PMT16-04510 City of Menifee Permit No.: PMT16-04610
29714 HAUN RD. Type: Residential Plumbing
<-NCCEl-A—> M ENIFEE, CA 92586
MENIFEE Date Issued: 12129/2016
P E R M I T
Site Address: 29306 KNOLL CT, MENIFEE, CA 92586 Parcel Number: 338-203-009
Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
CLEDYTHE WILKERSON ALL STAR WATER HEATERS INC
29306 KNOLL COURT 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92586 MENIFEE, CA 92584
Appllcant Phone: 9513010067
SIERRA SPRAGUE License Number:812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE. CA 92584
Fee Description 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
$115.15
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
spedifications 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_8ldg_Permft—Terrp1ate.rpt Page 1 of 1
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).
Chapter9(commencing With section 7000)of Division 3 of the Business and u I am exempt from licensure under the Contractor's 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
.%�
Expires 2�&9411Z Signature -.4 inwhich 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 a n owner-builder if it has not been constructed in its entirety by
u I hereby affirm under penalty of perjury one of the following decla 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 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 hisued. vvwvv.Ieginfo.ca.gov/caIavv.htmI.
Policy# Date
0 have and will maintain worker's compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 370D of the Labor Code,for the performance of the work for which pcBy my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier a nd policy owner or authorized to act on the property owner's behalf.I have read this
n umber 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 ei�4.11 enter the above identified property for inspection purposes
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less &04� Date�az 91/V/�
ci I certify that in the performance of the work for which this permit is issued, PROPEK>PWNER OR AUTHORIZED AGENT
Ishallnotemplo 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, DO ply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant !Z Date mixture containing a hazardous material equal to or greater that the
,-dC a mounts specified on the Hazardous Materials Information Guide?
WARNING:FAI U SECURE WORKER'S COMPENSATION COVERAGE IS Dyes ONO
UNLAWFUL,AN�S�HALLSSUIUECTAN 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($100,0013),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
CONSTRUCTION LENDING AGENCY Dyes 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) Dyes ONO
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 Dyes a 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 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
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 applica nt to a civil pena Ity 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( )all of or( )portion of the work,and the structure Is www.epa.Royllead 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 a 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. o No EPA Lead-Safe Certified Firm is required for this project bemuse:
ci 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business a nd 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.
�LELDMG & SAFETY PERM IT/PLANI CHECK APPIACA1 101�
.*Menif&D,
DATE ja�aakvw PERMIT/PLAN CHECK NUMBER 04m%p-ewEA 0
TYPE: OCOMMEKIAL ERESIDENTIAL 0MUL-n-FAMILY OMOBILEHOME CPOCIL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION C)DEMOLITION OELECTRICAL OMECHANICAL
ONEW F,(�PLUMBING ORE-ROOF-NUMBEROFSQUARES-
DESCRIPTION OF WORK Replace existing water heater: Same size and -lo(atlp,7A Me litee
Building I-P,
PROJECTADDRESS 29306 Knoll Ct. OtQeeu DEC 2 81016
ASSESSOR'S PARCEL NUMBER S' -
4; -:2C& CrD9 LOT TRACT
OWNERNAME Cledythe Wilkerson viec ved
ADDRESS 29306 Knoll Ct.
PHONE 951-672-2706 EMAIL
APPLICANT NAME Sierra Sprague
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL alistar.sierra@gmall.com
CONTRAcroWS NAME Sierra Sprague OWNERBUILDER? OYESADO
BUSINESSNAmE All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 EMAIL alistar.sierra@gmaii.com
CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION$ 800-00 SCIFT LSQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
SIVIIP
BUILDING PLANNING ENGINEERING FIRE GREEN
=INVOICE FAIDAMOUNT OCASH OCHECKN OCREDITCARD VISJVMC
A NIDL
NT
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VLWMC
OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLETTER 0 YES 0 NO
-Ity OlIviertifee Building Safety DePOrtment297.14 Haun Rd. Mer?ifee,CA 92586951-67,-6777
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wWw.citvOfmen1fee.u5(nspect;on Reque.5t Line 951-246-6213
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