PMT13-02337 City of Menifee Permit No.: PMT13-02337
29714 HAUN RD.
CC.FOA> MENIFEE, CA 92586 Type: Commercial New
MENIFEE Date Issued: 05/14/2014
PERMIT
Site Address: 27750 NEWPORT RD, MENIFEE, CA Parcel Number: 336-380-009
92584 Construction Cost: $706,388.58
Existing Use: Proposed Use: Restaurant
Description of New Commercial 5526sf
Work;
Owner Contractor
APPLE SOCAL LLC ,
6200 OAK TREE BLVD, STE 250
INDEPENDENCE, OH 44131
Applicant License Number:
HENERY KLORER
10955 LOWELL AVE 700 OVERLAND , KS 66210
Fee Description 0 yt Amount is
Power Apparatus 10 1,500.00
Services, Switchboards, Control Centers& Panels 1 283.00
Re ep'acl�e Swif j Iaf °Fzfi` `� + '�'�".
Plumbing Fixtures and Vents, fixtures 42 311.00
Greese*1 erce°toY +' 0
Gas System 1 116.00
Yvan;" a �' w 9
Sewer 1 150.00
Air an li" �e
as b v u4 ,,
Hood Served by Mechanical Exhaust 4 876.00
BOildn n;Pe I Maw . . 27OO1
GREEN FEE 1 29.00
PaC0V1ER,GIALµx"' ,z..,�' �.�• T" 'f`r�` h . r,•�rc ,4
A xe; -'JJE taw fix,
Document Reproduction Reimbursement 79 78.54
New�Con act oL. ME" tit Fee � � u I 3t249 39s
New Construction Plan Check 1 2,112.10
$12,332.03
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 Templatexpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class License No. who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ lam exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contr e . I and land that a copy of the applicable law, Section 7044 of the
❑ I have and will maintain workers' compensation insurance, as required by Busi ess a d Pr0 a siqq C de,is ailable upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this sub fitted r at t f IIb eb te:htt ://www.Ier info.ca. ovlc w, tml.
permit is issued.My workers'compensation insurance carrier and policy number are:
Prope ner Aut oriz d Agent Date
Carrier
Expires Policy#
K31y my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars t be c mless) with plicable city and county ordinances and state laws relating to building
co structi n.Ire resentatives of this city or county to enter the above-
❑ I certify that in the performance of the work for which this permit is issued,I ide titllwpn7
n e ion purpo s.
shall not employ any persons in any manner so as to become subject to the l /
workers' compensation laws of California, and agree that if I should become `
Cie
subject to the workers'compensation provisions of Section 3700 of the Labor Propeorized Agent Date
Code, I shall forthwith comply with those provisions.
City Business License#
Date; Applicant;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, ❑YES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDINGAGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor'sPRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
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 HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law(Chapter 9(commencing with
Section 7000)of Division 3 of the Business and Professions Code)or that he or ❑YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f EPORtING.
compensation,will do( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
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 X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
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).
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION CHECKLIST
CEC-LTG-`IC(Revised 08109) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE (Page 1 of 4) LTG-1 C
Project Name: Date:
1 �e' , LG
Project Address: Climate one: Building CFA: z
Unconditioned Floor Area
r�
General Information
Building Type: Id Nonresidential ❑ High-Rise Residential ❑ Hotel/Motel
❑Schools ❑ o Public Schoolsols ❑ Conditioned Spaces ❑ Unconditioned Spaces
Sc
Phase of Construction: Rr New Construction ❑ Addition ❑ Alteration
Method of Compliance: Complete Building ❑ Area Category ❑ Tailored
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name: Signature:
Company: Da '
c yr te:
Address: If applicable:
CEA#
.•t �� CEPE#
Clly/State2ip rP
Phone:
Principal Lighting Designer's Declaratl n Stat6ment
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting
design.
• This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Title 24,Pages 1 and 6 of the California Code of Regulations.
• The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the
enforcement agency for approval with this building permit application.
Name: Signature:
�rr
Company: - Phone:
rS - bL 177
Address: License#� a
City/State/Zip: D Date:
a v.
Lighting Mandatory Measures /
Indicate location on building plans of Mandatory Measures Note Block: C�{
LIGHTING COMPLIANCE FORMS&WORKSHEETS(check box if worksheet is Included)
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms,please refer to the
Nonresidential Manual ublished b the California EnergyCommission.
Er LTG-1C Pages 1 through 4 Certificate of Compliance. All Pages required on plans for all submittals.
❑ LTG-2C Lighting Controls Credit Worksheet
Er LTG-3C Indoor Lighting Power Allowance
❑ LTG-4C Pages 1 through 4 Tailored Method Worksheet
❑ LTG-5C Pages 1 and 2 Line Voltage Track Lighting Worksheet
2008 Nonresidential Compliance Form
August2009
I
STATE OF CALIFORNIA I
CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION CHECKLIST
CEC-LTG-70(Revleed 08/00) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE (Page 2 of 4) LTG-'IC
INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST
Project Name: t Date:
r1 I A&Jce
Installation dertificate, LTG-I-INST (Retain a copy and verify form is completed and ❑ Field Inspector
si ned.
