PMT18-05427 City of Menifee Permit No.: PMT18-05427
AV- AV 29714 HAUN RD.
;t MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 11/14/2018
PERMIT
Site Address: 26307 BLUEBELL ST, MENIFEE, CA Parcel Number: 335-393-004
92586 Construction Cost: $1,940.00
Existing Use: Proposed Use:
Description of REPLACE 40 GALLON GAS WATER HEATER IN SAME LOCATION
Work:
Owner Contractor
TY MILLARD A R S AMERICAN RESIDENTIAL SERVICES OF
26307 BLUEBELL ST CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD#201
Applicant Phone: 9012719700
JIMMIE PHILIPPS License Number: 765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNI)
965 RIDGE LAKE BLVD#201
MEMPHIS,TN 38120
Fee Description Qty Amount($)
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_Tem plate.rpt Page 1 of 1
Mfy\ Pv�,W p5- A-05
CITY OF MENIFEE vecuk
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
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 Code and my license is in full force and effect. the following reason:
License Class P�_ License No. �CPS��S� _ By my signature below I acknowledge that,except for my personal residence
Expires ,' I Signature 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 LA ION have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under pe a 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
www.lesinfo.ca.eov/calaw.html.
this permit is issued.
Policy fi Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensatfon 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 worker's 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
�e� � �'`5 Cf� with all applicable city and county ordinances and state laws relating to
Carrier /� I building construction.I authorize representatives of this city or county to
Policy f! Expires 40 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 q
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwit h rovisions. Will the applicant or future building occupant handle hazardous material or a
3� / mixture containing a hazardous material equal to or greater that the
Applican Date amounts spJe fied on the Hazardous Materials Information Guide?
WA I FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes [�'No
U FUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
D 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 guideline/
CONSTRUCTION LENDING AGENCY o Yes o o
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 boCun�airy of a school?
(Section 3097 Civil Code) o Yes =0
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California HeSpIth&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardousfn rial reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes No
Business and Professions Code).Any city or county that requires a permit to Date r
construct,alter,improve,demolish or repair any structure,prior to its ROPER WNER 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 (�Ep
ENOVATION 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 apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be work
thatRRP-certifiedistfirms 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
o 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o 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
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION M E N I F E E
DATE: PERMIT/PLAN CHECK NUMBER EM 05LO
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: Q COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW OPLUMBING ORE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Replace 40 gallon gas water heater in same location.
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS O YES ONO
PROJECTADDRESS 26307 Bluebell St zIP92586
ASSESSOR'S PARCEL NUMBER J J7 - 3`1 LOT toox TRACT P-7 -4
OWNER NAME Ty Millard
ADDRESS
PHONE 951-207-2475 EMAIL
APPLICANT NAME Jimmie Phillips
ADDRESS 1520 W Linden St Riverside, CA 92507
PHONE 951-341-9371 EMAIL
CONTRACTOR'S NAME ARS Rescue Rooter OWNER BUILDER? OYESQNO
BUSINESS NAME
ADDRESS 1520 W Linden St Riverside, CA 92507
PHONE 951-341-9371 EMAIL
CONTRACTOR'S STATE LIC NUMBER 765155 LICENSE CLASSIFICATION C36
VALUATION $ 11940 SQ FT L SQ FT
APPLICANT'S SIGNATU DATE=14ZI'W1
CITYSTAFFUSEONIY
DEPARTMENT DISI KWU 10 ACCEPTED BY CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL I GREEN I SMIP `-
OWNER BUILDER VERIFIED YES NO DRIVERS LICENSE# NOTARIZED LETTER YES NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
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STATE OF CALIFORNIA City of'M Ljnife
