PMT16-03046 City of Menifee Permit No.: PMT16-03046
29714 HAUN RD. Type: Residential Plumbing
't7�CCFELA—> MENIFEE,CA 92586
MENIFEE Date Issued: 0911512016
P E R M I T
SiteAddress: 30505 SILVER SAND CIR, MENIFEE, CA Parcel Number: 364-132-036
92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER. SAME SIZE AND LOCATION
Work:
Owner Contractor
TINA WOODARD ALL STAR WATER HEATERS INC
30505 SILVER SAND CIRCLE 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
MENIFEE,CA 925a4
Fee Description Qtv Amount
Residential Water Heater 1 83.00
Building Permit Issuance 1 2T00
GREEN FEE 1 1 00
General Plan Maintenance Fee-Plumbing 1 4A5
$115.15
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
spedfications or from preventing bulliding 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.BidgPewit Template.rpt 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).
Chapter9(commencing with section 7000)of Division 3 of the Business and ca I am exempt from licensure under the Contoctor'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. By my signature below I acknowledge that,except for my personal residence
Expires, Signature_. I,which I most he.resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKERS COMPENSATION DECLARATION have built as a n owner-builder if it has not been constructed In Its entirety by
o 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 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 3700 of the La bor Code,for the performance of work for which wvivi.leginfia.m.govIcalaw.litnil.
this permit is issued.
Policy# Date
V have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
/section 3700 of the La bor Code,for the performa nce of the work for which ca By my signature below I certify to each of the following:I a m 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
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 representarives 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 OWNER OR AUTHORIZED AGENT
ca I certify that in the performance of the work for which this permit is issued,
Ishallnoterriplo 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 fia itbol: mplywi. those provisions. Will the applicant or future building occupant handle hazardous material or a
�' 11 5 , lv� mixture containing a hazardous material equal to or greater that the
App-_5 blo � I Date amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE 15 a Yes a 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 modifiation from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Kir Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ca Yes ca No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified faciflity,be m6thin 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 SCAQMID
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,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 cayes ca 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 IRRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of th e 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 childmre facility to be RRP-certified firms and comply with
an Applica 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 themselves or through their
ca 1,as owner of the property,or my employee With wages as their sole employees.For more information about EPA!s RenovatiDn Program visit:
compensation,will do I )all of or( )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 ca An EPA Lead-Safe Certified Renovator wifli 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.:
com pletion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ca No EPA Lead-Safe Certified Firm is required for this proJect bemuse:
ca 1,as owner of the property a in 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.
CK APPI ]CATION
PLAN CHE
BUILDING & SAFEFY PERMIT,",
Menifee
DATE PERMIT/PLANI CHECK NUMBER 0-0�31NILIO
TYPE: 0 COMN ERCIAL ORESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 RI o SIGN
SUBTYPE: CADDITION OALTERATION ODEIVIOLITION CELECTRICAL OMECFtANICAL
ONEW F,(�LUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WOM Replace existing water heater. Same size and locatio
PROJECTADDRESS 30505 silver sand cir
ASSESSOR'S PARCEL NL MBER 3LJ8- JS� rJ&P LOT - TRACT
OWNERNAME tinalwoodard
ADDRESS 30505 silver sand cir
PHONE 951-314 365 EMAIL
APPLICANTNAmE L3ReaMiller
ADDRESS 30300 F uerta Vallarta
PHONE 9511-301-0067 EMAIL allstar.sierra@gmail.com
CONTRACTOR'S NAME LaRea Miller _OWNFRBUILDEFt? 0 YEStNO
BUSINESS NAME All Star Water Heaters
ADDRESS 30300 Pi jerta Vallarta Way
PHONE 951-301-CO67 EMAIL allstar.slerra@gmaii.com
CONTRACTOR'S STATE ICNUMBER 812894 LICENSE CLASSIFICATION C36
VALUATIONS 800.00 49 FT _- L SO FT
07 1
APPLICANT'SSIGNATU E DATE
MERARTIVENT DISTRIBUTION SMIP OX CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING EN1111111 I FIRE GREEN
INVOICE PAID AMOUNT OCASH OCHECK# OCREDITCARD V]SkPAC
AMOUNT
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 00E�Dnr (PA�RD VIWMC
rC VIWMC
OWNER BUILDER VERIFIE 0 YES 0 No DIL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menife?Building&Safely Oepurtme029714 Haun Rd.Menifee, CA92586.951-672-6777
www.Cityofmen1yee.us InspeCtiol?Request Line 951-246-6213 .
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