Certificates of Acceptance, LTG-2A and LTG-3A (Retain a copy and verify form is ❑ Field Inspector
com feted and si ned.
A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces Installed Lighting Power
listede. on this Lighting Schedule is only for Id CONDITIONED SPACE ❑ UNCONDITIONED SPACE
The actual indoor lighting power listed below includes all installed permanent and portable lighting systems in
accordance with 146 a
❑ Only for offices:Up to the first 0.2 watts per square foot of portable lighting shall not be required to be included in
the calculation of actual indoor lighting power density in accordance with the Exception to§146(a). All portable
li hting in excess of 0.2 watts per square foot is totaled below.
Luminaire Schedule (Type, Lamps, Installed Watts
Ballasts
A B C D E F G H
Field
Flow wattage was Inspector
determined s
L
It °m" 0— CEC Accordin �' ro[]
H Complete Luminaire Description a M m`'M m
N c Default g to .p c vi u,
(i.e,3 lamp fluorescent troffer, E from §730 E E ��„ m 'm 'm
z F32T8 onedlmmable_electronicballast)_ ' NAS Bore M M c a u
alit l c ❑ ❑
i ❑ f� a ❑
n +J' t a ❑ Ear° ❑,.
L. �"iY vy�.__ ❑ L� ❑
L ' I d' ❑ L'f Pr ❑
y ❑ El ❑
❑ @ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
0 —❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
INSTALLED WATTS PAGE TOTAL:
Building total number of pages Installed Watts Building Total
(Sum of all pages) d f )
Enter into LTG-1 C Pa e 4 of 4
1. Wattage shall be determined according to Section 130(d and a). Wattage.shall be rating of tight fixture,not rating of bulb.
2.If Fait then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if
necessary,
2008 Nonresidential Compliance Form
August2009
■
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION CHECKLIST
CEC-LTG-1C(Redsed 08109) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE (Page 3 of 4 LTG-1 C
Project Name: Date:
INDOOR LIG NG SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST
Fill in controls for all spaces:a)area controls, b)multi-level controls, c)manual daytighting controls for daylit areas>
250 fP, automatic daytighting controls for daylit areas>2,500 ft2, d)shut-off controls, e)display lighting controls, 0
tailored lighting controls-general lighting controlled separately from display, ornamental and display case lighting
and )demand responsive automatic controls for retail stores>50,000 flz in accordance with Section 131. _
MANDATORY LIGHTING CONTROLS - FIELD INSPECTION ENERGY Field
CHECKLIST Inspector
Number Pas
T e/Descri tion of Units Locadion in Building s Fail
❑ ❑
❑
❑ ❑
❑ ❑
❑ ❑
❑
Field Inspector's Notes or Discrepancies:
2008 Nonresidential Compliance Form
August2009
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION CHECKLIST
CEO-LTG•1C(Revised 08109) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE (Page 4 of 4) LTG-1 C
Project Name: Date:
Conditioned and Unconditioned space Lighting must not be combined for compliance
Indoor Lighting Power for Conditioned Spaces Indoor Liahtina Power for Unconditioned Spaces
Watts Watts
Installed Lighting tt � Installed Lighting
from Conditioned LTG-1 C Pa e 2 4 v from Unconditioned LTG-1 C Pa e 2
Lighting Control Credit Lighting Control Credit
Conditioned Spaces(from LTG-2C) _ Unconditioned Spaces from LTG-2C _
Adjusted Installed _ Adjusted Installed
Lightin Power m cr y _. Lighting Power
Complies if Installed 5 Allowed i Complies if Installed s Allowed
Allowed Lighting Power p Allowed Lighting Power
Conditioned Spaces from LTG-3C t �^-� Unconditioned S aces from LTG-3C
Required Acceptance Tests
Designer:
This form is to be used by the designer and attached to the plans. Listed below is the acceptance test for the Lighting system,
LTG-2A and LTG-3A. The designer is required to check the acceptance tests and list all control devices serving the building or space
shall be certified as meeting the Acceptance Requirements for Code Compliance. If all the lighting system or control of a certain type
requires a test„list the different lighting and the number of systems. The NA7 Section in the Appendix of the Nonresidential
Reference Appendices Manual describes the test. Since this form will be part of the plans,completion of this section will allow the
responsible party to budget for the scope of work appropriately. Pones can be grouped by type ofLuminalre controlled,
Enforcement Agency:
Systems Acceptance.Before Occupancy Permit is granted for a newly constructed building or space or when ever new lighting
system with controls is installed in the building or space shall be certified as meeting the Acceptance Requirements.
