PMT14-01057 City of Menifee Permit No. PMT14-01057
'WCCEL29714 HAUN RD. Type: Residential Mechanical
'' MENIFEE, CA 92586
MENIFEE Date Issued:
05/08/2014
PERMIT
Site Address: 25750 SANDY LODGE RD, MENIFEE, CA Parcel Number: 339-052-022
92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT 3.5 TON PACKAGE UNIT
Work:
Owner Contractor
YOLANDA TORRES COOL AIR SOLUTIONS INC
25750 SANDY LODGE ROAD 41162 SANDALWOOD CIR STE 101
MENIFEE, CA 92586 MURRIETA, CA 92562
Applicant Phone: 9516762665
COOL AIR SOLUTIONS INC License Number: 874502
41162 SANDALWOOD CIR STE 101
MURRI ETA, CA 92562
Fee Description
Q1 Amountll
aForced A f or G avltwTYPe Furnace or Bumper # v ;xYy49 p0
Air Handling/Condensing Units SFR 1 133.00
Bullcng P emit Iss aance
...�,..a� ,
GREEN FEE 1 1.00
$310.00
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 staled, 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_eldg Permlt_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 i u rce and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class C� Lice e 10 who builds or improves thereon, and who contracts for the projects with a
Expires Signatu� licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION ECLARATION
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ I 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
❑ 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:http'//www.leainfo.m.gov/calaw.htrni.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Zsov�_Ia Aec Prope y Owner or Authorized Agent Date
Expires Policy
❑ 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 state laws relating to building
construction. I au orize re ecr sentatives 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 identified propert or the inspection ses.
shall not employ any persons in any manner so as to become subject to the c.5�/
workers' compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions o Section 3700 of the Labor Property er_oC9uS orized Agent Date
Code, I shall forthwith comply with those provi s.
City Business License# 3S�
Date; 6 `� Applicant;
WARNING: FAILURE T CURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS U LAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
--- CIVIL—FINES-UP-T-O-ONE-HUN.DRED_T-HOUSAND—aOJ.LARS WILL TIdE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, ❑YES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
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 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 ❑YES 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 PRINT NAME:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed AYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable items) (Section 7031.5. Business and Professions Cade: 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 I 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).) HAZARDOUS IONMAT 25505RIALf E 5533 AND 25534 CONCERNING
❑ 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 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).
'CITY ,O MENIFEE IPLCt<No: Permit No:
City of Menifee
i iitee, C! faun RoadBuilding & safety Dep Da`FI
Ibien ;> y27��
Phone: (951)672-6777 MAY 0 8 2014
om
Pax:(951 )679-3843 Ck# Ck :310
Received -T6
.udding Combination Permit
To Be Completed By Applicant
Legal DescripOnn- Planning Case: F. I : RI: R:.
Property erlrj,., Asaessor b Parcel Number:
2s�so Sloe,!) LoJ e 1Zd 3390.5$022
Project[Tenant Name: Unit#: Floor rt.
Name: iQn� l OY O 1 ICS Ph aX°382_ 917 Fax No.
Property Address: Z57SO San R�( Unit Number Zip Code Ovener �ITg1
Email Address: r
Name: i,�Vt(O/'rQ.h I ✓VQ,(7 W�QJ"
Ph ne No —7 �a�Iq
W 67(c-2tv&5 P`%�/-6-2&-2[o(o0
Applicant Address 7 Ii,,P� S / d+A a+ G!S 0re Y' 11 to t unit Nyrfo t%Q 0.� Zip Code 9`z5 2
Email Address:
Name./� 1 tti�pp N/
(2ool Ha/ Sofo4 OnS P 15/ o�p�D Z�DtOc F j1-&xG-Z(o t9O
Contractor Address l��2d4/ i
.--__ t c;,, 11 t0 1 City •�] Stay Zip C26:5 2-
*v�CJ a..-a 3f 7CJrft Cl (:.71 `J,7
Conn +or-v Clty Business License No. Cnntaclo�Gii Sate of California License No.
� '. 3 r6 Classification:!,
Number of Squares.
