PMT15-03285 City of Menifee Permit No.: PMT15-03285
29714 HAUN RD. Type: Residential Plumbing
'(�kCCEL/-> MENIFEE,CA 92586
MENIFEE Date Issued:
10/2212015
PERMIT
Site Address: 28652 AMBORELLA WAY, MENIFEE, CA Parcel Number: 364-213-011
92584 Construction Cost: $1,000.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40-GAL WATER HEATER, SAME LOCATION
Work:
Owner Contractor
RENEE TAYLOR TRUTEAM OF CALIFORNIA INC
28652 AMBORELLA WAY 260 JIMMY ANN DRIVE
MENIFEE,CA 92584 DAYTONA BEACH, FL 32114
Applicant Phone:3863042222
ED PONCE License Number:221517
TRUTEAM OF CALIFORNIA INC
260 JIMMY ANN DRIVE
DAYTONA BEACH,CA 32114
Phone:9517226905
Fee Description Div Amount ISI
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 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_BIdg Pennit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for thi
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 k
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion o
License Class
X License . A2/:5'-/�� Improvements covered by this permit, I cannot legally sell a structure that I haw
Expires p113b� Signature �_�.- C� built as an owner-building if it has not been constructed in its entirety by license(
contractors. I understand that a copy of the applicable law, Section 7044 of IN
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: hftp,//www.leciinfo.ca.ciov/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 orAulhorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the propert,
< 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 thi:
mo Sin 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 compl!
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildinc
construction.I authorize representatives of this city or county to enter the above
Carrier.4/1 ' gq/'faR r o identified Qraperty for the Ins tion purposes.
Policy# 011E ItC jWg15-53 Expires 646/101 �6eC��-'U � `^ Date/ 17-h
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) ty
❑ I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Nil 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`a cified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. DYES E O
Applicant; Date; 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
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES EYNO
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 DYES KNO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAOMD
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 ❑YESRJO
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's 1 zi !— Date / zX
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(RRPI
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 Stale 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($500).) employees.For more information about EPA's Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work, and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.if,however, Certified Finn Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale).
❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractors)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
iPERMIT/PLAN •
?Menifee
DATE 10/22/2015 PERMIT/PLAN CHECK NUMBER
TYPE. ]COMMERCIAL RESIDENTIAL Q.MULTI-&AMILY OMOBILEHOME POOL/SPA QSIGN
SUBTYPE QADDITION EJALTERAT�ION DEMOLITION []ELECTRICAL QMECHANICAL
Q✓ E
[]NEW PLUMBING lREROOF•NUMBEROFSQUARES.
DESCRIPTION OF WORK Replace 40 gallon water heater City of aennifeDept.
PROJECTADDRESS 28682 Amborella Way qj$
ASSESSOR'S PARCEL NUMBER 304,213.011 LOT TRACT Receive
PROPERTY OWNER'S NAME Renee Taylor
ADDRESS 28652 Amborella Way,Menifee,CA 92W
PHONE (714)323-9462 EMAIL
APPLICANT NAME Ed Pence
ADDRESS 475 Rivera St, Unit:D,Riverside, CA 92501
PHONE (951)722-6905 EMAIL
CONTRACTOR'S NAME Truteam Of O'A lrio r - OWNER BUILDER? AYES QN0
BUSINESS NAME
ADDRESS 476 Rivera St, Unit:D.Rivensicfa,CA 92601
PHONE (951)683.4429 EMAIL
CONTRACTOR'S STATE LIC NUMBER 221517 LICENSE CLASSIFICATION Q2
VALUATIONS $1,000.00 SO FT 2374 L SO FT
APPLICANT'S SIGNATURE DATE 10/22/2015
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION - CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT GG
AMOUNT ( . \� ���•,J O CASH C;CHECK R O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 'CASH C:CHECK IT OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Maun Rd. Menifee, CA 92586 951-572-6777
www.cityofinenifee.us inspection Request Line 951-246-6213
CERTIFICATE OF COMPLIANCE CFIR-ALT-01-F
Prescriptive Residential Alterations (Page 1 of 3)
Project Name: Ronep Taylor•28652 Amboralio Way Datp PropaTod: 2015.10-22
A.General Information
DI Project Name Renee Taylor 0$ pats prepared . 2015.1422
03 Project Location 28652 Amborella Way 04 Building Front Orientation 0
(deg) City Of Menifee
OS [A City Menifee 06 Numoarof Dwelling DnitS 1 6p
with Additions
07 21p Code 92584 08 Fuel Typo Natural gas
09 Climate Zone 10 10 TotalConditioned Floor Area 2374 1
11 Building Type Single family 12 Slab Area 0
— Exceptions to Minimum Ages
13 Project Scope Water heating 14 Solar Reflectance and No Exceptions
Minimum Thermal or SRI
B.Building Insulation Details(Section 150,2(b)1)
This section does not apply to Shls project.