RESIDENTIAL ALTERATIONS -WATER HEATER Build'+� Dept'
CEC-CFiR-ALT-01-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF111-ALT-01-E WATER HEATER
Prescriptive Residential Alterations for Water Heater (Page 1 of 2)
93
A. GENERAL INFORMATION
Site address: Bu itgType: o Single Family Dwelling
96307 Bluebell Sti ❑ Multi Family Dwellings
City, Zip Code: MENIFEE, CA Cli tie Zone: 10
G. WATER HEATING SYSTEMS (Section 150.2(b)1G)
01 02 1 03 04 05 06 07 08 09 11 12 13 14 15
Water Water Water #of Water Fuel Rated Rated Heating H rig Standby Exterior Back-Up Central Dwelling
Heating Heating Heater Water Heater Type Input Input Efficiency Effi ncy Loss InsuL Solar DHW System Unit DHW
System System Type Heaters Storage Type Value Type V e",j R-Value Savings Distribution System
Identification Type in Volume I Fraction Type Distribution
or system {gal} Type
Name
WH DHW Stor 1 40 as btu 38k EF 1 8 n/a n/a n/a n/a n/a
3�<
WATER HEATING SYSTEMS
Water heating compliance for an alteration is described in Section 150.2(b)1G.For single dwelling a g ,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 tr 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 conne d',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 cen 1lsystems must use certified equipment as defined under Section
110.1 and 110.3.
NOTE: If the proposed installation does not meet the requirements allowed specifically for alterations se form CF1R-NCB-01 to document the water heater alteration.
Instructions for sections with column numbers are given below:
1. Water Heating System Identification or Name:enter a unique name for the Water Heati System.
2. Water heating system type: Domestic Hot Water(DHW),Hydronic,Combined Hydronic, Central. DHW is for domestic hot water,hydronic is a water heating O
t
system used for space heating only;combined hydronic are when the water heater will p ide both space conditioning and domestic hot water. ,
3. Water heater type:For non-central systems only Small Storage or Small Instantaneous ar Mowed. For central systems pick from Large Storage,Small Storage, w
Heat Pump,Boiler,Large Instantaneous,Small Instantaneous or Indirect. W
mono
,f
.Y
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E WATER HEATER
Prescriptive Residential Alterations for Water Heater (Page 2 of 2)
4. Number of water heaters in system:In single-family and multi-family with water heaters ach dwelling units the value is 1. For multi-family central systems
serving multiple dwelling units enter the total number of water heaters.
S. Water heater volume(gal):tank capacity in gallons.For individual water heaters for a d ing 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. Rated Input Type: Enter the equipment input rating type,for gas or propane fired units a B uh,for electric fired system the units are kW.
8. Rated Input Value: Enter the numeric value of rated input.
9_ Heating Efficiency Type:Energy Factor,AFUE,or Thermal Efficiency.From product literat or a California Energy Commission directory.
10. Heating Efficiency Value:Enter the value from product literature or a California Energy C mission directory
11. Standby Loss(percent):Applies only to large storage water heaters,Enter n/a for small age or instantaneous water heaters.
12. Exterior Insulation R-Value: Enter the R-value if exterior insulation on the storage tank is Called
13. Back-up solar savings fraction:If compliance requires a back-up solar system,indicate th olar contribution (e.g.,0.30). External calculations are required.
14. Central DHW Distribution System: For multi-family buildings with using a central distribu r19 ystem a demand recirculation system with at least two distribution
loops must be installed.This requirement applies to any building with eight or more units e system is non-central or project is individual units enter n/a.
15_ Dwelling Unit DHW Distribution Type:For a Central DHW this field shall be Standard.If n -'central then pick from Standard,Demand Recirculation—Manual
Control,Demand Recirculation—Sensor Control. If non-central electric water heater this t be Standard,no recirculation system shall be installed.
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name: oOwner Authorized agent ❑Contractor S ature:
Company: ARS Rescue Rooter ractor X ense#: 765155
Address" 1520 W Linden St P n`' 951-341-9371
C'ty/state/z'p: Riverside, CA 92507 Date:
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at: 1-800-777.-3300.
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