PMT17-02828 City of Menifee Permit No.: PMT17-02828
29714 HAUN RD.
rACCEL/!7 MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued:
08/10/2017
PERMIT
site Address: 31234 SHADOW RIDGE DR, MENIFEE, Parcel Number: 372-243-012
CA 92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
REFUGIO CARRILLO ALL STAR WATER HEATERS INC
31234 SHADOW RIDGE DRIVE 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584 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 1$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 carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Men'rfee.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
hereby affirm under penalty of perjury that 1 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 underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License Nop Q/�R/ 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
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
D I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.)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 ,eww.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
44 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 "y my signature below l certify to each of the following:)am the property
this permit is issued.My worker's 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
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#a 24.57 Expires ;2 enter identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred &47 Date
dollars($100)or less PROP 1d NER OR AUTHORIZED AGENT
01 certify that in the performance of the work for which this permit is issued, ® GO�
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g :JJ
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,1 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 Dale amounts specified on the Hazardous Materials Information Guide?
WARNING:FAI 1-10 SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes o No
UNLAWFUL,AN SHALL 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($100,00D),IN occupant require a permit for the construction or modification from South
ADDITION TO3 THE COSTLAB OF OR CODE,INTEREST,
ADATTOGES AS ROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY o Yes o No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the permitting checklist.l understand my requirements underthe State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(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 file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING fRRP)
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
D 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 of or( )portion of the work,and the structure is www.eoa.eov/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 o 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 rule please fill out the RRP
Acknowledgement.
m
� p
�;A[s1n
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL ✓ RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA o SIGN
SUBTYPE: O ADDITION ()ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
0 NEW ✓ LUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace existing water heater. Same size and location.
City Of Menife
— - — — _ --- aujiding 8 Safety ept.
PROJECT ADDRESS 31234LShado^w-Ridge Dr.
ASSESSOR'S PARCEL NUMBER �J -t�M��'ak)�- LOT TRACT
OWNER NAME Refugio Carrillo Rec
ADDRESS 31234 Shadow Ridge Dr.
PHONE 951-376-9712 EMAIL
APPLICANTNAME Sierra Sprague _
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar.sierra@gmail.Com
CONTRACTOR'S NAME Sierra Sprague OWNtg BUILDER? O YES V 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 LICENSE CLASSIFICATION C36
VALUATION$ 800.00 SQ FT LSQFr
APPLICANT'S SIGNATURE -- DATE
DEPARTMENTDISTRI BUTTON CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I 50.1!� 'Q d
INVOICE PAID AMOUNT L;
AMOUNT h 5' � I OCASH DCHECKA CREDIT CARD NSA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH O CHECK N CREDIT CARD VISAIMC
OWNER BUILDER VERIFIED O YES. NO D1 NUMBER NOTARIZED LETTER O YES O NO
[lty Df t.e!0iJae Bt rildin;u SD fe±y t)eizG;t;ne-a 29714;?:,un Rd: M2Nifee, CA 92586 95 J o-7)-6777
WWW.eitvafimenif.oF.1:tnrpectian Re,gaesttLo:e'19;: 246-6213
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