PMT18-00036 City of Menifee Permit No.: PMT18-00036
29714 HAUN RD. Type: Residential Plumbing
�!-�CCEL/k MENIFEE,CA 92586
MENIFEE Date Issued: 01/04/2018
PERMIT
Site Address: 27425 FREEDOM LN, MENIFEE,CA Parcel Number: 360-563-006
92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE WATER HEATER-SAME SIZE(50G)AND SAME LOCATION.
Work:
Owner Contractor
JUANITA YARBROUGH ALL STAR WATER HEATERS INC
27425 FREEDOM LANE 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584 MENIFEE,CA 92584
Applicant Phone:9513010067
ALL STAR WATER HEATERS INC License Number:812894
30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584
Phone:9513010067
Fee Description Owl Amount lSl
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_Pennit_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 perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and a 1 am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full farce and effect. the following reason:
License Class License No. By By my signature below l acknowledge that,except for my personal residence
Expires .3O Signature ea—g .�- 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 I
WORKER'S COMPENSATION DECLARATION
have built as a n owner-builder if it has not been constructed in its entirety by
❑1 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 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 Labor Code,for the performance of work for which ,„N,H.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy If Date
rid 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 1 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 ad on the property owners behalf.I have read this
num her are: application and the information I have provided is correct.I agree to comply
Carrier LG with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#r�6j/G/y�rQ�X]QS Expires enter identified property for inspection purposes.
(This section need not to be completed is the permit is for one hundred Date
dollars($100)or less PROPR9>PdNER OR AUTHORIZED AGENT
al certify that in the performance of the work for which this permit is issued, �15O
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If `
workers compensation laws of California,and agree that if l 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 or future building occupant handle hazardous material ora
Applicant ,2_ Date mixture containing a hazardous material equal to orgreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAI U SECURE WORKER'S COMPENSATION COVERAGE IS oyes kao
UNLAWFUL,AN SHALLSUEUECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant arfuture building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),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)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oyes tFLNo
1 hereby affirm that under the penalty of perjury there is a construction Will the proposed building or madified 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 kNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
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 703L5 1,4l a No
Business and Professions Code).Any city or county that requires a permit to
construct,alter,improve,demolish or repair any structure,prior to its �� Date / y
PROPERTY OWN Elf O�U7HORIZED 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 fRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contactors
Business and Professions Code)or that he or she is exempt from Iicensure 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
o 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
pmperty 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 ofsale. a No EPA Lead-Safe Certified Firm is required for this project bemuse:
01,as owner of the property am exclusivel�,c ntracting 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.
,v
Wed
DATE PERMIT/PLAN-CHECK NUMBER
TYPE: 0 COMMERCIAL R]RESIDENTIAL Y 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0-SIGN
SUBTYPE: OADDITION GIALTERATION ODEMOLITION CIELECTRICAL OMECHANICAL
0 NEW WIPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace existing water heater. Same size and location,
PROJECTADDRESS 27425 Freedom Ln.
ASSESSOR'S PARCEL NUMBER LOT TRACT
—
OWNER NAME Juanita Yarbrough
ADDRESS 27425 Freedom Ln,
PHONE 951-365-8756 EMAIL
APPLICANT NAME Sierra Sprague
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar..sierra@g mail.com
CONTRACTOWSNAME SierraSprague -OWNFROUILDER? OYESONO
BUSINESS NAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
PHONE 9 51-301-0067 EMAIL alistar.sierra@gmaii.com
CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATIONS 800.00 SO FT L SO FT
APPLICANT'S SIGNATURE DATE
CITY DEPARTMENT DISSTRIBUTION BUSINESS LICENSE
W '
U ULDMG "N 6 e "IIE'N
ILVING PLANNING ENGINEERING FIRE GREEN SMIP
CA�
INVOICE PAID AMOUNT 0 CASH 0 CHECK 9 2CRECIT CARD VISA/MC
AMOUNT
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# O CREDIT CARD VIWMC
OWNER BUILDER VERIFIED 0 YES -n NO DLNUMBER NOTARIZED LETTER C) YES NO
City 0ffvjepifee StIpeling&Sopjy[)epojDjiejrt?9714 ficiall Rd n. ,n CA '3SC 9
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