The LTG-ZA and LTG-3A forms are not considered a complete form and are not to be accepted by the enforcement agency unless
the boxes are chocked and/or filled and signed. In addition,a Certificate of Acceptance forms shall be submitted to the enforcement
agency that certifies plans,specifications,installation certificates,and operating and maintenance information meet the requirements
of§10-103(b)of Title 24 Part 6. The field inspector must receive the property filled out and signed forms before the building can
receive final occupancy. A copy of the LTG-2A and LTG-3A for each different lighting luminalre contmi(s)must be provided to the
ownerofthe..building.for their records.
Luminaires Controlled LTG-2A and 3A
Controls and
Sensors and
y 'n Automatic
o Gaylighting
Equipment Requiring E y o Controls
Testing Description z Location Acceptance
13
13
13
2008 Nonresidential Compliance Farm
August 2009
F
I'
STATE OF CALIFORNIA
ENVELOPE COMPONENT APPROACH
CEGMECH-iC Revised e3/1e CALIFORNIA ENERGY COMMISSI.,.:
CERTIFICATE OF COMPLIANCE and
FIELD INSPECTION ENERGY CHECKLIST (Page 1 of 5) MECR-I C
Pmjeot Name: - Date: ,Y ® . Climate Zone 0
Conditioner)ilooc
General Information
i
Buildia T e: Nonresidential ❑Hi -Rise Residential ❑Hotel/Motel Guest Room
❑ Schools(Public School)❑ Relocatable Public School Bldg. ,(Conditioned Spaces ❑ Unconditioned Space's
Phase of Construction: New Construction ❑ Addition 0 Alteration
Approach of Compliance: Component ❑ Unconditioned(file affidavit)
Front Orientation:N,E,S,W or in Degrees:
RVAC SYSTEM DETAILS FIELD INSPECTION ENERGY CHECKS IST
_ Meets Criteria or Requirements
Equipment Inspection Criteria _ Pass Fail-Describe Reasonr
Item or System Tags i
(i.e,AC-1,RTU-I,I-IP-1) ��.' 1 .. ❑
E uiment"t a3: _ Piro ❑
No of Systems _..__/ _ _ ❑
Max Allowed heating Capacity) . .d � _ _ ❑
Minimnm.I-leatin ,F,ft7cienc I _ _Ail prda _
Max Allowed C;oolin Capacity'. . ,19— ,�"' ❑
Cooling Effcieuc ' ❑
Duct Location/R-Value Y- :oust �' _ ❑
When duct testing is required,submit r ,- ❑ ❑
MECR-4A& MECII-4-II.ERS
Economizer O
Thermostat � 6h , —__ / ❑
Fan Control .__. r -L .0 ❑
FIELD INSPECTION ENERGY CH ECKLIST
Equipment Inspection Criteria Pass Fail-Describe Reason2
m Item or Syste Tags W
(ix.AC-1,WIV-1,HP-1) / ❑
E ui meat T e': _ �� _� -`r���: ❑
No of Systems i f ❑
Max Allowed_H.eatin Ca acit ' ..� 7 �� ❑�
Minimum Heating Efficiency' !P.% 13
Max.Allowed Cooling Capacity' _ �j _ O
CoolingFllicie_noy'_ .._-_ �. .'- _ _ _ ❑
Duct Location/R-V'alue ,�,,,. '- ❑
When duct testing is required,submit d,^e, ❑ ❑
MECR-4A& MECR-4-HERS C� _
Economizer
Thermostat _ � ram„ _ 13
Fan control ( CaL 8
1. /f£OAe Actual installed equipment.peiformance e/Jiclency and capacity is less than the proposed(from the energy compliance submittal or,from
the building plans)the responsible party shall rentbmit energy compliance to include the new changes.
Z for odditional deuailed discrepancy use Page 2 oft/te Inspection Checkl£se Forte. C,onapiiance,1blis{fa Fail box is checked.
3.Indicate Equipment Typc:Gas ftll or,Split),VAV,lIP(Pkg or split),Hydronic,PTAC,or other
2008 Nonresidential Compliance rorms March 2010
i
STATE OF CALIFORNIA j
ENVELOPE COMPONENT APPROACH
CEC-MECH-IC Revieau 03110 CALIFORNIA ENERGY COMMISSI...:'
CERTIFICATE OF COMPLIANCE and
FIELD INSPECTION ENERGY CHECKLIST (Page I of 5) MECH-14C
Project Name: Data ti E Climate"Lunen
Project Address: Conditioned Floor
vIOV" P"7 l�'f-':- lirlrt Area: a a
General Information
Buildin T e: Nonresidential 0 High-Rise Residential ❑Hotel/Motel Guest Room
0 Schools(Public School)❑ Relocatab➢e Public School Bldg. A Conditioned Spaces [3 Unconditioned Spaces
Phase of Construction: K New Construction 0 Addition 0 Alteration
Approach of Compliance: K Component ❑ Unconditioned(file affidavit)
Front Orientation:N,E,S,W or in Degrees:
HVAC SYSTEM DETAILS FIELD INSPECTION ENERGY CHECKLIST
Meets Criteria or Requirements
Ell ment N.nspestion Criteria Pas Fail-Describe Reason"
Item or System Tags
(I.e,AC-i,RTU-1,PIP-1) ._
E ui meat Type: __ � p
No of S stems — 0
Max Allowed Pleatin r Ca aci t '
CI
Mnintu 1Heatin EffcBrae t yp rra d°CS . _.
