PMT14-01014 City of Menifee Permit No.: PMT14-01014
29714 Type: Residential Mechanical
�tGICE1. MENIFEEEE,, CA 9 92586 C2
MENIFEE Date Issued: 0 6/0 612 01 4
PERMIT
Site Address: 27501 CABRILLO DR, MENIFEE, CA Parcel Number: 336-240-001
92586 Construction Cost: $2,000.00
Existing Use: Proposed Use:
Description of FAU CHANGE OUT, SAME LOCATION
Work:
Owner Contractor
INIGUEZ ITZAYANA MASCO CONTRACTOR SERVICES OF CALIFORNIA
27501 CABRILLO DRIVE INC
MENIFEE, CA 92586 260 JIMMY ANN DRIVE
Applicant Phone: 3863042222
MASCO CONTRACTOR SERVICES OF CALIFORNIA INC License Number: 221517
3383 DURAHART STREET
RIVERSIDE, CA 92507
Fee Description
Oft Amount
fCRd HIrO G Vlf 'Te)=U1'n2...CPOfB
Building Permit Is
1 27.00
IG
RRR 'FEE -ads
+uxbE#o�S.
$177.00
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee. Except as otherwise stated, a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I 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 e-.2 t)_License No..2.2 b5-(�./� who builds or improves thereon, and who contracts for the projects with a
Expires 9/AQ/-7o/57- Signature�.� licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am 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# contractors. I understand that a copy of the applicable law, Section 7044 of the
`7,� I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
'section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto'//www.leginfo.m.(3py/Cglaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property caner or ufhorized Agent Date
Carrier OIC4-�- I NSr✓a ns/e—
Expires 4130/.TO/`( Policy# (ti,iLk! 'l732 0 G 4/
l§(By 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($100)or less) with all applicable city and county ordinances and stale laws relating to building
construction.I authorize representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes.
shall not emolov any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should becomeJ{.
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent Date
Code,I shall forthwith comply with those provisions.
�� City Business License#
Date; S�6 �/z( Applicant;�� �— t
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 HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES XNO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending
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 -,KRO 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's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed ❑YES 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, ENO 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
provisions of the Contractor's State License Law(Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
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 �7�p CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to 7 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) COZDE SEC IION 255051';E5533, ND 25534 CONCERNING
HAPO�❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( )porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractors State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIFEE PLCK No: Permit Nc:
29714 Haun Road City of Menifee LA
Menifee, CA 92586 Building & Safety Dept. Date: Date:' 1
XA
Phone: (951)672-6777 MAY 0 6 2014 Amount. Amount:
Fax:(951)679-3843 me
Building Combination P PIP II
awed
To Be Completed By Applicant
Legal Description: � � 2 D�-f- Planning Case: F: L: RL R:
Property Address: Assessor's Parcel Numb at.
7 01 04-& n . O_ v
ProjecUTenent Name: Unit#: Floor#:
Name: P o. Fax No.
Property Address*-, y- Unit Number Zi Code Owner 2 (� �A- . ✓.rl f I - p si
Email Address:
Name: Phone No Fax No.
C i�nlo 9S �,-� z-GFo7
Applicant Address33 5 Unit Number Zip Code
n f O
Email ss'
Name:
l 5 Cc� CoL-rjE c en I S or (/( Pt10 N- Fax No.
6 z`
Contractor Address: Cit.? ' fate Zip Code
33 83 wkaw r ✓eKsidY YA. s-o-
on[ractor s ny usmess tense o. Contractor's City State of California License No. Classification:
C-zU
Number of Squares:
Square Footage
Description of Work: A(/ CK� F O ( Cast of Work:$ 19
Applicant's Signature 4-0 C *l t ti Cjpv
w G-- Date:
Co /
To Be Completed By City Staff Only
Indicate As R-Recelved or N/A-Not Applicable "
—'SComptet�4etS-of fully dimensioned drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan Mechanical Plan ❑ Title 24 Energy(on 8'%x 11)
- ❑ ❑ Structural Calculations
Foundation Plan ❑ Cross Section ❑ Plumbing Plan
❑ Single Line diagram for also.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan 1 ❑ Sound Report-Residential
Class Code: Indlrate New Construction Alteration' Addition* Means/ntethods
Work Type: Repair' _ Ll Retrofit' Revision to Elosling Perrtlil' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group Indicate Indicate if YES or NO Indicate allNGeo-ach.Haz.Zone
AI Project Construction Sprinklered that apply: Coastal Zone
Completion:
Type(s) YES or NO Noise Zone
RquO ? d on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commis Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit special ass:Bldg.
