PMT18-02522 City of Menifee Permit No.: PMT18-02522
29714 HAUN RD.
�A-CCELIk�. MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 05/23/2018
PERMIT
Site Address: 25537 SERPENS CT, MENIFEE, CA Parcel Number: 339-153-013
92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER, SAME LOCATION
Work:
Owner Contractor
THEODORE GOODRICH ALL STAR WATER HEATERS INC
25537 SERPENS COURT 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 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
$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_Bldg_Permil Templale.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and whocontracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 700D)of Division 3 of the Business and D I am exempt from licensure underthe Contractors5late License Law for
Professions code and my license is in full force and effect. the following reason:
License Class license No. Qecry 22,9'1 By my signature below 1 acknowledge that,except for my personal residence
Expires O Signature � in which l must have resided for at least one year priorto completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legallysell a structure that I
have built as an owner-builder if it has not been consbucted in its entirety by
a 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 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 websile:
by Section 3700 of the Labor Code,for the performance of work for which www.Ieglnfo.ca.Rov/caIaw.IitmI.permit is issued.
Policy 4 Date
0 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 Wy 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 Cc with all applicable city and county ordinances and statelaws relating to
building construction.I authorize representatives of this city or county to
PolicyR JU/G/����. 2dl Expires enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or lessw�'�' Date 221
PROP � NER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit a issued, ��O�
I shall not em Ifolov 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,1 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:FAI U SECURE WORKER'S COMPENSATION COVERAGE IS o Yes ,IyNo
UNLAWFUL,AN SHALL SUBJECfAN 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 Districtconstruction
or modification
permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
Airlines
Qua
CONSTRUCTION LENDING AGENCY oYes to-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 �o_No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMO
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 al Safety Code,Se
Contractors License Law for the reason(s)indicated below by the
Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)ISection 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to ;oYes oNo
/-_ Date
construct,alter,improve, applicantsh for pair any hepermit 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(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 apre-1978
and the basis fort he alleged exemption.Aicany nt too Violation of it penaltyction of not by residence or childcare facility to be RRP-certified firms and comply with
than
Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($S00). managers who do the paint-disturbing work themselves or through their
D 1,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 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 of safe. D No EPA Lead-Safe Certified Firm is required for this project because:
D 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 rill out the RRP
Acknowledgement.
- 'M
M
DATE gal 51 PERMIT/PLAN CHECK NUMBER
TYPE: Q COMMERCIAL ❑✓RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOLISPA 0 SIGN
SUBTYPE: 0 ADDITION O ALTERATION 0 DEMOLITION ELECTRICAL 0 MECHANICAL
0 NEW PLUMBING 0 RE-ROOF-NUMBER OF SQUARES: _
OFSCRIP?ION nr 1vk,`0RK Replace existing water heater. Same size and location.
. PROJECTADDRESS 25537 Serpens Ct. _ _ lD
-- _, -C' o enl ee
ASSESSOR'S PARCEL NUMBER Jjk?nL LOT _ TRACT -_-- Dept:
OWNER NAME Theodore Goodrich
-
- _—. - -Z 3�0,
ADDRESS 25537 Serpens Ct. .__ _
PHONE 951-301-9992 EMAIL .- - R-edeEved
APPLICANT NAME Sierra Sprague
ADDRESS 30300 Puerta Vallarta�_
PHONE 951-301-0067 _ _ EMAIL _allstar.sierra@gmail.com
CONTRACTOR'S NAME Sierra Sprague _ -- vW,QE.^.FUfLDEStd - 0 YES '-'NO
_
1 BUSINESS NAME All Star Water Heaters
1 ADDRESS 30300 Puerta Vallarta Way— — — — —
iPHONE 951_301-0067 EMAIL allstar.sierra@gmail.com
CONTRACTOR'S STATE LIC NUMBER 812894 ___ _^ LICENSE CLASSIFICATION C36
VALUATION$ 800.00 SQ FT . .— -- L SO FT
//
APPLICANT'S SIGNATURE DATE_S[
DEPARTMENT DISTflIRUTION CITY OF MENIFEE BUSIrvESSUCENSE NUMDER ;
BUILDING PLANNING ENGINEERING FIRE GRELN I� SINIP
AMOUNT •1 PAIDAMOUNT 1, .IC p q OCREDITCARD VISA/Mc
CASH CHECKB
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK" •O CREDIT-CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
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