C.Roof Replacement(Section 150.2(b)IH)
Tha sampn Jocs nol appal tP rim prole6.
D.Fenestration/Glazing Allowed Areas and Efficiencies(Section 150,2(b)1)
This section does not apply to this project.
Regntration Number:215-A6366659A-11001KI0000.0000 Registration Date/nme: 2075.10-220BAB:g3 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013-1.006 Report Ganerated:2 015 4 0-2 2 WA&14
Schema Version:2013.1.006
CERTIFICATE OF COMPLIANCE CFIR-ACT-01-E
Prescriptive Residential Alterations (Page 2 of 3
E.Fenestration Proposed Areas and Efficiencies-Add(Section 150.2(b)1A)
This section does not apply to this praiser.
F.Fenestration Proposed Areas and Efficiencies-Replace(Section 150.2(b)10)
This section does not apply to this project.
G.Space Conditioning(SC)Systems-Heating/Cooling(Section 150.2(b).
This section does not apply to this project.
H.Water Heating Systems(Section 150.2(b)16)
01 02 03 04 05 O6 02 08 09 10 11 12 13 14 is
Water Number of Water Back-up
Water Heating Water- Heater Heating Heating Standby Extttlar Dwelling Unit DHW
System In or Heating Heater water Storage Ford Type gated. flared Efflcieney Efideney ... Insulation solar Central OHW system System DHtribahm
System "caters In Input Type input wine Savings Distribution Type
Name Type Type System vuo;_ typo Valp4 (gerce ) -R-Value Fraction Type
This field This field
Natural Energy section setlbn Thlsfieldorsectianis Standard distribution
WHS p1 DNW Boller 1 40 gas Btu/Hr 40000 Astor lEfl .6l arisnot 16 arts not notapplicable system
applicable applicable
I.Space Conditioning Systems And Water Heating Systems In Multifamily Dwelling Units
This section does not apply to this project.
Registration Number:215-A6366659A-000000000.0000 Registration Date/Tnne: 201610-22 OD:48:25 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013-1.006 Report Generamd:2015-10-22 09:48:14
Schema Version:2013.1.006
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescrfptive Residential Alterations (Page 3 of 3)
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation Is accurate and complete,
eocumentathm Author Name: Decomenlnpan Author Sigmtum:
Edward Ponce
Company: simartufo pate
Masao Contractor Services 2015.10.22 09:48:25
Address CWHERSCertlficaaon ldentificallchinf. pllablel:
1015 N MARKET BLVD
an/state/Zip: Intent:
SACRAMENTO CA 95834 9164194012
Responsible Person's Declaration statement
I certify the following under penalty of hriuM under the laws of the State of California:
1. Theinformationp.Wed on this Certificate of Compliance is Me and correct.
2. 1 am eligible under Divblon 3 of the Business and Professions Code to accept rospondlullty for the building design or system design identified on this Certificate of Compliance(responsible designer).
3. That the energy feature;and performance specifications,materi.1k, n.pcnenb,and manufannred dafes hit the building design or rystem design Identified on this Certificate ofCrnpllameconform to the
refinements of 24,part l and Part 6of the Callrorele Code of Ragulallbm.
4. The building deal,.fiamume or getem design lemur¢.Identified an this Certificate:ofCompliance are consulter with the Information promded on other applicable compliance documents,worksheets,
calculations,plans and specifications submlned to the onforcemer"geney for approval with thle building permit appllmtler.
S. I will ensure that a registered copy of thls Certificate.of Carmilanco shag be made available with the building permiesl issued for the building,and made avalable to the enforcement agency for all appllcabla
Inspections.)understand that registered ropy of this prlaicate of Compliance is;poi to be induded with the documentation the builder provides to the building owner at acwVanry.
Respondble Designer Name: - - - Responsible Cmagrar SignaNre: e, �
Edward Ponce
company: Date Signed:
Masco Contractor Services 2015,10-22 09:48:25
Address: - Licanw:
1035 N MARKET BLVD 221517
Citytstate/bp: Phone:
SACRAMENTO(A 95834 916-419-4012
Wgdallysighedby CidCERni. This di a(gnaher,is provided in order to secwe the content afous repeated document any in no wayimpliea Regfelmtbn Provide maWnsibility for the ecturary offhe information.
Registration Number:215-A6366659A-0GWOGG00-0 Registration Data/Time: 2015-10-2209:48,25 HERS Provider.CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013-1.006 Report Genemted:2015.10.22 09t411:14
Schema Version:2013.1.006