Max Allowed Coolin Ca acit —
Cooln r Et6ciencyr ----
Duct Location/R-Value
When duet testing is required,submit (3 L7
MECH-4A&MECH-4-HERS
Economizer ® --
,� - - --
Thermostat - —__
Pan Control -- — ° E 0
F1.ELD INSPECTION ENERGY CIIECKLISP
Equipment Inspection Criteria Pass Fail-Describe Reason
Item or System'Iags -T ❑
(i.e.AC-1,RTU-1,HP-I)
No of Systems ❑ 13
Max Allowed Pleating(.rapacity _--�, 1
Minimum Besting Etficionc ' 0 GI
Max Al g C lowed Coolinapaeit ❑ 0
CoolinEi'ficiency"_ _ _
Duct Location/R-Value _
When duct testing is required,submit 11
MEC11-4A&MECH-4-11ERS ---_ —
Economizer ❑ C]
Thermostat
Pan Control
1, if the Actual installed equipment performance efficiency and capacig+is less than the Proposed(from the energ7 compliance submittal or from
the building plans)the responsible pany shall resubmit energ7 compliance to inchrde the new changes.
2. For additional detailed disc epaucsy ore Page 2 of-the Inspection Cheddist Form. Compliance faits tf a Fail box it checked.
3.Indicate Equipment Type:Gas(Pkg or,Split),VAV,UP(Pkg or split),I-lydronie,PTAC,or other
2008 Nonresldenrial Compliance Forms March 2010
STATE OF CALIFORNIA
ENVELOPE COMPONENT APPROACH
CEC-MECH-1C(Revised 03110) CALIFORNIA ENERGY COMMISSI
Certificate of Compliance and
FIELD INSPECTION ENERGY CHECKLIST (Page 2 of 5) MECH-1C_
ProjwtNmu:Yjq4LN�--S, Date;
Discrepancies:
2008 NonrcsidLntial Compliance Forms March 2010
u
,�•Ta, o ,� � C o .4 o,,"i Q chi
1301300013130
FSr� a
Q`°a w 'O T C-0 Lz. CO ❑ ❑ ❑ ❑ ❑2 2 ❑ ❑ ❑ ❑
� xV' > V
mac°,
L h �� � � a L U f U ° Ol P � � fl• VJ
aka � v ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
E t3xo oomY °a "; 8 ` �
lz SE
E ti m 4 C C a e a a G.
K U '' y •' o a o m i t
W u cO1i O, i d C O x s
'Ji d m2 3 4 y d � t3 [Ux7 O C Q ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
z y 3 i y y Z'i m <t
z igd a•s o � � 0 W CO Q) 0000 ❑ ❑ ❑
zi m W U
Mid
ya. r � � � 4a g = zo czi Q 'NoQ 'S� ❑ ❑ ❑ 0 ❑ 0 ❑ ❑
0
S o f iY n � A as a oya � a p cx c o o 19 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
v > N
co = °o a a u qj
Q u q cy b y u m y
c Q
V r a h ° m y o 5 z r x $ .
a Z Qy k anion uU � a�i ❑ ; U 0110000130
a.
is
F per+ og � g2 , = t � s
W ay o $ o o ¢ � zt o � y
OU bi)
LT.
`3 O a ' °a Q m.�a — 2czC
cq
m VC
1U
nE 4 o W p _U
LL J x F..i U Z °�' •CD tl u .�' O e �°' " cvy I
LLI w
Wigac � C2J W e w s ccm �, a � s ,°, � W [^ o
W U 2 �i A h a m W v] p vj h p y
N
% k
/ � \
$
# --
Q $ 3
7 00
(
£ 2 } �
) 0
) w �
z § k
k u { ,/
u ( j /\ O ❑ ccOOQGOO ❑ co ❑ OOOOGOOOOOOO
k
§ \ j�§ k0000OOOBGOQc0O ❑ QOCOOOOQOO ❑
[ $ a
3 ; §®\ 11OOO ❑ ❑ Ocoon ❑ OOODOOOOOO ❑Pro
gO ❑
) w m } )\\[ 1300o013013130130013130130o21313132130
a 4 a \ )! 3
z § f \
o PkCL
! l
L f k\o{ f�! { R> \
L
a
1
STATE OF CALIFORNIA a
ENVELOPE COMPONENT APPROACH '
CEC-MECH-IC Revised 03/t0 CALIFORNIA ENERGY COMMISSI—'
CERTIFICATE OF COMPLIANCE and
FIELD INSPECTION ENERGY CHECKLIST (Part 5 of 5) MECH-1C
Project Name: � ,,.. _ Date.:
Documentation Author's Declaration Statement y�
+ 1 certify that this Certificate of Compliance documentation is accurate and complete-
1 .
