PMT18-05021 City of Menifee Permit No.: PMT18-05021
�f 29714 HAUN RD.
® MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 1 011 712 01 8
PERMIT
Site Address: 28778 RICHFIELD CIR, MENIFEE, CA Parcel Number:
92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER, SAME LOCATION
Work:
Owner Contractor
ENDAH EKAWATI ALL STAR WATER HEATERS INC
28778 RICHFIELD CIRCLE 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 O_yt 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
$115.16
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 carded 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_Pennit_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 Contractors State License law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. �.TR� By my signature below l acknowledge that,except formy personal residence
Expires O Signature � O in which l must have resided for at least one year priorto completion of
WORKER'S COMPENSATION DECLARATIONImprovements 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
❑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
this permit is issued. www.leginfo.ca.eov/calaw.html.
Policy g 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 W.Py 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 1 have read this
number are: 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.l authorize representatives of this city or county to
Policy If r� �BL7 Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred , Date�1y �—
dollars($100)or less PRO PERSY� NER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued, + / O
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 4 �•7
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 forthwith comply 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 on the Hazardous Materials Information Guide?
WARNING:FAOSHALL
CURE WORKER'S COMPENSATION COVERAGE IS O Yes ;Q No
UNLAWFUL,AUBJECT 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($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air quality Management District(SC[ion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
Airllnes
Qua
CONSTRUCTION LENDING AGENCY oyes lmft
I hereby affirm that under the penalty of perjury there is a construction WIII the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes 'Oft
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the permitting checklist l understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the Ca Biennia Health&Safety Code,Section 25505 and 25S34 concerning
checkmark(s)I have placed nenexttothe applicable item hazardous material reporting.$)(Section 7031.5 �
Business and Professions oyes o No Code).Any city or county that requires permit to ,�
-�=-+— Date . YXi_.
construct,also
the
f rthep permit
to file a signedor ota PROPERTY OWNER OR AUTHORIZED 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 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 Rcensure 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 residence compensor ationre for mosty to ork that
painicomplywith
than
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 1,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 doIIall 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(5323).
Code,The Contractors State License Law does not apply to an owner of oAn 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-guilder will have the burden of proving that it was
not built or improved for the purpose of sale. a 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 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
.._.may
DATE A ��J�>�t45 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL Q✓RESIDENTIAL O MULTI-FAMILY ,O MOBILE HOME O POOL/SPA O SIGN_
SUBTYPE: C?ADDITION Q ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW ✓PLUMBING , RE-ROOF-NUMBER OF SQUARES_ Menefee
DESCRIPTION OF WORM. Replace existing water heater. Same size and locati&aildin j Dept.
--'OCT. 1 i 2018
I PROJECTADDRESS 28778 Richfield Cir ived
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME Endah Ekawatl
ADDRESS 28778 Richfield Cir
PHONE 626-382-9130 EMAIL
APPLICANT NAME Sierra Sprague
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar.sierra a gmail.corn
u CONTRACTOR'S NAME Sierra Sprague .OWNER BUILDER?_O YES ONO_
I 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 812894 LICENSE CLASSIFICATION C36
I VALUATION$ 800.00 SQFT LSQFT —_. .J
- -- fi
APPUCANT'SSIGNATURE
DEPARTMENT DISTRIBUTION I CITY OF MENIFEE BUSINESS LICENSE NUMBER
I d
BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP --
INVOICE PAID AMOUNT 1`�, t5 n
AMOUNT 11 C�CA:I! CHECK R 'I CREOR CARD-VISNMC
PLAN CHECK FEES PAID AMOUNT � OCASH OCHECK# _ OCREDITCARD VISAtMC ,
LNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES CI NONO j
_ . IVlenitre 8illiifbl0$ SLfVly t:eprr�m uC 2.7.i9 ffaur,Rd. M_rree, -
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