OffioalA oroval
Expedite Project(s). Child Care City Project Green Building I Landmarki Affordable Housing
For Staff Use Only
Buildin ISafety Permit Specialist ICity Planning Civil Engineenng I EPWI I-Admin Iranspodalion Nigmt, Rent Con Vol
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
Simplified Prescriptive Certificate of Com
ones 10 to IS pliance 2008 Resit, dal WACAlrerardons CF to er m an
Climate Z
Site Address:
. 7 6 i//1U ll;t. Enforcement Agency., Date; Permit q;
l� �-/�11y
ui ment I list Minimum Efficient ' Conditioned Floor
Packaged Unit Duct insulation uirement Area Thermostat
Pomace � 13 COP Over 40 ft of ducts added or Q Setback Indoor Coil ®HSPF laced in unconditioned space Served by system (/J'not backalready
Condensing Unit EER Resistance ff R 6 (CZ 10-15) sf present,munbe
Other LLLLJJJJ R 8 (CZ/a-IS) Inswlled)
!. Equipment Type. Choose the equipment being installed;if more than one 2. nimum system,use anodter UP-/R-ALT-NVAC jor each system.
Mi Equipment Ecierccies: !3 SEER, 78'/n AFUE, 7,7HSPFfor typical residential,ystems.
HERS VERIFICATION SUMMARY Listed below are four NVAC alteration
picks one of the appropriate Options. Each Options. The installer decides what work is being done and
Op Option lists the HERS measures that must be conducted.A copy of the forms shall be left on site for fins)
inspection and a copy given to the homeowner. At final,the inspector verifies that the work listed on this form was in fact the work completed by the
Installer. The inspector also verifies that each appropriate CF•6R and registered CF-4R forms(no hand filled CP-4Rs allowed)are filled out snit
si led. nnin October 1 2010 a r literati co of the CF-IR and CF-6R shall also be oa site for fast im oa I.HVAC Chan eout R aired Forma:
• All I-IVAC Equipment replaced ¢-6R forms: MECH-04,MFAi-21-HERS and(for split systems)MECH-25-HERS
CP-4Rforms: MECH-21and forsplit s stems ME( i-25
• Condenser Coil and/or
• Indoor Coil and/or CF-6R forms: MECH-2I-HERS and(for split systems)MECH-25-HERS
• Furnace CF-4R forms: MECH-21 and(for split systems) MECH-25
For Split Systems: Duct leakage <15 perceatt; RC,CCA>300 CFM/ton(Minimum Air Flow Re
For Packaged Units: Duct leakage <15 quirement),TMAH
Exempted from duct leakage testing if: percent
1.Duct system was documented to have been previously sealed and confirmed through HERS verification,or
2.Duct systems with less than 40 linear feet in unconditioned space,or
3.Exisdn ducts stems are constructed insulated or sealed with asbestos
2.New HVAC System Required Forms:
• Cut in or Changeout with new
ducts:(all new ducting aW all CF-6R forms: MECH-04,MECH-20-HERS,and(for split systems)MECH-22-HERS,and
new ui ment CF-4R forms: MECH-20,and(for split systems)MEG(-22,and MECH-25 MECH-25-HERS
For Split Systems: Duct leakage e <6 reel[percent;R
For Pecks ed Unite:Duct teaks a C,CCA_>350 CFM/ton,FWD,TMAH,STMS,alai either HSPP or PSPP.
❑3.New Ducts with Replacement R uired Forms:
• Includes replacing or installing all new ducting CR6R fortes: MECH-04,MECH-20-HERS (for split systems)MECH-25-HERS
,and and/or outdoor condensing unit and/or indoor CF-4R forms:MECH-20 and(for split systems)MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems:Duct leakage <6 percent,RC,CCA>300 CFM/ton,TMAH For Packs ed Units:Duct leaks a <6 item
4.New Ductia over 40 feet R aired Forms:
• Includes adding or replacing more than 40
linear fcet of duct in unconditioned cc. CF-61t forms: MECH-04,MECH-2I-HERS CF-4R forms: MECH.21
For split a stem or packaged units: Duct leakage <15 percent
EXCEPTION:Existing duct s stems constructed insulated or sealed with asbestos.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
° I certify that this Cenificste of Compliance doeum motion is accumte and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept eymayibility for the design identified on this Ceedficate of(:omp
liana.
• I certify that the energy features and performance specifications for tine design identified on this Cenifieate of Compliance conform to the requirements of Title 24,
Pans I and 6 of the California Code of Regulations.
° The design feacum identified on this Certificate of Compliance are comiatertt with the info calculations, lens ands ifications submitted to the en orcementa ens fore meat with the oarm t am ntedon other applicable compliance forms,worksfkets,
Name:
Signature: >
Company;J .n_.
Date:
Address: �;
-3J ,L f -5! ' License: ��
City/State/Zip: `
� C/lJ- Phone: �,
21708 Residential Campltance Fornrs —
July 2010