PMT18-04590 City of Menifee Permit No.: PMT18-04590
29714 HAUN RD.
Type: Residential Plumbing
AAr MENIFEE,CA 92586
MENIFEE MENIFEE Date Issued: 09120/2018
PERMIT
Site Address: 28853 GALAXY WAY, MENIFEE,CA Parcel Number: 339-362-015
92586 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER, SAME LOCATION
Work:
Owner Contractor
JENNIFER BENTLEY ALL STAR WATER HEATERS INC
28853 GALAXY WAY 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92586 MENIFEE, CA 92584
Applicant Phone:9513010067
SIERRA SPRAGUE License Number: 812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE,CA 92584
Fee Description OQrt Amount!$)
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 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 Bldo Permit Temnlate.rot P.—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 71100)of Division 3 of the Business and 01 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 a License No.sf M? � B m signature below I acknowledge that,except form• Y y g g p ypersonal residence
Expires pJaAr Signatures 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
01 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 wehsite:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leginfo.ca.goy/calaw.hrml.
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 DKBY 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 an the property owners behalf.I have read this
number are: G application and the information I have provided is correct.I agree to comply
Carrier C with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Q7AS Expires enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPRK> NER OR AUTHORIZED AGENT
D i certify that in the performance of the work for which this permit is issued, ��O I
I shall not employ 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 orgreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAt U SECURE WORKER'S COMPENSATION COVERAGE IS D Yes �o�No
UNLAWFUL,AN SHALLSUBJECiAN 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 Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 37060E THE LABOR CODE,INTERESi,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY DYes '',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) ❑Yes O No
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 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Cade).Any city or county that requires a permit to .OYes D No
construct,after,improve,demolish or repair any structure,prior to its "'--��` - Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNERORAl1THORIZED AGENT
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 Iicensure receiving compensation for most work that disturbs paint in apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving or childcare facility to beork that
firms and complypre-19th
thanApplicant fora permit subjects the applicant toacivil 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
0I,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.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 ❑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 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.
DATE m@611% PERMIT/PLAN CHECK NUMBER^ _Q-wb^
TYPE: O COMMERCIAL ❑✓RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: .')ADDITION O ALTERATION O DEMOLITION C. ELECTRICAL O MECHANICAL
O NEW WIPLUMBING ,RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace existing water heater. Same size and location.
PROJECT ADDRESS 28853 Galaxy Way 9 .P
ASSESSOR'S PARCEL NUMBER- LOT TRACT
OWNERNAME Jennifer Bentley _
4
ADDRESS 28853 Galaxy Way
PHONE 949-205.3765— - EMAIL
APPLICANT NAME Sierra Sprague _
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar_sierra@gmail.corn_
I CONTRACrOWS NAME Sierra Sprague QW 1 R Bli!L3E'T'_O YES N _
III BUSINESS NAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
PHONE 951-301-0067 ^_ _ EMAIL allstar.sierra@gmail.wm
CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION$ 800.00 SQ FT L SQ FT
APPUCANT'S SIGNAIURE',' DATE
I, OEPARTMLYT DISTRIBUTION CrfY OF MENIFEE BUSINESS LICENSE NUMBER
rA�MOUNI
INGP(ANVING ENGINEERING FIRE GR _ "�OICF PAIU.ANIpUNi I GCASH 0CREDIT CARD VISNMC
� CHECK _ 77
PAID AMOUNT
PLAN CHECK FEES I O CASH O CHECK k CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED GYES O NO DLNUMBER NOTARIZED LETTER - YES NO
rn
o o n o a �
m „ A
iom �
yZrr
MI
i0. = N �' I CD CO
p
O
V m
o n N m w.{ m w D p r .B�
c T 3 c o m m n n A mm a sa
e c E p C ^
o v v m U m m N m K I ! N m _
m o o F: 7 4 °ci Ica
.i I O V3
J _ ry 'r eI
2
n
to s lei
to I
R
_f o to
ro
T. ,o T N o w
E � a �'
to
o .. c = d cnaal p1 CL
w
4 Ti I
?. rz o n o �• m s
N o j1 r_ m � w � y � A• N C � ��
J m s � m n �• m y, °°' I 3 d D
b ..
Cit;QI 4enifee
8101dfnd'Dept. W .v p
S`14 21 2018RE
o Rim
e Ned
�1✓1� 1� - 1} �I��U
u I _NI ro v m S C n �
n o � n
c •N v ui 2 ? °' a p v w 3 vy7~ °' °' m a TO
c N m ro C �. x° o o �mt c c 3, 0
] N k v = ]N @ '° y r , m ran
N fD O ]R 0 4 a e m •a+ A 'O
3 n `1 `1 m m c a c o. y
z 3 d i m v rn 3CD n
m m a Z
.p N N I O n •^�- r O a '" m m. @@ @ O pnjy
T co N I V I •• p' C M ^ A a m S C m 3 c W
,It 0 @ Z
0. r 0 d m 0, a � � N S N B C@ � � � � O � w
] et
_. C d u C a
@ O. @ ]• O n ] C @ S d
O ]
^ n @ _.
i I Ej
oo O c ro ry
A
n 3
7 I �I a 3
R � c 4 a, o w s �'
pw I w c ?•. rc m m 7 ',ay' �, p 'cam*
cn s •- 3 On C n ]CD
n
] d e,
j O
p ]a m ` = ro N-
1 11 a
fo v n ^• m :� 3 3 @ R
ZN
� > > 3 u 'o a •'� 3 N
ci
n p'y D
_I I o
m
w
O 6