PMT15-02731 City of Menifee Permit No.: PMT15-02731
29714 HAUN RD, Type: Commercial Plumbing
' iCCE1nA�. MENIFEE, CA 92586
MENIFEE Date Issued: 09/03/2015
I
i
PERMIT
Site Address: 30125 ANTELOPE RD, MENIFEE, CA Parcel Number: 364-010-003
92584 Construction Cost: $300.00
Existing Use: Proposed Use:
Description of INSTALL HOSE BIB INSIDE PRODUCE PREP ROOM
Work:
Owner Contractor
WRI GOLDEN STATE TIGE INC
PO BOX 924133 P 0 BOX 2134
HOUSTON, TX 77292 APPLE VALLEY, CA 92307
Applicant Phone: 9515388089
EFREM NUNEZ License Number: 555274
TIGE INC
P0 BOX 2134
APPLE VALLEY, CA 92307
Fee Description gtv Amount
Building Permit Issuance 1 27.00
, E
General Plan Maintenance Fee-Plumbing 1 5.80
$149.80
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,orwhere 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 ❑ I am exempt from licensure under the Contractors'State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9 (commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence in
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of
License Class License Oo. 5.�7 improvements covered by this permit, I cannot legally sell a structure that I have
Expires Signature built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKERS'COMPENSATION DECLTRATION Business and Professions Code,is available upon requestwhen this application is
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: http//www lepinfo.ca.gov/calaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation, issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
❑ I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
Carrier identified property for the inspection purposes.
Policy# Expires Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
Q I certify that in the performance of the work for which this permit is issued, I
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers' compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwi comply with those provisions. ❑YES ❑ NO
dxs✓
Applicant; Date; 3 L Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENS TION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND El YES ❑ NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES El YES ❑ NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist. I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous material reporting.
OWNER BUILDER DECLARATIONS El YES ❑ NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION REPAIR AND PAINTING(RRP)
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law (Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of theproperty, or m em to employees with wages as their sole w'w'w'epa.gov/lead or contact the National Lead Information Center at
Y P Y 9 1-800-424-LEAD(5323).
compensation, will do( )all of or( ) porting of the work, and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale).
❑ 1, as owner of the property an exclusively contracting with licensed El No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
�Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: IZOMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION 0 ELECTRICAL O MECHANICAL
O NEW XPLUMBING O RE-ROOF-NUMBER/OF SQUARES 4TRACr
DESCRIPTION OF WORK �NS/4�/ /fldS e 4,6 lAlvice, A e /100
City ('f NAon1,
�r BDildin A Sane. D:—t,
PROJECTADDRESS 5, 012 SS 7-CIQ Q /!q . 1y
ASSESSOR'S PARCEL NUMBER 3LQq—r2n—n'�j LOT
OWNER NAME KtU6f/\
ADDRESS 16/ZI Gl/
//7e $%, C/NC/N�tlait O*/a yira0;Z,
133
PHONE _ 5-/3 76?— /4./t(7 _ EMAIL
APPLICANT NAME CFr e vV% AIUAI) ''// Co, o�a
ADDRESS l�/L y// �'�OGO /C,c/,. % /e I/ade C
PHONE qr/ S 39 8o 3 7 EMAIL
CONTRACTOR'S NAME /6c / .dG . (��C+ti �(iL e3 OWNER BUILDER? O YES kNO
BUSINESS NAME �I6 e Z,A✓r- /� /e ADDRESS /�'/L yG� ryryC@@�Ou �{��I • 4I 61al E CPt • �Z ,/?
Qq
PHONE ?Irl 5.39 U d U 1 EMAIL CONTRACTOR'S STATE LIC NUMBER Ss S o27y LICENSE CLASSIFICATION /5"1
VALUATION$ 300� SQ FT �Gd L SO,FT
APPLICANT'S SIGNATURE ! DATE , �n 45
MOW
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE AID AMOUNT
AMOUNT 1 0CASH 0CHECK# E%CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER `.% YES n NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
00
m
o �
city of Menifee stir
Building & Safety Dept. '.
SEP 0 3 2015 _
O Received U T
LL
c�6 5+3 L
b9�
Z
uq a T`3
O a
O
ry
O
O Q
J a'
s�c Fy ❑ W "
-_� O Z
HO W
U) LL (3
I I
� I n
' I I �I V �
mOJ �L 7�
-----� u� c W .A
\\ CITY OF MENIFEE o
ja) 7;7 BUILDING AND SAFETY DEPA TMENT ao
PLAN APPROVAL
REVIEWED BY I3
DATE
'Approval of these plans shall not be construed tobE a permit for,or an
appruval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved pla s must be kept on the
F)
p jobsite until completion.