Name: ,/' t' ,_ - Signature: -�---
Zt
Company:�^ `P � Date:
< g, �y
Adddrress:,/ If Applicable
! �E Zl '! Ta CEPE4
city/State/zip U Phoar
Principal Mechanical Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the mechanical
design.
• This Certificate of Compliance identifies the mechanical features and performance;specifications required for compliance with
Title 24,Parts I and 6 of the California Code of Regulations.
• The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the
enforcement agency for approval with this building permit application.
Name: } _—� Signature:
Company Name: J ��i , — Date:
Address: G:7 _;a) P7.�.-,etm� �.- /yt✓', License
Chy/StateJ7.,ip Phone:c g^wry j
R9 r+1da +r " d'� e^✓ Cs✓ / G/er '..f 9 f¢.�.v—
Mandatory Measures
Indicate location on building plans ofNote Block for Mandatory Measures
MECIIANNICAL COMPLIANCE FORMS&WORKSHEETS(eheck box if worksheet is included
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forrns, refer to the 2008 Nonresidential
Manual Note: The Enforeenrent Agency niay require all forms to fie,incorrorated onto the GuildinK pdarts. _ _
Jd MECH-'IC Certificate of Compliance.Required on plans for all submittals.
Od MECH-2C Mechanical Equipment Summary is required for all submittals. _
rX MECH-3C Mechanical Ventilation and Reheat is required for all submittals with mechanical ventilation_._
0 MECH-4C Fall Power Consumption is required when for all prescriptive submittals,
2008 Nonresidential Compliance forms March 2010
PLAN CHECK INSPECTION REPORT
Date: r Permit no.: Site ID#:
_a ,"�{ Time in: ,� Time out: L,
Company: _ I Service Area: .�
Address: ���, ` Class:
�, �,.
Phone#: 1 Purpose of Inspec ion: i
Responsible p rty: Title:
Contact person: Title:
PLANPLAN CHECt(L�gT; INSPECTED APPROVED
YES NO N/A YES NO
Rough Plumbing [3' ❑ ❑ 0 ❑
PretreatmenVinterceptor Size Gal. 0 ❑ ❑ El, ❑
Sample Station (3' ❑ ❑ ❑
CI
�+*. _i.--r,-fir•--_• ... ._ _� �
n
Ins Ion Summa -
/ I F
11
Print Name nat e
Received ..1 -< '
City of Menifee
K R cOnstllthm Finance
32395 State Highway 74,Suite A JUN 16 2014
Hemet, CA 92545
ReMlived
LETTER OFITRANSMITTAL
WE ANSMIT:
Special Inspection Reports
Compression Test Results
PROJECT NAME:
ADDRESS:
BUILDING PERMIT:
THESE ARE TRANSMITTED:
//For Your Use & Info
As Requested
For Your Review & Return
Other
COMMENTS:
By: K&R Consulting
Name: Roseanne Baker
Phone No. (866)617-2469
Fax No. (951) 658-6935
1\8Z C D1KIS 1tiing PAGE. OF
K&R JOB NO.
INSPECTORS DAILY REPORT AND INSPECTION AGREEMENT
. TYPE OF WORK INSPECTED
Reinforced Concrete ❑ Structural Masonry ❑Structural Steel Assemble ❑Post Tensioning ❑ Epoxy ❑Other
Project Name A , 1 eeaz TESTS PERFORMED Z YES ❑ NO
Address �y„� �A-.' ,,/ 141," ! Set(s) of 1% oncreMortar/Grout/Prisms/Other
Architect ����,�i✓cw /)..>,e4� ��} Slump Mix Temp AMB Temp.
Engineer j�/))�d �it.� t Set
Sub Contractor 5�, /� �j , Set 2
General Contractor Set 3
Inspection Date -1�-/y Set o
Bldg. Permit �((\� I?�-(?o137j� Sets
Plan File Sample Location(s) S
Other
Additional Remarks on Samples
G.7 I® /oofn �•..�c./ F/i e�.. <' ar�P peg �.J/ •re Ye
74?
✓G /L C. / de 9 � �r / r e C
v rr < mtvr vF
� U e Ga. / h, T Y+
Time In Time Out Regular Time Over Time Travel Time Milea e
z
Unless noted otherwise,the work observed is to the best of my knowledge,in
substantial compliance with approved plans and specifications. Provision of
construction monitoring by K&R Consulting field personnel is not insurance,nor
does it guarantee construction of any type. The Owner or a successor in interest
shall waive and indemnify K&R Consulting against all claims,liability,
damages,and expenses arising out of or relating to all acts.
Z3,
CO CTOR IVE SIGNATURE OF REGISTERED DEPUTY CERTIFICATION NUMBER
OFFICE (866)617-2469 • FAX(951) 658-6935
White-Office Copy Canary-Deputy Copy Pink-Jobsite Copy
Consulting PAGE. / OF /
K&R JOB NO.
