PMT18-03077 City of Menifee Permit No.: PMT18-03077
AR AM 29714 HAUN RD.jVW
MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 0 6/2 012 01 8
PERMIT
Site Address: 28900 VIA MARSALA, MENIFEE, CA Parcel Number: 340-082-031
92584 Construction Cost $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER,SAME LOCATION
Work:
Owner Contractor
CHARLOTTE RILEY ALL STAR WATER HEATERS INC
28900 VIA MARSALA 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
Pee Description D1t rr Amount ISl
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
$14s.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_Pemrit 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 contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and D l am exempt from licensure under the Contractor's State License Lawfor
Professions Cade and my license is in full force and effect. the following reason:
License Class License No. J?xz?,� By my signature below l acknowledge that,except for my personal residence
Expires . r Signatures in which l must have resided for at least one year pdorto 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
D I hereby affirm under penalty of perjury one of the following declaration:? 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 website:
by Section 3700 of the La bar Code,for the performance of work for which
this permit is issued. www.leelnFo.ca.eov/calaw.html.
Policy It Date
Qd 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 COY my signature below I certify to each of the following:I am the property
this permit is Issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
numberare: application and the information I have provided is correct.I agree to comply
Carrier 6 with all applicable city and county ordinances and statelaws relating to
building construction.I authorize representatives of this city or county to
Policy Expires Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($300)or less PROP D NER OR AUTHORIZED AGENT
Dl certify that in the performance of the work for which this permit is issued, ® ��Or�
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 9
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Cade,I shall forthw t 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 an the Hazardous Materials Information Guide?
WARNING:FAI U SECURE WORKER'S COMPENSATION COVERAGE IS oyes 1D•No
UNLAWFUL,AN SHALLSUBIECT 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 requires permit for the construction or modification from South
IN SECTION N TO
06 OF THE
LABOR CODE,INTERTION,DAMAGESDATTOROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 37060FTHE LABOR CODE,INTEREST,ANDATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY D Yes 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 performanre of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) Dyes Ln_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
Contractor's License Law for the reason(s)Indicated below by the California Health&Safety Code,Section 25SOS and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Bus [Yes D No
construct,alter,
Professions Cade).Any rre air ounty any structure,
prior
to its permit to Date
csuance,also r,improve,demofishofrepafrermit to file,siined to PROPERTY OWNEROR AUTHORIZED AGENT
issuanre,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP)
License Law(Chapter 9(commenting 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 formos[wark that disturbs paint Ina pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence compenor sation
re flirtytobeork that distuifled firmsandcamre-J37ply h
than
Applicant fora permit subjects the applicant too 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
a1,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.eca.Rov/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 DAn EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or Improves the p p j
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. 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 744,Business and Professions
Cade: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.
0i
DATE (,fJ �d'� PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL ORESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION C DEMOLITION O ELECTRICAL 0 MECHANICAL
O NEW ✓❑PLUMBING 0 RE-ROOF-NUMBER OF SQUARES _
DES011PPON Or WORK. Replace existing water heater. Same size and location.
PROJECTADDRESS 28900 Via Marsala
ASSESSOR'S PARCEL NUMBER �O-tJyo "�` LOT TRACT
OWNER NAME Charlotte Riley _
ADDRESS 28900 Via Marsala Received
PHONE 760-822-5483 EMAIL
APPLICANTNAME Sierra Sprague
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL alistar.sierra@gmail.com
CONTRACTOR'S NAME Sierra Sprague OWNER BUILDER? O YES '"0
BUSINESS NAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 EMAIL allstacsierra@gmail.com
CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATIONS 800.00 OFT ._ L SQ FT
APPLICANT'S SIGNATURE DATE �p
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BURRING PLANNING ENGINEERING FIRE GREEN )i SMIP
qY v:::ICE 1 �.5 PAID AMOUNT
AN;OU'I; OCASH OCHECI(A OCREDIT LARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0 CHECK B 'OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES O NO
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