PMT17-02426 City of Menifee Permit No.: PMT17-02426
29714 HAUN RD.
�CCEIJ-> MENIFEE,CA 9258E Type: Residential Plumbing
c"'""'"''"t.— MENIFEE Date Issued: 0 711 312 01 7
PERMIT
Site Address: 27521 ALTA VISTA WAY, MENIFEE, CA Parcel Number: 336303-018
92585 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER,SAME SIZE AND LOCATION
Work:
Omer Contractor
JOE GOMEZ ALL STAR WATER HEATERS INC
27521 ALTA VISTA WAY 30300 PUERTO VALLARTA WAY
MENIFEE,CA 92585 MENIFEE, CA 92584
Applicant Phone:9513010067
SIERRA SPRAGUE License Number:812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE,CA 92584
Fee Description Qtv Amount($)
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 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_Pernit_Template.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 perjurythat 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 D I am exempt from licensure under the ContractarsState License law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. ' �Q >K By my signature below I acknowledge that,except for my personal residence
Expires .30 Signature �� in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that 1
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 of the applicable law,Section
have and will maintain a certificate of consent ofself-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 ,,,z .v,leeinfo.ca.eav/cataw.html.
this permit is issued.
Policy# Date
pd have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which "V my signature below I certify to each of the following:I 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 coned.I agree to comply
Carrier E with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#r4 /,�j L//����.472.5 Expires enter above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date Zz1
dollars($100)or less PROP NER OR AUTHORIZED AGENT
D I certify that in the performance ofthe work for which this permit is issued, .?�5 O 1
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It _J {{✓
workers compensation laws of California,and agree that if]should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 ofthe Labor
Code,I shall forthw' co ply with those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAT U SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AN SHALLSUBIEGT 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($100,000),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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY oyes ONO
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer houndary of a school?
(Section 3097 Civil Code) o Yes D 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 perjurythat I am exempt from the
California Health
material
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 o 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 rile 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 700D)of Division 3 ofthe 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 of5ection 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
❑I,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 ofor( )portion ofthe work,and the structure is www.epa.gov/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 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. D No EPA Lead-Safe Certified Firm is required for this project because:
D i,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 role please fill out the RRP
Acknowledgement
»...
r:
• �..
DATE �]1 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL [Z]RESIDENTIAL 0 MULTI-FAMILY -O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION 0 DEMOLITION O ELECTRICAL O MECHANICAL
O NEW ✓ LUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTIONOF WORK Replace existing water heater. Same size and location.
PROJECTADDRESS 27521 Alta Vista Way ,ryry
ASS ESSOR'S PARCEL NUMBER LOT TRACT O enit
OWNER NAME Joe Gomez e t
ADDRESS 27521 Alta Vista Way
PHONE 951-723-8657 ^ EMAIL
APPLICANT NAME Sierra Sprague Received
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 _ EMAIL allstar.sierra@gmaii.com
CONTRACTOR'S NAME Sierra Sprague OWNER BUILD)ER? OYES)�:Yo
BUSINESS NAME All Star Water Heaters _
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 EMAIL allstacsierra@gmail.com
CONTRACTOR'S STATE LICNUMBER 812894 LICENSE CLASSIFICATION C36
VALUATIONS 800.00 SQ FT _ L SQ FT
APPLICANT'S SIGNATURE ssc a>- T_ DATE_7 _1 / 7
DEPARTMENT DISTRIBUTION I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PIANNIAFG ENGINEERING FIRE GREEN
INVOICE PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
AMOUNT
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISNMC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER 0 YES O NO
CIty of Menifee Building&Safety Department 29714 Haun Rd. Ivenifee, Ca 925&b 951-0^72 5777
www.citvOf,,enlfee.us Inspection Request Line 951-2,15 52.13
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