PMT14-01058 City of Menifee Permit No.: PMT14-01058
29714 HAUN RD. Type: Residential Mechanical
OWCCIE.. $?` MENIFEE, CA92586
V'OdRMMI'R$M4xw? MENIFEE Date Issued: 06/08/2014
PERMIT
Site Address: 29226 AVENIDA GAVIOTA, MENIFEE, CA Parcel Number: 341-133-026
92587 Construction Cost: $12,701.00
Existing Use: Proposed Use:
Description of REPLACE 2.5 TON (13 SEER) PACKAGE HVAC UNIT SAME LOCATION
Work:
Owner Contractor
PEGGY OWEN A R S AMERICAN RESIDENTIAL SERVICES OF
29226 AVENIDA GAVIOTA CALIFORNIA INC
MENIFEE, CA 92587 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9012719700
LAURA YENULONIS License Number: 791820
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNh
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Oly Amount($
Forced AM Gravlty,T�!pe,Fu naee or burner
Air Handling/Condensing Units SFF, 1 133.00
�BUIdIn,�G:PBrmfrt�lss4a>• 2"`' w.tiy. w," .Wr... ERi;
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 building 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 an my license is in full forw and effeCcctt. Code:The Contractor's License Law does not apply to an owner of a property
License Cis cerise No. who builds or improves thereon, and who contracts for the projects with a
Expire s,�..' �-��1{II Signatur licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DE R TION
❑ 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.
Policy# built as an owner-building If it has not been constructed in its entirety by licensed
y contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ 1 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:htta'ffi%www.IeQinfo.ca.gov/ca aw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier �C, "'�u Property Owner or Authorized Agent Date
Expires ��` `_�`- Policy pn�Jt�[ 6ml-a
Name ofA ent�.. ;rF-SC'6� C r.. Phone#K �n Fi�(a ❑ By my Signature below, I certify to each of the following: am the property
g 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 authorize representatives of this city or county to enter the above-
El I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes,.
shall not emclov any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become n 1•f
subject to the workers'compensation provisions of Section 3700 of the Labor Propert Ow r or Authorized Agent Date
Code, I shall forthwith comply with those provisions.
City Business icense#
Date;51._?A-1q __ Applican
WARNING: FAILURE TO S URE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS U FUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL-FINES-UP-T-O-ONE-HUNDRED-THOUSAND-DOLLARS- —---WILL--THE AP-P-L-ICAN-T OR-F-U-T-URE-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 ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY 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 ❑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
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 AYES 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
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 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($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation,will do ( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY `l/.l' ME19'YII'EE PLCK No: ..._... P t 4 op
29714 Haun Road Date: Dae: O
Menifee, CA 92586 -
Phone: (951)672-6777Amount: ° (ram
Fax:(951)679-3843 Cit#: k#: 1S
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case: F: L:
Propert A dress: Assessor's Parcel Number.
Projec nant a e: Unit#: Floor#;
Name: Rho neQl . _ _ No
Property Address: r Unit Number Zip Code
Ownerr---
Email Address:
Name: ' Phon No. o_
\S :7
Applicant Addres ' 'O Y.1Ve Unit Number Zip Cod r'
Email Address: 2 0
SQr�\ s pp
Name: , P n o. I F -a •O 1
n
Contractor g9press: # State Zip Co 'ag
`o'lntractor Sys e 1 Contractor' to of Cali omia Lice se No. Cfassifical'
Numberof Squares: V
Square Footage k-
Description of Work: \1a-VQn ` st of Work:$
Applicant's Signatu _ r
,. wNe—Dale:
To Be complistaosy City Staff Only
Indicate As R-Received or NIA-Not Applicable
5 Completes sets of fully dimens•.o d wn to sale plans which include: 1 set of documents which include
❑ Tide Sheet ❑ Elevations ❑ Electrical Plan
❑ Geo Tech/Soils Report(on cd only)
❑ Plot 1 Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y x'11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Delads ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition- MeansNathods
Work Type. Repair" Retrofit' Revision to Exisling Permit Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
Buildings: #Units; if Stories Will the Building Have a Basement?
