PMT18-03929 City of Menifee Permit No.: PMT18-03929
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 0 810 812 01 8
PERMIT
Site Address: 24961 SPRINGBROOK WAY, MENIFEE, Parcel Number: 341-240-022
CA 92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER,SAME LOCATION
Work:
Owner Contractor
DONNA RAND ALL STAR WATER HEATERS INC
24961 SPRINGBROOK WAY 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 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
$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_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who bonds or improves thereon,and who contracts for the projects
hereby affirm under penalty of perjury that l am under provisions of with a licensed cantractor(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 Contractor's State License taw for
Professions Code and my license is in full force and affect. the following reason:
License Class C216 License No.��.,?.Q,�� By my signature below l acknowledge that,exceptformy personal residence
Expires JO Signatures in which l must have resided for at least one year pdorto completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an 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 tabor Code,for the performance of work for which www.IeginIb.ca.gov/caIaw.htmL permit is issued.
Policy# Date
44 have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 ofthe Labor Code,for the performance ofthe work for which p$y my signature below I certify to each of the follov ing: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
number are: application and the information I have provided is correct.)agree to comply
Carrier E with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#z��J�L�y.P,P/R7DS Expires enterthe above identified property for inspection purposes.
(This section need not to 6e completed is the permit is for one-hundred 4,- oami % ,ems Date
dollarsify that
or less PROPEi D NER OR AUTHORIZED AGENT
o I certify that In the performance of the work for which this permit is issued, ® f
I shall not emo �f_lov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE J 01
workers compensation laws of Caltfomia,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 forthwilp 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 orgreater that the
amounts specified an the Hazardous Materials Information Guide?
WARNING:FAICURE WORKER'S COMPENSATION COVERAGE IS oYes ;tz,No
UNLAWFUL,ANU SE SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe building by the applicantor future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modiRration from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management Otstrict cons(SCtionor See permitting from
checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines
Qua
CONSTRUCTION LENDING AGENCY oYes Ia,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) Dyes rNo
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
Contractors License Law for the reason(s)indicated below by the California Health&Safety Cade,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
'mYes DNj/
Business and Professions Code).Any city or county that requires a permit to ,..� = Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNEII ORAUIHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement -
that he or she Is licensed pursuant to the provisions ofthe Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
License Law(Chapter9(commencing with Section 7000)of Division 3 ofthe 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 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
D I,as owner ofthe property,or my employee with wages as their sole employees.For more Information about EPA's Renovation Program visit:
compensation,will do( )all ofor( )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 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner ofa aAn EPA Lead-Safe Certified Renovator will be responsible forthis 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. ci No EPA Lead-Safe Certified Firm Is required forthis project because:
o I,as owner ofthe property am exclusively 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 a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
9 f
DATE PERMIT/PLAN CHECK NUMBER C
TYPE: O COMMERCIAL ❑✓RESIDENTIAL O MULTI-FAMILY _0 MOBILE HOME 0 POOL/SPA C SIGN
SUBTYPE: O ADDITION O ALTERATION C DEMOLITION O ELECTRICAL O MECHANICAL
O NEW ✓ LUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace existing water heater. Same size and location,
PROJECTADDRESS _24961 SSp�ringbbrro`okk Way-
ASSESSOR'S PARCEL NUMBER _..l'S�'d�CJ'D� LOT TRACT _
OWNERNAME Donna Rand - _ City of MenifPa
ADDRESS 24961 Springbroo_k Way Building Dept.
PHONE 951-672-0980 EMAIL elir, 0.g10.18
APPLICANTNAME Sierra Sprague _
ADDRESS 30300 Puerta Vallarta _
PHONE 951=301-0067 _ - EMAIL allstar.sierra@gmail.com
CONTRACTOR'S NAME Sierra Sprague OWNER BUILDER? O YES O NO
BUSINESS NAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 — EMAIL allstacsierra@gmail.com
CONTRACTOR'SSTATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36 _ I
VALUATION$ 80000 _ SQFT _ LSQFT
APPLICANT'S SIGNATURE DATE
-
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMUER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP k_I,_.
INVOICE PAID AMOUNT '\Gj. 0 CASH O CHECK ft O CREDIT CARD VISNW
_AMO.UNT ✓✓
PLANCHECK FEES HAID AMOUNT 0 CASH 0 CHECK# O CKEDO CARD VIWIVIC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
C,';I!of Menifee BtlJJding&$Ufpq Lkpartmrnt 29714 Noun Rd,Met?f22, CA 9_586'95i-6;2-:T/7
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