PMT16-03547 City of Menifee Permit No.: PMT1 6-03647
29714 HAUN RD.
-5—A C
CIEU� MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 1110712016
P E R M I T
Site Address: 27294 PARK AVE, MENIFEE,CA 92586 Parcel Number: 336-204-003
Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
KIMBERLY DUNBAR ALL STAR WATER HEATERS INC
27294 PARK AVE 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92586 MENIFEE,CA 92584
Applicant Phone: 9513010067
SIERRA SPRAGUE License Number:812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584
Fee Description Qtv Amount($
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
$116.16
The issuance of this permit shall not prevent the building offidial from thereafter requiring the correction of errors 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.
AA Bldg_Permit-Ternplatespt Page 1 of 1
City Of Menifee
LICENSED DECLARATION 0 ]am exempt from ficensure under the Contractors'State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing v6rlth 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 e� 1&. License No. P/P7,17 improvements covered by this permit,I cannot legally sell a structure that I have
4e Signature built as an owner-building if it has not been constructed in its entirety by licensed
1�'O, contractors. I understand that a copy of the applicable law. Section 7044 of the
WORKER&COMPENSATION DECLARATIO Business and Professions Code,is available upon request when this application is
D I hereby affirm under penalty of perjury one of the following declarations submitted or at the following Web site:
I have and will maintain a certificate of consent of self-insure for workers; http."//�.leginfo.m.gov/�law.htmi
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Omer orAuthorized Agent
Policy# El 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 required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'ccimpensation insurance carrier and policy number are: with all applicable city and county ordinances and slate laws relating to building
construction.I authorize representatives of this city or county to enter the above.
Carrier _11576e iden!�Vrop
Policy# e,&Z 94?a Expires ZeQl ,!��r the inspection purposes. Date 4"
PropertyewnpdrAuthorized Agent
(This section need no
A be completed if the permit is for
one-hundred dollars($100)or less) City Business License#
0 1 certify that in the performance of the work for which this permit is issued,I HA7ARDOUS MATERIAL DECLARATION
shall not emplo 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 Infionnation Guide?
Code,I shall forthwith comply with those provisions. DYES ONO
1_15�
Applicant; Date; /,�C_4 Will the intended use of the building by the applicant or future building
I occupant require a permit for(he construction or modification from South
WARNING: AILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAOMD)?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 OYES D NO
CONSTRUCTION LENDING AGENCY I have mad the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury 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 0 YES 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-1978
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 any Applicant 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 EPNs Renovation Program Visit;
0 1. as owner of the property, or my employees with wages as their sole www.epa.gov/lead or contact the National Lead Information Center at
compensation,Will do( )all of or( )porting of the work, and the structure is 1-800-424-LEAD(5323).
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 El 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
BUILDING &:SAFETY PERM[ PLAN C.HECX APPiJCATl().N.
MINN I
Menifee
DATE I ilg lit p PERMIT/PLAN CHECK NLIMBERA%Nn�g Qljn�A-1
TYPE: OCOMMERCIAL [ZIRESIDENTIAL OMULTI-FAMILY OMODILEHOME OPOOL/SpA OSIGN
SUBTYPE: OADDITION OALTERAMON ODEMOLITION OELECTRICAL OMECHANICAL
ONEW EkLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace existing water heater. Same size and location.
PROJECT ADDRESS 27294 Park Ave
City of Menifee
--SWMin—gD-e-p—t
ASSESSOWS PARCEL NUMBER LOT TRACT
OWNERNAME Kimberly Dunbar
ADDRESS 27294 Park Ave NOV 0 2 2016
PHONE 951-265-5020 EMAIL ---Rsrc7,efved
AppLICANTNAmE Sierra Sprague
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar.sierra@gmaii.com
CONTRACTOR'S NAM Sierra Sprague OWNER BUILD 0 YES"0
BUSINESSNAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way —
PHONE 951-301-0067 EMAIL allstar.slerra@gmall.com
CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION$ 800-00 SQFT LSQ FT
APPLICANT'S SIGNATURE E
w �- -NIFEE BUSINESS LICENSE NUMBER
E�AT
TMi T DISTRIBUTION
BUILDING PLANNING ENGI ER G FIRE GREEN SIVIII, x
INVOICE PAIDAMOUNT OCASH 0CHECK# 0 CREDIT CARD VISA/NIC
AMOUNT 115. V5
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0CRFDiTCAR0 V,1SA/MC
YE ) N
OWNER BUILDER VERIFIED OYESC) No DL NUMBER NOTARIZED LE17ER 0 YES 0 NO
Cfty of 114eflifee Liclildirg&Safety Departinent 29714 HaunRd, Menifee, CA 92586 951-672-0'777
www.cityofnisnifee.Lis flispection Request Line 951-246-6213
tio
CL
0
EO
Lu x E 0
7 lid
M CML
c LU a
o L Do
c 0
r
LV w
:1 M 0
�j
u
LL, -.p
bD
C?
co
u
EL c
oa 0
0 'a
>0 M
0 Z E
40 w w -Z a
>
M C U 0
M M
W w M M
3: �o a
m u
o 2 -3 2- 2
w 2 o
:� �E U M E
3 0 u
0 M 1 6 w E L� 0 16
4i 75
0
0 M
LU
2 E
o o
UZZ , E oj �c - ��
M w a
0
L 0 M M o
Mm =a z E 3: -
lz W) E c. m - S E
ui 0 >
E
0
to r -Z U 0
ko
E m E 2
Jo
E
a a E a bo
3r,
z
0 LW
- w 0
z
(U
al V
& . 9 5 a m c 0
W Ix 0) c 4t -2 Z w
P 2 M " a) 2 (.� ow -- M. v -3: 's,
j 14P r�- .2 ',\ ' a A 75 ms .
cli r M W eL
< 5, M
as E
LL
M LU
Itz
U, M 0
'C 6 1
c CL
w
c E w
0
V
w CL IT
Or M
I 1 2 : w m 7.
.0
uj
z
ui
LUL
I c
0 .2
E
LU N w
m
a cr o
rg It .2
m l
12
l M
M
4r
w
0
13
0
0
> m Q m o -L OC
E C%
0 co
to W 'CIII
CC C)
M 0
0 E c C:)
r
0 0 a I C @
0 L CD C;
0 E MW 0
o a C 0
al - Eo� gwot= c =
D 0
u u
0 0
w 0 c
0 U
V M m
=
0
u
W C
, 0 0 0 .
t v U:
Q 0 0 V
al
>
0
W 0 U
E '0
0
0
0 M 0 0
> 0
e c
0
E E c 0 m E5 r
m I - w
d V. " a a cr E
1 0
0 'l �
(U W M D 0 w
cu
m < 2 E
> .2 6 w
E
IN c 0 'a
0 E �5 u
M , W a u 4 E
U E o Q'
i , (3
to
Wa a c w 0
Lu 0 C
d) OD
D: Q
a .0 w Lf)
c m E
LU 5 cc
0 V, z
ca 0)
z m c
, 4A 0
3w: w cc M 0
0 w M <
1A
0
a -;G c CL t
>
u
>
M a)
:3 'E
0 75 0 x co
0 1111 S . a 4
tj tu @ E n a z
4) E to 60 CL a)
-, g = 2 .9 S h4 C, E Is Z 0 cr
LL. 'a 0 2
0 IS 9 = -
CD
cc co
LU m
0
u a)
:z CO
ui uj
L6 6 t%Z Cd ai
9; 12.
9u lu
E E
t! CL
m
w 7