V of N
Bldg.Code Occupancy Group Indicate Indicate it yES or NO Indicate all Geo-tech.Haz.Zone
At Projects Sprinkler Completion: Construction p that apply I Coastal Zone
Type(s): C Of O yES or NO Noise Zone
Required? Listed on Hislotic Resources Irventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project I Irlec.Vehicle Charger Landmark Seismic Retrofit Ispeoat rase:act,
01huni Approwti
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Builom lSahtq IPerini+Specialist Cily Punning I Cmd Fn ineenng EPWM-Admen iransparialion Mgmt. Rent ConVal
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAltefatlons CF-IR-ALT-HVAC
Climate Zones 10 to 15 h 6
r�n,td�r
rss: 0. U Y E rmehtA cy: D5 +, Permit
Conditioned floor
man, 1' List Minimum Et7cicncv' Duct insulation requirement Area Thermostat
ged knit Over 40 0 of ducts added or Setback
e n AFUE ®COI replaced m unconditioned space ad by'sysusm ®nor nlreudp
Cot. SEER ❑1ISPh i"9 R 6 1CL J(J 13.) a sr preen:,must be
namg Unit Fi:R ❑ResistanceFMJi R 8 £CZ 14-!Si I rnsrndedr
'. Equipment Type-Choose the equipment being inxtatted:ilmore dum one sysrem.use another CF-t R-A0-HV4C jnr each.rvctem.
?. Minimum Equipmem Efficiencies: 13.SF,ER 7,V%AFUE'. ?.21d.SYFJir rypicnt resic(rnria!sysrem.
HERS VERIFICATION SUMMARY listed Mow are lour 14VAC 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 fors shall be left on site far final
inspection and a copy given to the homeowner. Al final,the inspector Verifies that the work listed on this for was in fact tire work completed by the
insstalltm The inspector also verifies that each appropriate CF-6R and registered CF'-4R forms(no hand tilled CE-4Rs allowed)are filled out and
signed. Beginning October].2010,a registered copy of the CF-1R and CF-611 shalt also be on she for final ins ectiom
L HVAC Chan Bout Required Forms:
• ,all HVAC lquipment replaced CF-6R fors: MECFi-04.MECFI-21-11ERS and(for split systems)MECH-25-HERS
('f-4R forms: MECH-21 and(for split systems MECH-25
• Condenser Coil and for
• indoor Coil and nor CF-6R forms: MFU-1-21-HERS and(for split systems)MEC11-25-HF,RS
(F-4R fors: MECH-21 and(for split systems)) MECH-25
• Furnace
For Split Systems:Duct leakage< 15 percent; RC.CCA'>300 CFMiton(Minimum Air Flow Requirement),TMAH
For Packaged Units: Duct leakage< 15 percent
Exempted from duct leakage testing it,
I.Duct s-sleet was documented to have been previously sealed and continued through HEItS verification,or
2.Duct systems with less than 40 linear feet in unconditioned space.or
3.Exista; duct. stems are constructed.insulated or sealed with asbestos
2.New HVAC System Required Forms:
• C'ut in or C.hangeour with new CF-61t forms: MECI-1-(M,MECFI-20-HERS.and(for split systems)MECH-22-HERS,and.-ViPCH-25-I4ERS
ducts:(all new dotting and a0 CT-4R forms: RIEC'1i,20,and(for split systems)MECH-22,and MECH-25
new equipment) I
For Split Systems:Duct leakage<6 percent;RC,CCA>350 CFNI''ton,FWD,TMAH,STMS,and either HSPP or PSPP.
For Packaged Units: Duct leakage 6 percent
3.New Ducts with Replacement I Required Forms:
• Includes replacing or installing all nece ducting CF-6R fors: MECH44,MECH-20-HERSomd.(for split systems)kf-,Cl 1-2i-IIBRS
andim outdoor condensing unit and'or indoor CF41Z forms:MECFI-20 and(for split systems)MI C II-25
coil and/or furnace, Not all equipment changed.
For Split Systems:Duct leakage<6 percent,RC:,CCA >300 CFM,'ton,'I;viAH
For Packaged Units: Duct leakage<6 percent
4.New Ducting over 40 feet uired Forms:
• Includes adding or replacing more than 40 CF-6R terms: MECFI-K ME,Cli-21-HERS C:F-4R forms: MEC14-21.
linear feet of duct in unconditioned space.
For splits'stem or packaged units: Duct leakage< 15 percent
EXCEPT(oN,Exton•duct systems constructed.insulated or scaled with astrestos.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I cenifi that this Certificate of Compliance ib,cumematinn is accurate and complete,
• 1 an eligible under Division 3 of the Calitornia Business and Professions Code m accept responsibility for the dazign identited on this Certificate or(:'ompliame
• I centfg that the energy natures and performance>pecificatiom For the design idenified oil this Certificate of Compliance conform to the requirements of I ide 24.
Parts I and 6 of the Cal ifomia Code of Regalatso s.
• I he design features identified on this Certificate of Compiiamx are consistent with the ini ocwrstnted xn.
calculations,plans ands eifications submitted to life entd omens akencv for approval nit tltc -t liar
Name: DANIEL TRAVERSI Signatu :
Company: ARS Date:
Address: 1225 GRAPHITE DRIVE License: 791820
city'statc:7ip: CORONA, CA 92881 Phone: 951-280-3101
1104 P..,id.—inF/'nr«nl:n«..n V-- , 1.6. 'nllit