INSPECTORS DAILY REPORT AND INSPECTION AGREEMENT
TYPE OF WORK INSPECTED
Reinforced Concrete ❑ Structural Masonry ❑Structural Steel Assemble ❑Post Tensioning ❑ Epoxy ❑Other
Project Name _4,11,1 eLl. TESTS PERFORMED XJ YES ❑ NO
Address i ,�o�/t / Set(s) of 3 Grier /Mortar/Grout/Prisms/Other
&e%C P G
Architect Slump Mix Temp AMB Temp.
Engineer Sett
Sub Contractor SeiG 71, -,,j Set 2
General Contractor e r m Set 3
Inspection Date -/-1y� Set 4
Bldg. Permi Sets
Plan File Sample Location(s) c-, /
Other enc%xucrz 4-A, v
Additional Remarks on Samples g�l3j ya,
3/ >' ct�ra+rti/ v lP c sr etc
�<,</ ca„ao��%•Pf/ A ,n,i � '/ - J Li�ct, tr' ,�
Time In Time Out Regular Time Over Time Travel Time Mileage
Unless noted otherwise,the work observed is to the best of my knowledge,in
substantial compliance with approved plans and specifications. Provision of
construction monitoring by K&R Consulting field personnel is not insurance,nor
does it guarantee construction of any type. The Owner or a successor in interest
/ shall waive and indemnify K&R Consulting against all claims,liability,
damages,and expenses arising out of or relating to all acts. p
c6NTRAcToMWsENTATIV SIGNATURE OF REGISTERED DEPUTY CERTIFICATION NUMBER
OFFICE (866)617-2469 • FAX(951) 658-6935
White-Office Copy Canary-Deputy Copy Pink-Jobsite Copy
CITY OFMENIFEE PERMIT # (oll'3- 0a,
BUILDING AND SAFETY DEPARTMENT 1
29714 HAUN RD., MENIFEE, CA 92586
TELEPHONE: (951)672-6777 DATE: �S I -I I �LA
(� EC-
APPLICATION FOR TEMPORARY CLEARANCE FOR UTILITY CONNECTION
PLEASE PRINT LEGIBLY OR TYPE
SECTION I-APPLICANT INFORMATION
ADDRESS OF PROPERTY:
LOT NUMBER: TRACT NUMBER:
ASSESSORS PARCEL NUMBER: COMMUNITY NAME:
NAME OF PROPERTY OWNER: SUPERINTENDANT PHONE:
/-?e1ol-e. S0 . I . L.(,C, -�IY- r+
ADDRESS OF PROPERTY OWNER: - 3 BUSINESS PHONE:
,y z,P o Oa lC a , Clevpilc.�-.c�C7h�
Reason For Re uest: 6-o ti
l/2 G �7�<� s o Goo!/« C q G v,7<, 1-10G
SECTION 2-BOND
1. The applicant for a Temporary Clearance for Utility Connection must post a cash bond or Cashier's check
made payable to the City of Menifee in addition to the required $148.37 inspection fee and $27 processing
fee.The amount of the bond shall not be less than $2,000 or the estimated costs, as approved by the Building
Official, for the completion of the remaining items for the Applicant to obtain permanent utilities, whichever is
higher.
2. In the event that all remaining items to be completed for the Project are not completed in compliance with the
plans as submitted by the Applicant by g ✓S' -71- za �S<, the Applicant will forfeit the
deposited bond.
SECTION 3-APPLICANT DUTIES
1. Applicant waives any cause of action against either the City of Menifee or any of its officers and employees
because of any defect in the construction or installation of electrical equipment, or for any other defect in
construction of the above mentioned building, or for any connection to or disconnection from any utility which
many cause any damage whatsoever to the premises, any other premises, or any person or persons, and
agrees to hold the City of Menifee or any of its officers and employees, harmless from any damage or injury of
any kind caused by such temporary clearance.
APPLICANT INITIALS:
2. Applicant further covenant and agrees to have the above building completed and in compliance with all
building codes, ordinances, and regulations, and ready for final inspection by
and further agrees that if the final inspection and approval is not granted before such date that the electrical
service may be disconnected by the City of Menifee without any notice and the applicant agrees to hold the
City of Menifee, its officers and employees, harmless from any and all damage and injury which may arise
therefrom.
APPLICANT INITIALS:
3. Applicant acknowledges that any occupancy of the above mentioned llfdilding without final approval or a
Certificate of Occupancy shall constitute an occupancy violation in accordance with Section 111.4, of the
2013 California State Building Code, and will result in the immediate disconnection of utilities by the City of
Menifee.
APPLICANT INITIALS:
1,, 1zvw J (A &OL4n. ,S , hereby agree to comply with the above-described terms in this Application for
(APPLICANT)
Temporary Clearance For Utilit Conn Ction.
