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PMT15-03371 City of Menifee Permit No.: PMT15-03371 29714 HAUN RD. Type: Commercial Alteration -XCCELA-> MENIFEE, CA 92586 MENIFEE Date Issued: 11103/2015 PERMIT Site Address: 26912 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-320-016 CA 92584 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of ADA RESTROOM ALTERATION w/3 SERVICE SINKS Work: REFERENCE PMT15-01974 U/G SEWERIWATER Owner Contractor CHERRY HILLLS PLAZA LLC 26912 CHERRY HILLS BLVD MENIFEE, CA 92584 Applicant License Number: MENIFEE, CA Fee Description Qtv Amount($) Receptacle, Switch, Outlet&Fixture 11 166.00 Plumbing Fixtures and Vents,fixtures 7 136.00 Gas System 1 116.00 Water Heater 1 83.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 148 148.37 GREEN FEE 1 1.00 SMIP COMMERCIAL 1 2.00 New Construction Permit Fee 1 23.00 General Plan Maintenance Fee-Plumbing 1 16.75 General Plan Maintenance Fee-Electrical 1 8.30 $727.42 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_Bldg_Permit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION �I wing reason:am exempt from licensure under the Contractors'State License Law for th, /fog I hereby affirm under penalty or perjury that I am licensed under provisions of 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 ii Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion c License Class License No. 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 license) contractors. I understand that a copy of the applicable law, Section 7044 of thi WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is ElI hereby affirm under penalty of perjury one of the following declarations: submitted or at the following Web site: htt ca. ov/ mi. 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 orAuthori d Age t Policy# ❑ By my Signature below, I certify to each of the following: I am the propert, ❑ 1 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: 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 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 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 one-hundred dollars($100)or less) City Business License# HAZARDOUS MATERIAL DECLARATION ❑ 1 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 forthwith comply with those provisions. ❑YES ❑NO 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 OYES ❑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: 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 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 purpose of sale). Firm Certification No.: ❑ I, 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 contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP . 11 • a Menifee DATE to 01 is PERMIT/PLAN CHECK NUMBER TYPE: COMMERCIAL RESIDENTIAL MULTI-FAMILY 0MOBILE HOME POOL/SPA SIGN SUBTYPE: ADDITION ; ALTERATION DEMOLITION ELECTRICAL MECHANICAL C% NEW \/PLUMBING RE-ROOF-NUMBER OF SQUARES r DESCRIPTION OF WORK City of Me ifee / llal y v°Gi PROJECT ADDRESS ! �: �►ty Of M-nifee ASSESSOR'S PARCEL NUMBER `j —('�� LOT TRACT C`' I' ivQ apt OWNER NAME LL P 'CT Xr n ADDRESSL6k�tLvl) r n PHONE S/j 6 1CJ— Z=(�:V EMAIL — �— / s I, APPLICANT NAME /��LL.S T L L L ADDRESS , L LS PHONE EMAIL 7 CONTRACTOR'S NAME OWNER BUILDER? YES 0; NO BUSINESS NAME ` �'� �� f 1`t'i° � 01(q 7� ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ Q�(� _ SQ FT 6D L SQ FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE I PAID AMOUNT AMOUNT <- CASH CHECK# CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH %CHECK# CREDIT CARD VISA/MC OWNER BUILDER VERIFIED 0 YES NO DL NUMBER NOTARIZED LETTER 0 YES NO City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 S101 Z 0 AM NOV 0 2 2015 I H I t V t-I.AL I r V KIN IA WATER HEATING SYSTEM GENERAL INFORMATION CEC-NRCC-PLB-01-E Revised 05115 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-PLB-01-E Water Heating System General Information (Page 1 of 2) Project Name: � Date Pre areZ• A.GENERAL INFORMATION/SYSTEM INFORMATION 1. Water Heater System Name: 2. Water Heater System Configuration: 3. Water Heater System Type: 4. Building Type: 5. Total Number of Water Heaters in Systems: 6. Central DHW Distribution Type: � S 7. Dwelling Unit DHW Distribution Type: B.WATER HEATER INFORMATION Each water heater type requires a separate form. 1. Water Heater Type: 2. Fuel Type 3. Manufacture Name 4. Model Number 5. Number of Identical Water Heaters: 6. Installed Water Heater System Efficiency: 7. Required Minimum Efficiency: 8. Standby loss percent or Standby loss total: p Gib 9. Rated Input 810 Pilot Energy: 911 Water Heater Tank Storage Volume: ] 12 Exterior Insulation On Water Heater: 13. Volume of Supplemental Storage: 14. Internal Insulation on Supplemental Storage: 15. Exterior Insulation on Supplemental Storage: CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 "I A I t Vt-I.ALWUKINIA WATER HEATING SYSTEM GENERAL INFORMATION CEC-NRCC-PLB-01-E Revised 05115 CALIFORNIA ENERGY COMMISSION Ae CERTIFICATE OF COMPLIANCE NRCC-PLB-01-E Water Heating System General Information (Page 2 of 2) Project Name: /� a n. Date Prepar J.