ERCIAL EIRESIDENTIAL CIMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECrRICAL OMECHANICAL
0 NEW ZPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION Or WORP Replace existing water heater. Same size and location.
PROJECTADDRESS �27580 grosse point dr ckp5%ka�
ASSESSOR'S PARCEL NLMBER LOT TRACT
OWNERNAME jimcarder
ADDRESS 27580 grosse point dr
PHONE 951-723-8392 EMAIL
APPLICANTAIAME L3Rea Miller
ADDRESS 3030OFuertaVallarta
PHONE 951-301-0067 EMAIL alistar.sierra@gmail.com
CONTRACTOR'S NAME LaRea Miller OWNERBUILDER? C)YES4dNO
BUSINESS NAME All Star Water Heaters
ADDRESS 30300 Pyerta Vallarta Way
PHONE 951-301-CO67 EMAIL alistar.sierra@gmail.com
CONTRACTOR'S STATE ICNUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION$ 800. 0 0�7 SQ FT LSQFT
APPLICANT'S SIGNATt zz?�= DATE 2- /L3
DEPARTMENT DISTRIBUT101 CrIY OFTFNI"FEE BMUSINESS UCE14E NUMBER
BUILDING PLANNING EA INEERINO FIRE GREEN SMIP
INVOICE PAID.AMOUNT
AMOUNT V!5 \\5-%5 1 0 CASH 0 CHECK# 0CR5DITCARD V1SA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VIWMC
OWNER BUILDER VERIRE) 0 YES 0 No DLNUMBER NcTARIZEDLE.rrER 0 YES 0 NO
City oj tvi e n ife�B u Win g&Safety Department 29714 Itioun Rd. Menifee, CA 92586 951,672-0'777
wWw.cjtyofn7cnifee,us Inspection Retwest Line 951--246-6213
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