PMT18-05064 City of Menifee Permit No.: PMT18-05064
29714 HAUN RD. Type: Residential Plumbing
ZA MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 10/22/2018
PERMIT
Site Address: 26712 SUN CITY BLVD, MENIFEE, CA Parcel Number: 337-351-005
92586 Construction Cost: $1,300.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER SAME SIZE AND LOCATION, INSIDE CLOSET
Work:
Owner Contractor
JUANA CAMBEROS JAKS PAINTING
26712 SUN CITY BLVD 4874 PACIFIC AVENUE
MENIFEE, CA 92586 OLIVEHURST, CA 95961
Applicant Phone: 5307554455
JOSIAH WOTILA License Number:624368
JAKS PAINTING
4874 PACIFIC AVENUE
OLIVEHURST, CA 95961
Fee Description QQt rr Amount($)
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
$115.15
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_Bldg_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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions Codee+and my license is in full force and effect. the following reason:
License Class i -!) f7 License No. J By my signature below I acknowledge that,except for my personal residence
Expires 750 Signature i in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATI N have built as an owner-builder if it has not been constructed in its entirety by
0 1 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
www.IeRinfo.ca.Rov/calaw.html.
this permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
I have and will maintain workers compensallon insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ❑By 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: application and the information I have provided is correct.I agree to comply
, L(�7 r with all applicable city and county ordinances and state laws relating to
Carrier yS rr � Ids� (1 �`7 building construction.I authorize representatives of this city or county to
Policy#�r1�",' l"1�,� Expires 7/ I I �r enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o 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 CITY BUSINESS LICENSE#
worker's 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 it those provisions. f} Will the applicant or future building occupant handle hazardous material or a
Applicant �� Date 1 l� C� mixture cont fining a hazardous material equal to or greater that the
amounts s-or
on the Hazardous Materials Information Guide?
WARNING:F ILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 o Yes t_-No
UNLAWFUL,AND 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 o Yes 0.
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 agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes �(—No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
us o
checkmark(s)I have placed next to the applicable item hazardo ate ial r porting.
oyes N
s)(Section 7031.5 7
Business and Professions Code).Any city or county that requires a permit to / Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY O ER 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(RRP)
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 licensure 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 RRP-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
❑I,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 do( )all of or( )portion of the work,and the structure is www.epa.gov/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 a ❑An 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. 0 EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
6051 tQ1 1 03071� '�����g AAckknowledgement.
�I
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
I
Menifee
DATE I C) I (c, % PERMIT/PLAN CHECK NUMBER g
TYPE: COMMERCIAL RESIDENTIAL : MULTI-FAMILY MOBILE HOME ::> POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL MECHANICAL
NEW PLUMBING RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK G 40f( s� I1tiS 1 C`C
�`�v PLI,� ✓� CIoSet
PROJECT ADDRESS C 1t
ASSESSOR'S PARCEL NUMBER 337- -F�-oc)5 LOT I ! TRACT
"( PROPERTY OWNER'S NAME J �j (��5 L1 r
"( ADDRESS ZL-1 � 2- U("I It\ b,�' �l J (\) 111 ch CI
PHONE 7;I0 -5018- O81 L EMAIL
APPLICANT NAME i -zt, 004 tj L
ADDRESS M 01 L
PHONE -�(�����.Z�S EMAIL
CONTRACTOR'S NAME OWNER BUILDER? YES NO
BUSINESS NAME �/ Lk \PJATa
ADDRESS Y� �,D 0\\
PHONErj'��5 �� EMAIL ghAW
CONTRACTOR'S STATE LIC NUMBER �� LICENSE CLASSIFICATION
VALUATION $ SQ FT L SQ FT
APPLICANT'S SIGNATURE "1N.-' DATECITY STAFF,uskoffily-11
2 Z'
Id
f
DEPARTMENT DISTRIBUTION CITY OF M &&FEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I ' SMIPINVOICE
JS�
'1 �J•1 PAIDAMOUNT
AMOUNT CASH CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH CHECK# CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER YES NO
City of Menifee Building&Safety Department 2.9714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspectior, Request Line 951-246-6213
STATE OFCALIFORNIN City of N'llanifee
RESIDENTIAL ALTERATIONS—WATER HEATER Building Dept,
CEGCF111-ALT-01-E(Revised M14) CALtFORN A ENERGY COMMJSSION
