PMT18-01403 City of Menifee Permit No.: PMT18-01403
29714 HAUN RD. Type: Residential Plumbing
<A-CCEL/> MENIFEE, CA 92586
MENIFEE Date Issued:
03/30/2018
PERMIT
Site Address: 26092 BLUEBELL ST, MENIFEE, CA Parcel Number: 335-422-080
92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER, SAME LOCATION
Work:
Owner Contractor
DANA WOOD ALL STAR WATER HEATERS INC
26092 BLUEBELL STREET 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92586 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 OQt Amount fSl
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 carded 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 Pe"1t_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 O I am exempt from licensure under the Contractols State License law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. JZ.,�,��9'/ By my signature below I acknowledge that,except for my personal residence
Expires O Signature�6L. in which l must have resided for at least one year pdarto 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
01 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 workefs 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 issued. www.leginfo.ca.eov/calaw.html.
Policy# Date
Qd have and will maintain workefs compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which pxBy 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 owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier C/ with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy it 717.S*Expires ZM enter the above identified property for inspection purposes. 7""
(This section need not[0 6e completed is the permit is for one-hundred e�[ —
dollars($100)or less PROPER OR AUTHORIZED AGENT
Dat 7 IZ
0 I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# ✓�5 O1 S
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 or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAR U SECURE WORKER'S COMPENSATION COVERAGE 15 0 Yes 1rrNo
UNLAWFUL,AN SHALLSUBIECT AN EMPLOYER TO CRIMINAL PENALTIES Will the Intended use of the budding 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 madiR[ation from South
IN SECTION ON TO
06 OF THE
OF COMPENSATION,CODE,INTERS TMADATTOGES AS ROVIDEDS Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECf10N 3706 OF THE Lg80R CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY OYes '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) 0 Yes ;oflo
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.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25S34 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.S bYes o No hazardous material reporting.
Business and Professions Code).Any city or county that requires permit to � - � ..
Dateconstruc
Issuance,also alter,improve,demolish for the any permit to
a prior signed to 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 IRRPI
License Law(Chapter9(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 Rcensure receiving compensation for most work that disturbs paint in a pre-1978
and the casts e alleged exemption.Any violation Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
than
Applicant for or a a permit subjects the applicant too civilit penalty of not mom required practices.This includes rental property ownersand roe
rty
than($500). managers who do the paint-disturbing work themselves or through heir
al,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 of 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 aAn 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 ofsale. 0 No EPA Lead-Safe Certified Firm is required forthis project because:
a 1,as owner of the property am exclusively.co stracting 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 If your project does not comply with EPA flRP rule please fill out the RAP
Acknowledgement.
,;.
M �
DATE L�J 1 �j PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL ❑.1 RESIDENTIAL O_M_ULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL O MECHANICAL
O NEW ✓PLUMBING O RE-ROOF-NUMBER OF SQUARES__
OES011PTION OF WORK Replace existing water heater. Same size and location.
PROJECTADDRESS 26092 Bluebell St.
ASSESSOR'S PARCEL NUMBER �j3� •tlaa•Ob0 LOT TRACT
OWNER NAME Dana WOOd
ADDRESS 26092 Bluebell St.
PHONE 909-816-2330 EMAIL
APPLICANT NAME Sierra Sprague
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 `-_ EMAIL alIstar.sierra@gmail.com
gmail.com
CONTRACTOR'S NAME Sierra Sprague OWNER BUILDER? O YES ONO
' BUSINESS NAME All Star Water Heaters
ADDRESS 30300 Puente Vallarta Way
PHONE 951-301_0067 EMAIL allstacsierra@gmail.com
CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
I
VALUATION$ 800.00 S FT _ _ L SO FT'/
APPLICANT'S SIGNATURE c� _-_ _ DATE
DEPARTMENT DISTRIBUTION CITY OF MCNIFEE BUSINESS OCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GRLEN SMIP
INVOICE PAID AMOUNT 0C/SH 0CHECK# OCREDITCARD VIWMC
AMOUNT
PLAN CHECK FEES PAID AMOUNT 0 CASH O CHECKA O CREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
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