APPLICATION 0
rr idea-iforusewherelead-free*valves are required.Designexi
for installation on potable water lines to protect against bat
4.!iF�_ backsiphonage and backlaressure of contaminated watel6u
n� into the potable water supply-Assembly shall provide proU
tection where a potential health hazar"IsManifee
LOW4-EAD Building & Safety Dept..,
P I M�T_
STANDARDS COMPLIANCE
C iK
ASSE0 Listed 1013
SEP 0 3 2015 0
IAPMOO Listed
-SA Certified B64.4
FEATURES
Sizes: 0 1/2" L2 314' El 1" ZI 1-114!' Q 1-11Zl E] Z' AWWA compliant C511 Received
Maximum working water pressure 175 PSI Approved by the Foundation for Cross Connection
Maximum working water temperature 180OF Control and Hydraulic Research at the University of
Hydrostatic test pressure 350 PSI Southern California
End connections Threaded FNPT ANSI B1.20_1 NSF0 Listed-Standard 61,Annex G(3/4"-2-)
LEAD PLUMBING LAW COMPLIANCE
OPTIONS (CA H&S Code§11 6875,VSA§2470h)
(Suffixes can be combined) *(0-250A MAX.WEIGHTED AVERAGE LEAD CONTENT) A�
0 - with full port QT ball valves(standard) Lead Plumbing Law Certified by IAPMO R&T
1:3 S - \Adh Model SXL lead-free bronze ly-type strainer I.,
El FT - with integral male 45'flare SAE test fitting
G Certified by NSF International(3/4'-2")
0 AG - with air gap MATERIALS
0 SAG - with Model SXL lead-free bronze"r-strainer Housing Reinforced Nylon, FDA approved
and air gap Fasteners Stainless Steel, 300 Series
Q BOF - with Blow out[Flush fitting Elastomers Silicone(FDA Approved)
Buna Nitrile(FDA Approved)
ACCESSORIES Internals Delrin, Nylon, NSF Listed
0 Repair kits Springs Stainless steel, 300 series
0 Thermal expansion tank(Mdl.XT) Ball Valves Cast Bronze,ASTM B 584
0 Soft seated check valve(Mdl.40XL) Struts Forged Brass, ASTM B 124
0 Shock arrester(Model 1250XL)
0 QT-SET Quick Test Fitting Set OPTIONAL LEAD-FREE STRAINER
(440CIEL SXL) H_
0 Test Cook Lock(Model TCL24) X
Q Blow out/Flush fiflifing F-
RKI-3775BOF D(RK34-375BOF(111T or 3(4"%
or RK114-350-375BOr-))
7 Ai ff E�
DIMENSIONS& WEIGHTS(do not include pkg.) L�PA C a
A
11—GGj [ I—
DIMENSIONS
75' L F- 1
SIZE A 8 C I D I E WITH
G
in. imm! in. mm in. I BALL
113 1 20 1 3718 225 in. min
VALVES
In. rnm tbs. k
�114 20 8718 225 11516 79-15A6 75 3 71 - 12114 311 3 76 12114 '9
.;f ill 6, 75iS 98 12 bi`8 321 3 76 121/4 2.6
2114 IUZ 114,9116 370 2.6
0'2 2"; ' 13JR W 3 3/4 1 15 niA 1 114 1�Z[ 9.7 4.4
3 3 &t 1534 1 20'jQ '1 3314 95 ',8-,12 7 319 PO 3 318 86 3/d , g� , ! _.u.b 93
.1 Ci 406 �va7F I
559 4112 114 20114 9,8 ttk� I �0 I�i 318, P
-1/4;
gin 2 -AA 20 314
-Izs.b 10-7
Page WI INS Urn cO-PanY,1747 Conan Y' ee in Canada:zjRN I DUS, IESIT �3544NVshuaDr i auROntasr..i o L4V I446 Phone M9os5g=Gs8-I272 I=:'9 051 406.12t27l00Fa,-8051238666Product sPP'R -eto Line: 1-877-BACKFLOW(1-877_222_5356) . WebSite:
O
Ot -NO
" be wall)ILL' ✓ I -! %Gtii''1 cii�[ '").: ..-i'j stwT�& 1{LT?d CcLS'1�-(j CtCIYI'tf%. / 1
:C,ter, 3e-uz is al the -s., k Tee !o a Y2:
t...ne r [ 't' aff,:;Gf.:'? __ ._7Y :-5c a t r'x_1iPee i:3tf EP"5_(.�J:of U.
�.i%. ' [Ji..<� e��1 , 11
s[�3 -, -�i _J '? r- VL
.:>E ��,n_1�.'S i'�;Ll
._ lose 'Bib (Qty- =)
_. <i_': Brass Tee(Qty- 1QQ)
.3 �fi"i 4 " i S �b(Qy- F)
/. Bass B�shiz< � _
pressure Gage-Mfin. 56 PST fQty- I}
"->
x Brass Nip. (('sty-?)
:/"x 2'>Brass blip. (Qt-y-2)
7. =/" pressure)Reducer, (Set to_r__ 50 PSI) (Qtv - I)
3/Akins 375XL Backflcw Prevention (Qt3r - _)
'Nye Stra ner(Qty- 1}
J. 'iz" Ball Valve(Qty- 1)
I. l"x %" Stainless Steel Faucet supply Flex (Leng-tlI s job specific. -For excessive
dis_ances use F/a"copEe car io ica Y2 '� I':_-ia`e adapters or each end(strapped tc
4rall}_ Use tV2"X V" S>taL_le3s Steel^aUCCi vS*FF,sJply i 2ex iG comiect to water sot4Tce and
an-ifold.)
D_•a,P
ff'atl fnou atetd and ta,=?fi-g.-l%✓t8cviy's:"fei`ti .`s ' e =4;EeiJl. Termfi ateci PQ-ma ch
xi.nting drains no :pore than 2"feorn fop of drain.
1 '/;'?VC (Length is i b spec dc.)
?. I %,"x 2"Be1t Adapter(As backflow rent caWb) (Qly- 1)
%<"Elbows +Couplings Wrnomis are job specific.)
Sink Fill Dispense UrAe
.Wall mountred fr on, behiad S2 enior zr..a>i fo sin,-'
1. %"PVC (Length is job specific.)
2. %a"Ell =Couplings(A-mo a s are job sgcciJ=C j
I>_",c A" Male to Barbed Elbow(Era ss or PVC) (Qty-2)
4. Y_"- %a"PVC Female Thread:o Female Slits Adapter(Qry,- 2"
r
CL
4^uT V
LLI
LL
IIIIIIIIIIII, Ill MOM
2
Ili
Ye��— Y —s _• P A 15 "� CEO � y S3
TI i
Ill I � -� •� - !� .� s
a
?r
-'_.