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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