PMT16-03546 City of Menifee Permit No.: PMT16-03546
29714 HAUN RD. Type: Residential Plumbing
<A—CCEUA? MENIFEE, CA92586
MENIFEE Date Issued: 11/0712016
P E R M I T
Site Address: 29469 SPRINGSIDE DR, MENIFEE, CA Parcel Number: 340-240-022
92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
LARRY GROTEFEND ALL STAR WATER HEATERS INC
29469 SPRINGSIDE DRIVE 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584 MENIFEE,CA 92584
Applicant Phone:9513010067
SIERRA SPRAGUE License Number:812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584
Fee Description Div Amount($I
Residential Water Heater 1 8100
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
specifications 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.
M_Bldg_Perml1—Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION 13 1 am exempt from licensure under the Contmclois'State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of
License!Class License No. P/Rp improvements covered by this permit,I cannot legally sell a structure that I have
Vsj&Z�:�Signatu�re g��CaV� built as an owner-building if it has not been constructed in its entirety by licensed
I�ItK contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKERS'COMPENSATION DECLARATIO Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
0 1 hereby affirm under penalty of pedury one of the following declarations: htti):I/�.leginfo-ca.govfcalaw.htmI
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 370D of the Labor Code,for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# 0 By my Signature below, I certify to each of the following: I am the property
OV, I have and will maintain workers' compensation insurance, as req owner or authorized to act on the property owners behalf. I have read this
uired by application and the information I have provided is correct. I agree to comply
section 3700 of the Labor Code. for the performance of the work for which this
permit is Issued.My workers'compensatlon insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above.
Carder 4161�& iden!��rop r the inspection purposes.
Policy# Expires /0 2�� Date
Propertyewnp�Authorized Agent
(This section need not be completed if the permit is for
one-hundred dollars(_$1 00)or less) City Business Ucense#
0 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emol any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California. and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. DYES 0 NO
101r�_ 14111
Applicant; Date; 1xr_1110 Will the intended use of the building by the applicant or future building
I occupant require a pennit for the construction or modification from South
WARNING: "��AILUIRE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES 0 NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES 0 NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of pequry there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous material reporting.
OWNER BUILDER DECLARATIONS DYES 0 NO
I hereby affirm under penalty of pedury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRPI
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1 978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from ficensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by anyApplicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
wvvvv.epa.gov/lead or contact the National Lead Information Center at
1, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the structure Is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property 0 An*EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the propeft
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale).
0 1, as owner of the property an exclusively contracting with licensed 0 No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
rrPTY P E R IT I Pwi CHECK APPLICATKIN
pp JEW -�l
IL' 2�11 I-," - . 1 . 1. , �T,
n if i�
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ERESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
1
SUBTYPE; OADDITION CALTERATION CIDEMOLITION OELECTRICAL OMECHANICAL
0 NEw F-/]PLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION Of WORK Replace existing water heater. Same size and location.
PROJECTADDRESS 29469 Springside Dr.
ASSESSOR'S PARCEL NUMBER QkAO- LOT TRA Fit
OWNER NAME Larry Grotefend Building Dept
ADDRESS 29469 Springside Dr. Nov 0 2 2916
PHONE 951-698-0474 EMAIL
APPLICANT NAME Sierra Sprague R El Me-
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar.sierra@gmaii.com
CONTRACTOR'S NAME Sierra Sprague OWNER BUILDER? 0 YES *0
BUSINESSNAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 EMAIL allstar.sierra@gmail.com
CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION$ 800-00 SOFT LSQFT
APPLICANT'S SIGNATURE DATE
0 MBER
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
' N W
91JILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT 0 CASH 0 CHECK It OCREDITCARD VI5A/MC
AMOUNT
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# 0 CREDrr CARD VISA/MC
Z (3 YES 0
OWNER BUILDER VERIFIED 0 YES -0 No DLNUMBERNOTARIZED LETTER 0 YES 0 NO
Cityof A4vrifee B,jil(jing&Safety Department 297L4 Hour?Rd, Menifee, CA 92586 9SI 67) 6777
WW141.City0I,menifee.U5 Inspection Request Line 951-246-6213
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