PMT16-04507 City of Menifee Permit No. PMT16-04507
29714 HAUN RD. Type: Residential Plumbing
<A-r,cELA-> MENIFEE, CA92586
MENIFEE Date issued: 1212912016
P E R M I T
Site Address: 27270 PINCKNEY WAY, MENIFEE, CA Parcel Number 336-331-030
92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
SHARRON LANSAW ALL STAR WATER HEATERS INC
27270 PINCKNEY WAY 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 Descriptlon ON 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 errors in the plans and
specifications or from preventing buillding operations being cardied 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 BidgPermit-Template,rpt Page I of I
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contncts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed cantractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the ConWctoes State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class CZ6 License No. By my signature below I acknowledge that,except for my personal residence
._� 11;:1
Expires F-IJ-19411Z Signature —.0 In which I must have resided for at least one year prior to completion of
improvements covered bythis permit.I cannot legallysell a structurethat 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 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 Labor Code,for the performance of work for which
this permit is issued. www.Ieginfc.ca.gov/caIaw.htmL
policy# Date
44 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 pKpy 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
number are; application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires e�.11 enter the above identified property for inspection purposes.
z 9/V ;,
(This section need not to be completed is the permit is for one-hundred Date�zz.l 42
dollars($100)or less PROP_E��NER OR AUTHORIZED AG ENT
ci I certify that in the performance of the work for which this permit is issued,
I shall not emp] 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 forthw, co ply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant:�� Date amounts specified an the Hazardous Materials Information Guide?
WARNING:FAI U SECURE WORKER'S COMPENSATION COVERAGE IS o Yes ci No
LLS
UNLAWFUL,AN�S�HALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVI L FIN ES UP TO ON E HUN DRED 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
CONSTRUCrION LENDING AGENCY o Yes a No
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 the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ci Yes o No
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
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 ciYes o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,Improve,demolish or repair anystructure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant far 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 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
a nd the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-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
a 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do I )all of or I )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 n An EPA Lead-Safe Certified Renovator wfll 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. o No EPA Lead-Safe Certified Firm is required for this project bemuse:
o 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.
Mff/PLA
BUR.DING &,SAFETY PEr N CHECK APPLICATION
DATE ja I Qe [Ito PERMIT/PLAN CHECK NUMBE!etma-ej4m-i
TYPE: 0 COMMERCIAL DRESIDEN-nAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE; CADDITION OALTERATION ODEIVIOUTION C)ELECrRICAL OMECHANICAL
0 NEW R]PLUMBING 0 RE-ROOF.NUMBER OF SQUARES-
DESCRIPTION OF WORK Replace existing water heater. Same size and location.
PROJECTADDRESS 27270 Pinckney Way Azw�
ASSESSOR'S PARCEL NUMBER '3&p-'35j-Cr60 LOT IRI&y gi
OWNER NAME Sharron Lansaw Building uvlj'
ADDRESS 27270 Pinckney Way DEC-& N16
PHONE 714-847-5764 EMAIL
APPLICANTNAME Sierra Sprague Receive
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar.sierra@gmail.com
cor%rrRAcTows NAME SlerraSprague _OWNERI301LDER? OYES?QNO
BUSINESSNAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 EMAIL alistar.sierra@gmall.com
CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION$ 800.00 SQFT LSQFT
APPLICANT`$SIGNATURE DATE 1Z=---
CITY OF MENIFEE BUSINESS LICENSE NUMBER
DEPARTMENT DISTRIBUTION ES
BUjLDING PLANNIN(i ENGINEERiNG FIRE GREEN SMIP
RiN
'INVOICE PAID AMOUNT OCASH OCHECK# CREDITMD VISA/MC
NVO'C 1 1
AMOUNT 0
D MOUNT
PLAN CHECK FEES PAI A OZASH OCHECCXK9 0CREEDrRTrCARD VISA/MC
, OWNER BUILDER VERIFIED OYESO NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Scidding&Sojety Department 29714 Hatin Rd.Menifee, CA 92586 951-672-6777
WWW.City0frnenifee.us fn$pectioel Request Line 951-246-6213
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