(APPLICANT) (DATE)
FOR DEPARTMENTAL USE ONLY
PLANNING 'cc FIRE
ZONE: ") tk I h V
APPROVED BY: W�DATE: $ APPROVED BY: DATE:
BUSINESS LICENSE �y PUBLIC WORKS/ENGINEERING
BUSINESS LICENSE # d �/ �� Q
APPROVED BY: DATE: APPROVED BY4 DATE:
BUILDING DEPARTMENT EASTERN MUNICIPAL WATER DISTRICT
APPROVED B G � DATE:
APPROVED BY: H DATE:
HEALTH DE ARTMENT
APPROVED BY: � Ipr DATE:
Inspection Job Card
POST IN CONSPICUOUS LOCATION WITH APPROVED PLANS
PERMIT NO: ' ®'
EMAIL INSPECTIONS TO bldc4RSRalCityofinenifee.us or CALL (951) A'0a6213 FOR INSPECTIONS
BETWEEN THE HOURS OF 8:00 A.M. AND 2:00 P.M. 24 - 48 HOURS IN ADVANCE
* SCHEDULING DEPENDENT UPON INSPECTIONS REQUESTED AND AVAILABILITY
BUILDING INSP BUILDING INSP ' •BtICDING INSP
INSPECTION DATE INITIALS INSPECTION DATE INITIALS,, INSPECTION DATE INITIALS
PRE-CONST. T-BAR CEILING / WALLS
MEETING
U.G PLUMBING gltf//V�
INSULATION ,UP_ FOOTINGS
FOOTINGS DRY WALL 7-le I!� GROUBTEAMI
U EXT/INT. LATH - _ DRAIN/SEAL
UFER/GROUND cGAS TEST r WALL FINAL
SLAB SHAFT ' TEDE POWER/
FIRE
AL
SITE APPROVAL HOOD/DUCT ELEC RELEASE
TRUSS
RU DECK/ 7 / SMOKE/ SEWER/SEPTIC _
Y FIRE DAMPERS
SHEAR/FRAME ROUGH CONDUIT WATER SERVICE
.COMBO FRAME 6 PATIO LEDGER FIRE FINAL
ROUGH PLUMB _�-/ POOLS MECH FINAL
ROUGH ELEC. tyJ PRE-GUNITE/
BONDING ELEC FINAL
ROUGH MECH. �- /� PRE-DECK PLUMB FINAL
FIRE COVER PRE-PLASTER SOLAR FINAL
WALL _ POOLENCLOSUR
FIRE COVER CEILING POOL FINAL BUILDING FINAL
REMARKS: NOTE: ITEMS MARKED IN RED ARE FIRE INSPECTIONS.
i;pahm PI,r� C � r� ilaiay inr . L/z/{ 'iVs
i -
l x�cLt 1 Ic- t Ii
_r h_ -
u I -,
( ?-
NOTICE: THIS PERMIT SHALL EXPIRE IF WORK IS NOT COMMENCED WITHIN OR IS SUSPENDED OR ABANDONED FOR
A PERIOD OF 180 DAYS (6 MONTHS) FROM THE DATE OF�'ERMIT SU ICE OR FROM THE DATE OF THE LAST INSPECTION.
CITY OF MENIFEE PERMIT # '
BUILDING AND SAFETY DEPARTMENT
i y 29714 HAUN RD., MENIFEE, CA 92586
TELEPHONE: (951) 672-6777 DATE: O� `05
1 )S
APPLICATION FOR TEMPORARY CLEARANCE FOR UTILITY CONNECTION
PLEASE PRINT LEGIBLY OR TYPE
SECTION I—APPLICANT INFORMATION
ADDRESS OF PROPE TY:
Z� SD ov,-E--yzr-t, VLI2-K (-E-e--2.t C-t+ C/I$�`+
LOT NUMBER: TRACT NUMBER:
ASSESSORS PARCEL NUMBER: COMMUNITY NAME:
jr J Zo 13 - C4z
NASM r�/0/TuP . t LTY O(_W._LNER SUPERINTENDANT PHONE:
C���G
ADD SS OF PROPERTY OWNER: 6 Z•�a C�aK ?vc d ✓ BUSINESS PHONE:
zS"�
Reason For Request:
O'er C-C> c •-L. �!l v-�-2s�z •�r 2. c� v'w. �,�5® .
f li'-P- 5 v' k(-e...ti D Let. V`t l I,-u�/ti C� ovt S Lv cl ,
SECTION 2—BOND
1. The applicant for a Temporary Clearance for Utility Connection must post a cash bond or Cashier's check
made payable to the City of Menifee in addition to the required $148.37 inspection fee and $27 processing
fee. The amount of the bond shall not be less than $2,000 or the estimated costs, as approved by the Building
Official,for the completion of the remaining items for the Applicant to obtain permanent utilities, whichever is
higher.
2. In the event that all remaining items to be completed for the Project are not completed in compliance with the
plans as submitted by the Applicant by 9, /3 1���� 1 the Applicant will forfeit the
deposited bond.
