PMT16-03464 City of Menifee Permit No.: PMT16-03464
29714 HAUN RD.
<A-CCELA—> MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 1012112016
P E R M I T
Site Address: 29491 RAINBOW FOREST WAY, Parcel Number: 340-300-013
MENIFEE, CA 92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
LARRY ROBERTS ALL STAR WATER HEATERS INC
29491 RAINBOW FOREST WAY 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584 MENIFEE, CA 92584
Applicant Phone:9513010067
SIERRA SPRAGUE License Number.,812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584
Fee Description Ply Amount($
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
$116.15
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 Mendee.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.BldgPerrnit-Template.rpt Page 1 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),
Chapter!)(commencing with section 7000)of Division 3 of the Business and u I am exempt from licensure under the Contractoes State License Law for
Professions Code and my license is in full form and effect. the following reason:
License Class C-2't License No. L(
By my signature below I acknowledge that,except for my personal residence
Expires 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 constructed in its entirety by
ci I hereby affirm under penalty of perjury one of the following clecla rations: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 workees 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 welisite:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.Ieginfo.ca.gov1caIaw.htmI.
Policy# Date
VI have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
/section 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 a m the property
this permit is issued.My workees compensation insurance carrier and policy owner or authorized to act on the property owner's behall.I have read this
numberare: application and the Information I have provided is correct.I agree to comply
Carrier A-r with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Zc. cLM- roupir's S— i 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
ct I certify that in the performance of the work for which this permit is issued,
I she 11 not employ any persons In any manner so as to become subject to the CITY BUSINESS LICENSE#
workees 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 itb- mply w provisions. Will the applicant or future building occupant handle hazardous material ora
App "' r Date A mixture iintaining a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes 0 No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI ES Will the intended use of the building by the applicant or future building
AND CIVIL FIN ES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant req ulm a permit for the construction or modifitation 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 TH E LABOR CODE,INTEREST,AND ATTORN EYS 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 10DO 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) a Yes o No
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,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 applicable item(s)(Section 7031.5 uYes 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,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 fRRPI
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 p re-1978
and the basis for the alleged exemption.Any violation of Section 703LS by residenm or childcare facility to be R RP-certified firms and comply with
an Applicant 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
o 1,as owner of the property,or my employee With wages as their sole employees.For mom information about EPA's Renovation Program visit:
compensation,will do I )all of or I )portion of the work,and the structure is wwwepa.jaoy/Iead 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 ct 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 pmject because:
c;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.
BIJ If-DIN G & SAFETY P E R M IT/PLAN CIH ECK APPLICATION
.' 'Menifee
DATE PERM[T/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL [Z]RESIDENTIAL_ 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOUTION OELECTRICAL OMECHANICAL
0 NEW W�LUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK Replace existing water heater. Same size and location.
PROJECTADDREss 29491 Rainbow Forest Way ctGk5%.4
ASSESSOR'S PARCEL NUMBER '3HC)- 5W- QjS LOT TRACT City of Menifee
OWNER NAME Larry Roberts Building Dept
ADDRESS 29491 Rainbow Forest Way
01414 UL I 2T 2016
PHONE 909-561-M3 EMAIL
APPLICANTNAME Sierra Sprague Receive I
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar.sierra@gmaii.com
CONTRACTOWSINAME SierraSprague OWNERBUILDER? OYES)ONO
BUSINESSNAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 EMAIL allstar.slerra@gmail.com
CONTRACTOR'SSTATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION S 800.00 SQFT -- - LSQFT
16 -',' //4,7
APPLICANT'S SIGNATURE DATE
CITY OF MENIFEE BUSINESS LICENSE NUMBER
DEPARTMENT DISTRIBUTION
NT
MG
BUILDING PLANNING ENGINEERING FIRE GREEN
=I VO(:E As rj C VISVMC
I I PAID.AMOUNT 0 CASH C)CHECK# OCREDITCARD VISAIMC
N I
AMOUNT
AS
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECX# 0 CREDIT CARD VISAJIMC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER - NOTARIZED UETTE
Cityof Menifeefluildirg&Sofeiy0epartment297J4F1aunRd,Menifee, CA92586951-672-6777
wWW.cijVofnjy,jifep,us Inspection Request Line 951-246-6213
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