PMT18-04153 City of Menifee Permit No.: PMT18-04153
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 08/22/2018
PERMIT
Site Address: 28543 CHAPPARAL VIEW DR,MENIFEE, Parcel Number: 372-222-001
CA 92584 Construction Cost: $0.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER WITH SAME SIZE(50 GALLON GAS)AND LOCATION.
Work:
Owner Contractor
BETTY MCKIM ALL STAR WATER HEATERS INC
29634 CAMINO DELORES 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92586 MENIFEE, CA 92584
Applicant Phone:9513010067
ALL STAR WATER HEATERS INC License Number: 812894
30300 PUERTO VALLARTA WAY
MENIFEE,CA 92584
Phone:9513010067
Fee Description ON Amount
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 building 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 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 o I am exempt from licensure under the Contractor's State License law for
Professions Code and my license is in full force and effreyR the following reason:
License Class License No. By By my signature below l acknowledge that,except for my personal residence
Expires O Signature --.._ In which lmust have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION /O 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 entirely by
o I 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 Labor Code,for the performance of work for which ,,tyyv,leeinfo.ca.eov/calaw.html.
this permit Is issued.
Policy It 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 Wy my signature below l certify to each of the foliowing: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 state laws relating to
building construction.I authorize representatives of this city or county to
Policy:r,��/G�j/,P,P/X7/1S Expires enter the above identified property for inspection purposes.
(This section need not to 6e completed is the permit Is for one-hundred �/"!f Date,[7�9
dollars($100)or less a l certify that in the performance of the work for which this permit is issued, PROP "NER OR AUTHORIZED AGENT�t_ f1f C
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g JV1..3
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 for hw ply with those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant co 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 0Yes !o,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
ADDITION 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY Dyes `ono
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 �ktlo
OWNER BUILDER DECLARATIONS 1 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 under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting. /
Business and Professions Code).Any city,or county that requires permit to bYes ❑No��— Date �/ /r�
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNEIEORAUTHORIZED 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 PIRPI
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 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 he RRP-certified firms and comply with
an Applicant for a perm it subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($i- managers who do the paint-disturbing work themselves or through their
o 1,as owner of the roe or employee with wa es as their sole employees.For more information about EPA's Renovation Pra ram visit:
property,rtY, Y6g
compensation,will do( )all of or( )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 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. a No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the 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 If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK AP• • -
ri:,
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL [ RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOLISPA 0 SIGN
SUBTYPE: 0 ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
0NEW ✓ LUMBING ORE-RODF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace existing water heater. Same size and location.
PROIECTADDREss 28543 Chapparal View Dr. "paC-),071wjl
ASSESSOR'S PARCEL NUMBER 3oa.aaa.wi LOT TRACT
OWNER NAME Meghan Rini
ADDRESS 28543 Chapparal View Dr. r'itvof Menifee
PHONE
951-330-8501 EMAIL BUBI Rng
APPLICANT NAME Sierra Sprague AUG 22 201
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar.sierra rrfal�6oM"1 v
CONTRACTOR'S NAME Sierra Sprague _ OWNER BUILDER4 O YES O NO
BUSINESS NAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 EMAIL allstar.sierra@gmail.com
CONTRACTOR'S STATE LIC NUMBER 612894 LICENSE CLASSIFICATION C36
E
VALUATIONS 800.00 SO FT _ L SQ FT
APPLICANT'S SIGNATU DATE
DEPARTMENT DISTRIBUTIDN I CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING NRE GREEN SMIP
INVOICE PAID AMOUNT 000ASH OCHECX# 0CREDIT CARD VISA/MC
AMOUNT
PLAN CHECK FEES PAID AMOUNT 0CASH OCHECKB OCREDITCARD VIWMC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee BLtliding&Safegl Department 29714 HOW?Rd.Menlfee,CA 92586 951-572-6777
www.cityo/nlenlfee.its inspection Request line 951-246-6213
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