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PMT18-05023 City of Menifee Permit No.: PMT18-05023 IZ- 29714 HAUN RD. Type: Residential Plumbing AF MENIFEE, CA 92586 MENIFEE MENIFEE Date Issued: 10/17/2018 PERMIT Site Address: 29373 HIDDEN LAKE DR, 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 MADDIE ROSSI ALL STAR WATER HEATERS INC 29373 HIDDEN LAKE DRIVE 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 gty Amount 1E) 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 $116.15 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of enors 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_BIdg_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 D 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. el�Rq-,e By my signature below I acknowledge that,except for my personal residence Expires O Signature �� in which I must have resided for at east one year prior to 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 worker's 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 ,,vs ,leeinfo.ca.eov/calaw.html. this permit is issued. Policy# Date M have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which CKPy 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 owner's behalf.I have read this number are: G application and the Information I have provided is correct.I agree to comply Carrier G with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy EAe-LY y,P,P/R7/11 Expires enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Dated 29 dollars($100)or less PROP NER OR AUTHORIZED AGENT o I certify that in the performance of the work for which this permit is issued, I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It 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,I shall forthw' con 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 on the Hazardous Materials Information Guide? WARNING:FAI U SECURE WORKER'S COMPENSATION COVERAGE IS O Yes In No UNLAWFUL,AN SHALL SUBJECT 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(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY OYes j O.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 agencyfor the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) o Yes -ONO OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD permitting checklist 1 understand my requirements under the State of I hereby affirm under penalty of perjury that l am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 'QYes ❑No i !% Business and Professions Code).Any city or county that requires a permit to _1. Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNEROR 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 LRRPJ 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 llcensure 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 RAP-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 ❑1,as owner of the properly,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.epa.eav/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a 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-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 bemuse: a 1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors Sate License law does not apply to an owner of If your project does not comply with EPA RAP rule please fill out the RAP Acknowledgement F 7.-.7 � � ���pp,� 4L DATE 1�1\tJ[ 11 V- PERMIT/PLAN CHECK NUMBERR� TYPE: ;-COMMERCIAL Q✓RESIDENTIAL ) MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION�C ELECTRICAL O MECHANICAL C•NEW ✓PLUMBING ORE-ROOF-NUMBER OF SQUARES ___ ___ DESCRIPTION OF WORK Replace existing water heater. Same size and location_ PROIECTADDRESS 29373 _Hidden Lake Dr. ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME Maddle Rossi _ _ -Qby Of Menl e Building De t. ADDRESS 29373 Hidden Lake Dr. PHONE 951-212-6423 J_ _. _ EMAIL _ DCT_J 6.201 APPLICANTNAME Slerra Sprague_ `- - ADDRESS 30300 Puerta Vallarta C715 PHONE 951-301-0067 EMAIL allstar.sierra Mggmail.com CONTRACrOR'S NAME Sierra Sprague OWNER BUILDEQ7 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'SSTATELICNUMBER 812894 _ LICENSE CLASSIFICATION C36 — VALUATION$ 800.00 SQ FT L SO FT ry APPLICANT'S 51GNATU RE DATE ___ r— DEPARMILNr DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NDMREP • BUILDING PLANNING ENGINEERING FIRE GREENINVOICE \� PAIDAMOUNT ��'� J HECKk %'CREDIT CARD VISA/MC AMUUNI L' C•CASH ` C _ PLAN CHECK FEES PAID AMOUNT 0CASH O CHECK If CREDIT CARD VGA/MC , OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER C YES 0 NO Wi CI`y of Ri: F'.I,Is!!s t1EUi07)Rep q z t+ m J' o sti `C a G9 t9 cn v f�In ;3 0 M W N w q tJ = rd•. 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