SECTION 3—APPLICANT DUTIES
1. Applicant waives any cause of action against either the City of Menifee or any of its officers and employees
because of any defect in the construction or installation of electrical equipment, or for any other defect in
construction of the above mentioned building, or for any connection to or disconnection from any utility which
many cause any damage whatsoever to the premises, any other premises, or any person or persons, and
agrees to hold the City of Menifee or any of its officers and employees, harmless from any damage or injury of
any kind caused by such temporary clearance.
APPLICANT INITIALS:
2. Applicant further covenant and agrees to have the above building completed and in compliance with all
building codes, ordinances, and regulations, and ready for final inspection by
and further agrees that if the final inspection and approval is not granted before such date that the electrical
service may be disconnected by the City of Menifee without any notice and the applicant agrees to hold the
City of Menifee, its officers and employees, harmless from any and all damage and injury which may arise
therefrom.
APPLICANT INITIALS:
3. Applicant acknowledges that any occupancy of the above mentioned I ding without final approval or a
Certificate of Occupancy shall constitute an occupancy violation in accordance with Section 111.4, of the
2013 California State Building Code, and will result in the immediate disconnection of ilities by the City of
Menifee.
APPLICANT INITIALS:
4. Applicant acknowledges that if a balance is due at the completion of this project, the amount owed will be
taken from the deposit and applied toward the balance.
APPLICANT INITIALS:
I, wig s �� CcL - S , hereby agree to comply with the above-described terms in this Application for
(APPLICANT)
Temporary Clearance For Utility Co ction.
(APPLICANT) (DATE)
FOR DEPARTMENTAL USE ONLY
PLANNING FIRE
ZONE:
APPROVED BY: i (J DATE: APPROVED BY: Ea DATE:
BUSINESS LICENSE PUBLICPUBLIC WO7mk
BUSINESS LICENSE# D 3 ��7
APPROVED BY: DATE: APPROVED DATE:
BUILDING DEPARTMENT EASTERN MUNICIPAL WATER DISTRICT
APPROVED BY: DATE:
APPROVED BY: DATE:
HEALTH DEPARTMENT
APPROVED BY: W DATE:
i
i
Inspection Job Card
POST IN CONSPICUOUS LOCATION WITH APPROVED PLANS
PERMIT NO: 1 ®_
EMAIL INSPECTIONS TO bldg-insDRdtyofinenifee.us or CALL (951 )245'�6213 FOR INSPECTIONS
BETWEEN THE HOURS OF 8:00 A.M. AND 2:00 P.M. 24 - 48 HOURS IN ADVANCE
* SCHEDULING DEPENDENT UPON INSPECTIONS REQUESTED AND AVAILABILITY
BUILDING INSP BUILDING INSP ' BUILDING DATE INSP
INSPECTION DATE INITIALS INSPECTION DATE .INITIALS, INSPECTION INITIALS
PRE-CONST' T-BAR CEILING / WALLS
MEETING
U.G PLUMBING !' INSULATION _S_ FOOTINGS
FOOTINGS DRY WALL ®I GROUTEAM/
U.G �C�6&F;«IC ,r EXT/INT.LATH 7�� DRAIN/SEAL
UFER/GROUND (p GAS TEST WALL FINAL
SLAB d SHAFT TEMP POWER/
PEDESTAL
FIRE SITE APPROVAL HOOD/DUCT ELEC. RELEASE ^
ROOFS DECK/ 7/f/ FIRE SMOKE
DAMPERS SEWER(SEPTIC -
SHEAR/FRAME / Y ROUGH CONDUIT WATER SERVICE
COMBO FRAME 7 PATIO LEDGER FIRE FINAL
ROUGH PLUMB _ ./ POOLS MECH FINAL a
ROUGH ELEC. PRE-GUNITE/BONDING ELEC FINAL
ROUGH MECH. -7-4�'/y ,� PRE-DECK PLUMB FINAL
FIRE COVER / PRE-PLASTER SOLAR FINAL
WALL POOLENCLOSUR
FIRE POOL FINAL BUILDING FINAL
COVER CEILING __
REMARKS: NOTE: ITEMS MARKED IN RED ARE FIRE INSPECTIONS.
S__wy
T-X& s
lLs�gsl\M
-n I
i
��1� l�.i-ZY"�rnG S'NE"i\Q "C"ut JY17hr �.�1LDir�(� a��POd /EX� Cy
(,A-it( t P ,
II A 1 CA ujotI
'-�' ,�( �(li�f i-1 �-"t'Y(�ll0.l.,r;�l� m'� ! nt� "TJ fam A.P /';I-„,'I)A fT� �an Il ll i 'k•'PrnP c .n(I C''"'�
60 lI zF'i'
sf e
NOTICE: THIS PERMIT SHALL EXPIRE IF WORK IS NOT COMMENCED WITHIN OR IS SUSPENDED OR ABANDONED FOR
A PERIOD OF 180 DAYS(6 MONTHS) FROM THE DATE OF�P SUANCE OR FROM THE DATE OF THE LAST INSPECTION.
' <> G / '.791s'so l G IA5vs/ ERMIT