PMT16-04508 City of Menifee Permit No.: PMT16-04508
29714 HAUN RD. Type: Residential Plumbing
<A-CCELX3' MENIFEE, CA 92586
MENIFEE Date Issued: 1212912016
P E R M I T
SiteAddress: 27405 PINEHURST RD, MENIFEE, CA Parcel Number: 336-142-002
92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER,SAME SIZE AND LOCATION
Work:
Owner Contractor
RUTH WARD ALL STAR WATER HEATERS INC
27405 PINEHURST ROAD 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 Qty Amount($1
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
$115.15
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 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 Ternplate.rpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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).
Chapterg(commencing with section 7000)of Division 3 of the Business and ci I am exempt from licensure under the Contractoes State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C.?Ia License No. ?/,m.9!�e By my signature below I acknowledge that,except for my personal residence
A� 4�:,
Expires 9-14-191,11Z Signature -.4— in which I must have resided for at least one year prior to completion of
":,0- 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
o I hereby affirm under pena Ity 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.Ieginlro.ca.srovJcaIaw.htmI.
Policy# Date
64 haw 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 "y my signature below I certify to each of the following:I am the property
this permit is issued.My workees compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
numberare: application and the information I have provided is correct.I agree to comply
Carrier with allapplicablecitVand county ordinances and state laws relatingto
building construction.I authorize representat1ws of this city or county to
Policy# Expires c? entertheabove identified property for Inspection purposes
(This section need not to be completed is the permit is for one-hundred Date��z 9/,VO/,
dollars($100)or less
a I certify that in the performance of the work for which this permit is Issued, PROPE1>0111NER OR AUTHORIZED AGENT
Ishallnotemplo any persons in any manner so as to become subject to the CITY 13USINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workees 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 Ora
mixture containing a hazardous material equal to or greater that the
Applicant:Zz Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAI U SECURE WORKER'S COMPENSATION COVERAGE IS ciYes cNo
I
UNLAWFUL,AN§iHALLSSUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modifiotion 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
CONSTRUCTION LENDING AGENCY ciYes oNo
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) ciYes; oft
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMID
permitting checklist.I understand my requirements underthe State of
I herebyaffirm under penalty of perjury that I am exemptfrorn 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 ciYes ci No
Business and Profmlons;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(RRPJ
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
and 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 propeft or my employee With wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is w%vw.epa-Roy/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 cr 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:
sa le.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 project became:
a 1,as owner of the property a m exclusively contracting With licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractoes State License Law does not apply to an owner of a If your project does not comply with EPA RAP rule please fill o ut the RRP
Acknowledgement.
W.
TTY PERMIT/PLAN CHECK APPLICAMN
Menifee
-DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL MRESIDENTIAL CIMULTI.FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: CADDITION 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. ifee
city ot me I
___:i��jdtnA)ep
PROJECTADDRESS 27405 Pinehurst Rd. DEC 2 Ob
ASSESSOR!S PARCEL NUMBER jtAQ-d7C2 LOT - TRACT
OWNER NAME Ruth Ward ,,,, Ived
ADDRESS 27405 Pinehurst Rd.
PHONE 702-328-5373 EMAIL
APPLICANT NAME Sierra Sprague
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 ---- EMAIL allstar.sierra&gmail.com
CONTRACrOR'S NAME Sierra Sprague OWNER-BUILDER? 0 YES *NO
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
VALUATICIN$ 800-00 SQFT LSQ.FT
DATE.
APPLICANT'S SIGNATURE agrn�
D.EPARTM.E.NT DI STRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP �c
INVOICE PAIDAMOUNT OCASH C)CHECK# OCRFDITCARD VISAIMC
AMOUNT 110).1
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VIWMC
OWNER BUILDER VERIFIED OYESO No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Merifee oupding&-Safety oepartment 29714 Haun Rd. Menifee, CA 92586 951-672-6,777
www.cit-Vofnjenifee.uq Inspectlon Request I ine 951-246-6213
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