PMT18-04588 City of Menifee Permit No.: PMT18-04588
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 0 912 012 01 8
PERMIT
Site Address: 30778 DESERT EAGLE WAY,MENIFEE, Parcel Number: 360-433-010
CA 92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER,SAME LOCATION
Work:
Owner Contractor
THOMAS JACKSON ALL STAR WATER HEATERS INC
30778 DESERT EAGLE 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 21 Amount fSl
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_PemriLTemplate.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 perjurythat 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 ❑I am exempt from iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No A L�ze By my signature below I 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 legally sell a structure that I
have built as an owner-builder if It has not been constructed in its entirety 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 websile:
by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca-gay/cala%v.litml.permit is issued.
Policy# Date
Isab 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 p$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
number are: application and the information I have provided is correct.I agree to comply
Carrier C L with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of the city or county to
Polity# ?�/G/'�/��f,Q,�(L Expires 12,4a enter the above identified property for inspection purposes..
(This section need not to be completed is the permit is for one-hundred �blice,c� Date,17 Z 9
dollars($100)or less PROP � NER OR AUTHORIZED AGENT
o I certify that in the performance of the work forwhich this permit is issued, !EN
I shall not emolov any persons in any mannerso as to become subject to the CITY BUSINESS LICENSE# -J 5 O
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,l shall forthwith 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 o Yes !o,No
UNLAWFUL,AN SHALL SUBIECF 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
IN SECTION
TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
N SECON 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oYes 'ciNc,
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 ;bAci
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 Code,Section 25505 and 25S34 concerning
checkmark(s)I have placed next to the applicable item hazardous material reporting_.
s)(Section 7031.5 •oYes ❑No
Business and Professions Code).Any city or county that requires a permit to _
construct,alter,improve,demolish or repair any structure,priorto its Date ,: /r
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.S 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
a 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 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(5373).
Code,The Contractors State License Law does not apply to an owner of a ❑An 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 sale. o 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 Contractors 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.
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DATE q`�1\Q� PERMIT/PLAN CHECK NUMBER �(�
TYPE: C COMMERCIAL ❑✓RESIDENTIAL ^ MULTI-FAMILY C'MOBILE HOME C, POOL/SPA a SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION '_'DEMOLITION ELECTRICAL 9 MECHANICAL
C NEW FVerPLUMBING i, RE-ROOF-NUMBER OF SQUARES
DESCRIPTION0I WORK Replace existing water heater. Same size and location.__
• PROJECT ADDRESS 30778 Desert Eagle Way 0-6
ASSESSOR'S PARCEL NUMBER !Uf0—L LOT TRACT
OWNER NAME Thomas Jackson
ADDRESS 30778 Desert Eagle Way
PHONE 760^214-3996 --—EMAIL
APPLICANT NAME SierraVallgUe
I ADDRESS 30300 Puerta Vallarta
PHONE 951-301-006.7_ EMAIL allstar.sierra@gmail.com
CONTRACTOR'S NAME Sierra Sprague __ OWNER RUILDER7 O YES NO
BUSINESSNAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way -
., PHONE 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
DEPAflTMENT DISTftIBUTIDN CITY OF NIENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREL-N .
I I1A
IIVVOICE PAID AMOUNT I
AMOUNT I 1 O CASH �)CHECKN C CREDIT CARD VI5A(MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK V CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED +=YES NO DL NUMBER NOTARIZED LETTER OYES 0 NO IJ
2(' ity'Of Menlfee _ ." .Ocpnrt:-'
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