PMT17-00323 City of Menifee Permit No.: PMT17-00323
29714 HAUN RD. Type: Residential Plumbing
�ACCEL/-Q.' MENIFEE, CA 92586
MENIFEE Date Issued: 02103/2017
PERMIT
Site Address: 27982 TATE RD, MENIFEE, CA 92585 Parcel Number: 336-511-016
Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
FATEMEH OSTADI ALL STAR WATER HEATERS INC
27982 TATE ROAD 30300 PUERTO VALLARTA WAY
MENIFEE,CA 92585 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 O-tt 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
$116.15
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_Sidg_Perrnit_Template.rpl Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires .90 Signature .1�..Ssisc�-- in which l must have resided for at least one year prior to completion of
improvements covered bythis permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy ofthe applicable law,Section
have and will maintain a certificate of consent of self-Insure for workers 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 tabor Code,for the performance of work for which www,leeinfo.ca.eov/calaw.html.
[his permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
Pad have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which t$y my signature below I certify to each of the following:)am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
E with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy#&mgQ �S/.PA/Rwx Expires enter the above dentified property for inspection purposes.
(This section need not to he completed is the permit is for one-hundred Date 2
dollars($100)or less PROP Id NER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is Issued, 6'
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthw' co ply with those provisions. Will the applicant orfuture building occupant handle hazardous material ora
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAI U�� SECURE WORKER'S COMPENSATION COVERAGE IS D Yes ❑No
UNLAWFUL,ANUSHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,00D),IN occupant require a permit for the construction or madifiwtion from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES farguidelines
CONSTRUCTION LENDING AGENCY o Yes o 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) D Yes D No
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe State of
I hereby affirm under penalty of perjurythat 1 am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors 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 oYes 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 Contractors 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.Anyviolation 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 clothe paint-disturbing workthemselves orthrough their
a 1,as owner of the property,or my employee with wages as theirsole 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.ltov/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 Contractors State License Law does not apply to an owner of 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 a re 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 Finn 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 Contractors 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.
qT
DATE �a 1�1 PERMIT/PLAN CHECK NUMBER Y�\T'i— OO�'Jd3
TYPE: O COMMERCIAL ❑✓ RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL I
ONEW JPLUMBING ORE-ROOF-NUMBEROFSQUARES—_ _
DESCRIPTION OF WORK Replace existing water heater. Same size and location.
city D en e
.
PROJECT ADDRESS 27982��T77,ate Rd
ASSESSOR'S PARCEL NUMBER 33L0-6%%- OI V LOT TRACT
OWNER NAME Fatemeh Ostadi -, " ed
ADDRESS 27982 Tate Rd Rec
PHONE 661-860-7160 EMAIL
APPLICANT NAME Sierra Sprague
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar.sierra@gmail.com
CONTRACTOR'S NAME Sierra Sprague OWNER BUILDER2 O YES NO
/ BUSINESS NAME All Star Water Heaters _
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 EMAIL allstar.sierra@gmail.com _
CONTRACTOR'S STATE LIC NUMBER 812894 UCENSE CLASSIFICATION C36
VALUATION$ 800•00 SQ FT LSO FT
APPLICANT'S SIGNATURE DATE -2
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN , SHIP X __
AMOUNT 1 15' PAIOAMOUNT
OCASH OCHECKtl CCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK N CI CREDIT CARD VISAIMC
OWNER BUILDER VERIFIED OYES 0. NO OIL NUMBER NOTARIZEDLETTER 0 YES O NO
City of rldenifee Buikdrrg&Safety Department,197i 4 Naun Rd.lvtenifee, Cl 92586 951-672-6777
www.ciivofinenrfee.us/n5prciion Requr;t Line 951-246-0 13
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