•Z. PLUMBING COMPLIANCE FORMS&WORKSHEETS(check box if worksheet is included) For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms,refer to the 2013 Nonresidential Manual Note:The Enforcement Agency may require all forms to be incorporated onto the building plans. YES NO Form/Worksheet# Title ❑ NRCC-PLB-01-E Certificate of Compliance,Declaration. Required on plans for all submittals. ❑ NRCI-PLB-01-E Certificate of Installation. Required on plans for all submittals. ❑ NRCI-PLB-02-E Certificate of Installation, required on central systems in high-rise residential, hotel/motel application. ❑ NRCI-PLB-03-E Certificate of Installation, required on single dwelling unit systems in high-rise residential, hotel/motel application. ❑ NRCI-PLB-21-H Certificate of Installation,required on HERS verified central systems in high-rise residential,hotel/motel application. ❑ NRCI-PLB-22-H Certificate of Installation,required on HERS verified single dwelling unit systems in high-rise residential, hotel/motel application. ❑ NRCI-STH-01-E lEertificate of Installation,required on any solar water heating DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and comp) ,te. Documentation A or Name: Docume ion A br Signature: Company: Signature . t(,2, 5 Address: N CEA/HERS Certification Identification(if applicable): City/State/Zip: &Aa"U % Phone: z- RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury,under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance(responsible designer). 3. The energy features and performance specifications,materials,components,and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building,and made available to the enforcement agency for all applicable inspections.I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: Company: Date Signed: Address: License: City/State/Zip: Phone: CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 11/2/2015 NPE-210A I Navien NPE-210A Credits&Rebate Finder Enter Zip Code %"gas pipe capable up to 24' Field convertible gas system Ultra condensing efficiency Installing Dealer/NSS Locator Dual stainless steel heat exchangers Select Low NOx emissions(5 20ppm) SCH 40,2"venting up to 60' Enter Zip Code Cascading capable r^ ENLARGE C0Mf0PtFio`,s/71._ , emissions S Pecifications--- Wan",inty Docilments Videos Download Data Field NPE-210A Natural Gas 19,900-180,000 BTU/H Heat Capacity(Input) Propane Gas 19,900-180,000 BTU/H UEF(for NO&LP) 0,96 Efficiency Ratings EF(Canada)(for NO&LP) 0.97 35"F(190C)Temp Rise 10.1 GPM(38 L/m) Flow Rate(DHW) 45"F(25"C)Temp Rise 7.8 GPM(30 Lim) 070F(360C)Temp Rlsv 4,6 GPM(17 L/m) Dimonslone 17,3"(W)x 27.4"(H)x 13,2"(0) Weight 82 Ibe(37 kg) Installation Type Indoor or Outdoor Wall-Hung Venting Typo Forced Draft Alroct Vent Ignition Electronic Ignition Water Pressure 15.150 PSI Natural Gas Supply Pressure(from source) 3,5"-10,6"WC Propanra Gas Supply Pressure(from source) W-13"WC Natural Gas Manifold Pressure(min to max) -0.04"WC to-0,30"WC http://us.navien.com/ProducYPagel/Detai Is/NPE-21 OA?Category=NPE-A%2Oseries 1/2 11/2/2015 NPE-210A I Navien Propane Gas Manifold Pressure(min to max) -0,02"WC to.O,60"WC r " Minimum Flaw Rats 0 GPM(0 Um) Cold Water Inlet 3/4"NPT Hot Water Outlet 3/4"NPT Connection Sizes Recirculation Inlet 3/4"NPT Gas Inlet 314"NPT(Suitable for use with 1/2"rigid gas pipe;refer to installation manual for sizing criteria) Main Supply 120 V AC,SOHz Power Supply Maximum Power Consumption 20OW(max 2A),35OW(max 4A)with external pump connected Casing Cold rolled carbon steel Materials bleat Exchangers Primary Heat Exchanger: Stainless Steel Secondary Heat Exchanger:Stainless Steel Exhaust 2"or 3"PVC,CPVC,Polypropylene 2"or 3"Special Gas Vent Type SH(Class 11,A/B/C) Venting Intake 2."or 3"PVC,CPVC,Polypropylene 2"or 3"Special Gas Vent Type BH(Class II,A/B/C) Vent Clearances 0"to Combustibles APS,Ignition Operation Detector,Water Temperature Safety Devices High limit Switch,Exhaust Temperature High Umit Sensor,Power Surge Fuse http://us.navien.com/Product/Pagel/Detai Is/NPE-210A?Category=N PE-A%20series 2/2