CERTIFICATE OF COMPUANCE CF1R-ALT-01-E WATER HEATER
Prescriptive Residential Alterations for Water Heater (Page 1 of 2)
0
A- GENERAL INFORMATION
Site address: 2�—� l Z Building Type: roll-muffi
Single Family Dwelling
Family Dwellings
City, Zip Code: i C"_ i-t- Climate Zone: T10
G. WATER HEATING SYSTEMS Section 150.2(b)1G
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15
Water Water Water It of Water Fuel Rated Rated Heating Heating Standby Exterior Back-Up central Dwelling
Heating Heating Heater Water Heater Type Input Input Efficiency Efficiency Loss(%) insul. Solar DHW System UnitDHW
System System Type Heaters Storage Type Value Type Value R-Value Savings Distribution System
Identification Type in Volume Fraction Type Distribution
or system (gal) Type
(Jame
o D N Smail ! 0 LS 19 N o Cc' IV .A nr K �'r l ,fit i
t
WATER HEATING SYSTEMS
Water heating compliance for an alteration is described in Section 150.2(b)IG.For single dwelling a gas or propane water heater,with a storage tank of 60 gallons maximum
or instantaneous(tankless)can be used.Dwelling Unit distribution systems are limited to Standard trunk and branch or demand recirculation for gas or propane water
heater.Demand recirculation is not allowed for electric water heater_If there is no natural gas connected to the building,an electric water heater may be replaced with
another electric water heater.However,changing from gas to electric is not allowed,Multi-family central systems must use certified equipment as defined under Section
110.1 and 1103.
NOTE:If the proposed installation does not meet the requirements allowed specifically for alterations,use form MR-NCB-01 to document the water heater alteration.
Instructions for sections with column numbers are given below: O
L Water Heating System Identification or Name:enter a unique name for the Water Heating System-
2--'Water heating system type:Domestic Hot Water(DHW),Hydronic,Combined Hydronic,or Central.DHW is for domestic hot water,hydronic is a water heating
system used for space heating only;combined hydronic are when the water heater will provide both space conditioning and domestic hot water_
3. Water heater type:For non-central systems only Small Storage or Small Instantaneous are allowed. For central systems pick from Large Storage,Small Storage,
Heat Pump, Boiler,Large Instantaneous,Small Instantaneous or Indirect.
CFIR-ALT-01-E WATE�HEATEIRR
CERTIFICATE OF COMP3.IANCE (Pa
Prescriptive Residential Alterations for Water Heater
4 Number of water heaters in system:in single-family and multi-family with water heaters in each dwelling units the value is 1.For multi-family central systems
serving multiple dwelling units enter the total number of water heaters.
5 ' dater heater volume(gal):tank capacity in gallons.For individual water heaters for a dwelling unit this will be 60 gallons or less_If instantaneous,enter n/a_For
multi-family central systems enter the total storage volume.
6. Fuel Type:Gas,Propane,Electric(Only if natural gas is not available)
7 mated Input Type:Enter the equipment input rating type,for gas or propane fired units are Btuh,for electric fired system the units are kW.
g, Hated Input Value:Enter the numeric value of rated input.
e•Energy Factor,AFUE,or Thermal Efficiency.From product literature or a California Energy Commission directory.
9. Heating Efficiency Type: gY
10 Heating Efficiency`value:Enter the value from product literature or a California Energy Commission directory
11_ Standby Loss(percent):Applies only to large storage water heaters,Enter n/a for small storage or instantaneous water heaters_
12_ Exterior insulation R-Value:Enter the R-value if exterior insulation on the storage tank is installed 030)_External calculations are required_
13 ,suck-up solar savings fractimn:If compliance requires a back-up solar system,indicate the solar contribution(e.g.,
14. Central DHW Distribution System:For multi-family buildings with using a central distribution units.f the system s non-central orrecirculation system with at least two project s individual units enter n/a�ation
9oops must be installed_This requirement applies to any building with eight or more _
15_ Dwelling Unit DHw Distribution Type:For a Central DHW this field shall be Standard.If nctral then pick from irculatiard,Demand Recirculation on cyst m shall be installed. ManualControl,Demand Recirculation—Sensor Control.If non-central electric water heater this must be Standard,no re
DWO C U M EMNT4aTl0N ALUTa1® °S DECLARATION sTATEMENT
I eertifV that this Certificate of Compliance documentation is accurate and complete.
g
Si nature:
Name: oOwner Authorized agent oContractor
Contractor license#: U `
f>J cr f 2 r
Company- f Phone. ')
Address: �- ;S ` a
✓-' 9 3 S
y
Date:
For assistance or slsaests®ns regarding the Energy Standards,contact the Energy tiotline at:1-800-772-3300.
t
al
ice..
a ;
e