PMT18-03075 City of Menifee Permit No.: PMT18-03075
29714 HAUN RD.
1 MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 0 612 0/2 01 8
PERMIT
Site Address: 28681 MOON SHADOW DR, MENIFEE, Parcel Number: 364-145-018
CA 92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER, SAME LOCATION
Work:
Owner Contractor
KERRIE CASTOR ALL STAR WATER HEATERS INC
28681 MOON SHADOW 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 t3ty Amount f51
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
$115.16
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_Pennit 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 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 o I am exempt from licensure under the Contractors State License law for
Professions Cade and my license is in full force and effect. the following reason:
License Class o License NoO.?iwe,� By my signature below I acknowledge that,except for my personal residence
Expires , ' Signature�s Inwhich 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 constructed in Its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:1 licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent ofself-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
this permit is issued. www.leeinfo.ca.eov/calay.htmL
Policy# Date
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 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
numberare: application and the information I have provided is correct.I agree to comply
Carrier E with all applicable city and county ordinances and statelaws relating to
building construction.I authorize representatives of this city or county to
Policy#AVGfe,!&RW.S'Expires 441 Z44R enter identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date�/2 Z
dollars($100)or less PROP NER OR AUTHORIZED AGENT
/
o I certify that in the performance of the work for which this permit is issued, `✓O
Ishallnotemolov 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,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:FAI 110 SECURE WORKER'S COMPENSATION COVERAGE IS o Yes �Qwo
UNLAWFUL,AN SHALL SUBIECT 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 antQuality Management District construction
t(SCtionor modification
permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY 0 Yes 'D,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 SI No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
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
hazardous material reporting.
chsiness and
I have placed next to the applicable item(s)(Section permit .oyes D No /
construsand Professions Code).Any rre air anytythatrequlresapermit to �!' „ = Date
issuance,als enquires h applicantsh frepafrany structure,a signed to PROPERTY OWN OR AUTHORIZED AGENT
issuance,also requires the applicant for the permltto 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 inapre-1978
and the basis for the alleged exemption.Any violation of Section 70315 by residence ompencationfor mosty to ork that disturified bs
painicamre-197ply h
than
n($50 Applicant permit subjects the applicant too civil penalty of not more required practices.This includes rental property owners andproperty
than($500). managers who do the paint-disturbing work themselves or through eir
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 oforI )portion of the work,and the structure is www.eoa.eav/lead or contact the National Lead information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-900-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a
property who,through employees'or personal effort,builds or Improves the o An EPA Lead-Safe Certified Renovator will be responsible for this project
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. o No EPA Lead-Safe Certified Firm Is required for this project because:
o I,as owner of the property am exclusivefy.contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of IF your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
I t!i .xt( y
i r y f
.atiT
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL ❑✓RESIDENTIAL O MULTI-FAMILY a MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: OADDITION O ALTERATION O DEMOLITION ELECTRICAL O MECHANICAL
O NEW ❑✓PLUMBING O RE-ROOF-NUMBER OF SQUARES _
DESCRIPTIONOFWORY. Replace existing water heater. Same size and location.
PROJECTADDRESS 28681 Moon Shadow Dr. �I
ASSESSOR'S PARCEL NUMBER 3cp LA-gLJ,j-n�4:3 LOT TRACT Buildingoeee
OWNER NAME. Kerrie Castor Ii1
ADDRESS 28681 Moon Shadow Dr. �� U
PHONE 951-219-3816 _ EMAIL
APPLICANTNAME Sierra Sprague _ ` Vqu '
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 _ EMAIL allstar.sierra@gmaii.com
gmail.com
CONTRACTOR'S NAME Sierra Sprague OWNER BUILDER? O YES XNO
BUSINESS NAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 EMAIL allstar.sierrac@gmail.com
CONTRACTOR'S STATE LIE NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION$ 800.00 SQFT _ LSQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
- - ' 1
BULLDING PLANNING ENGINEERING FIRE GREEN SMIP X
AMOUNT `\ .15 PAID AMOUNT rJ OCAS. OCHECKR OCREDITCARD VGA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK R O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of M'e;tifee Building V S!:fecy Dep(,rtn)&,A;!97rt4 47:,.;:..:. mlenlfee.. CA 9-585
ww r.c' vvf.^len;Fec.us jj.U>ecticm Renuest rw c 951-246-5213
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