Square Footage —�---
Description of Work: Er } ac 3.5�^ A - .1 Cost of Work: S _
n atll4 CN V )v cco
Applicant's Signature Date:-I-
f !
-- To Be:Completed By City Staff.Only --,
Indicate As R-Received or N/A Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include. 1 ,et or documents which IncbJe
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan title 24 Ener
❑ Mechanical Plan ❑ 9Y(on 8'/,x 11)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration` Addition' Means/methods
Work Type. Repair Retrofit- Revision to Existing PerrniP Required? YES NO
Proposed Building Use(s): Existing Building U&e(s):
#Buildings #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group indicate a a:e all
At Project Indicate YES or NO I'nd"= Geo-tech. Hoz Zone
Construction Spnnhlered that apply: Coastal Zone
Completion: Type(s): C Of C
YES or NO Noise Zone
Required?
Listed he 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 s ."."' bid,
0`ical Ap-mbal
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
Fcr Staff Use Only
BuildinoiSefrdy Permit Specialist Ci,y Plannmo Cbl Eng'n ' g EPWM
THANK YOU FOR HELPING US CREATE BETTER COMMUNITY
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-SR-ALT-HVAC
Climate Zones 10- 15
Site Address: Enforcement Agency: Date: Permit#:
25750 Sandy Lodge Rd Menifee, CA 92586 City of Menifee I May 7, 2014 -O IOS 1
Duct insulation Conditioned Floor
Equipment Typel List Minimum Efficiency2 requirement Area Thermostat
IM Package Unit
❑Furnace H AFUE 78% ❑COP ❑R 6 (CZ 10-13) Served by system ®Setback
[3 Indoor Coil ®SEER 13.0 [1HSPF If not already present must be
❑Condensing Unit ❑EER_ ❑Resistance ❑R 8 (CZ 14-15) 1603 sf installed)
❑Other
1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies: 13 SEER, 7B%AFUE, Z7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final 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-411
forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1,2010,a registered copy of the CF-iR
and CF-611 shall also be on site for final inspection.
®1. HVAC Changeout I Required Forms:
.All HVAC Equipment CF-611 forms: MECH-04, MECH-2I-HERS-_a E98-'-lit ry em MEGH 2_ HERS
replaced CF-411 forms: MECH-21 and (faF s..!:t System_) f49GH
. Condenser Coil and/or CF-6R forms: MECH-04, MECH-2I-HERS_Rd 4ap-- systems) MCGH HERS
. Indoor Coil and/or CF-4R forms: MECH-21 -_a (l:BF s-i t System_) ^4_�H`�=
. Furnace City of Menifee
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if: MAY U 8 2014
❑ 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. Existing duct systems are constructed, insulated or sealed with asbestos �e
❑4.The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Ch
❑2. New HVAC System Required Forms:
.Cut in or Changeout with CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
new ducts: (all new MECH-25-HERS
ducting mall new CF-411 forms: MECH-20, and (for split systems) MECH-22, and MECH-25
equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD,TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑3. New Ducts with/or without Required Forms:
Replacement
.Includes replacing or installing all new
ducting and/or outdoor condensing unit CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some CF-4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA > 300 CFM/ton,TMAH
For Packaged Units: Duct leakage < 6 percent
❑4. New Ducting over 40 feet lRequired Forms:
.Includes adding or replacing more than 40 CF-6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space. CF-4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's/Responsible Designer's Declaration Statement)
•I certify that this Certificate of Compliance documentation is accurate and complete.
•I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
•The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms,worksheets,calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Moriah Neugebauer Signature: Moriah Pkugebawr
Company: COOL AIR SOLUTIONS INC Date: May 7, 2014
Address: 41162 SANDALWOOD CIR STE 101 License: 874502
City/State/Zip: MURRIETA/ CA/ 92562 Phone: (951) 676-2665
Reg: 214-A0032313A-000000000-0000 Registration Date/Time: 2014/05/07 18:09:09 HERS Provider: Cd10ERTS, Inc.
2008 Residential Compliance Forms July 2010