PMT14-01908 I
City of Menifee Permit No.: PMT14-01908 Ii
29714 HAUN RD. Type: Residential Mechanical
.k ! MENIFEE, CA 92586 I
o.A$°A.0 MENIFEE Date Issued: 07/23/2014
PERMIT
Site Address: 28301 LOS CIELOS RD, MENIFEE, CA Parcel Number: 336-211-013
92586 Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT SAME SIZE
Work:
Owner Contractor
MARY SCHILLING PERFECTAIR
28301 LOS CIELOS RD P 0 BOX 8056
MENIFEE, CA 92586 MORENO VALLEY, CA 92552
Applicant License Number: 972661
EDGAR VERDIN
PERFECT AIR
P 0 BOX 8056
MORENO VALLEY, CA 92552
Fee Description Qtv Amount
Air Handling/Condensing Units SFR 1 133.00
I I
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 Cade 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_Templatesirt 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 Cade 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 C—a0 License No. of VrooCo l who builds or improves thereon, and who contracts for the projects with a
Expires c:, of-Ito Signature _ licensed oonlractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION ❑ lam 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 entirely 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 louinfo ca oov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property Owner or Authorized Agent Date
Carrier
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 authorize representatives of this city or county to enter the above-
certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes.
all not employ any persons in any manner so as to become subject to the ��
workers'compensation laws of California, and agree that if I should become c,�r.- v2Y f I'\ _ �❑
subject to the workers'compensation provisions of Section 3700 of the Labor property O er or Authorized Agent Date
Code,I shall forthwith comply with those provisions.
City Business License if
Date;0-7-1-5— IL/ 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, AYES 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 TaN0 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 pYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 19 N0 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 pYES 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, ,-JkNO 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 INFORMATION GUIDE AND THE SCAQMD PERMITTING
Section 7000)of Division 3 of the Business and Professions Code)or that he or 1zi)(
she is exempt from licensure and the basis for the alleged exemption. Any J ES
\ 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($500).) CODE, S I STION 25505
MATE 50 25533 AND 25534 CONCERNING
HAZARDO❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( )porting of the work, and the structure is PROPER OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; X `}
The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENI EE PLCK No: P R o:
29714 Haun Road ^�I D
Date: Date:
Menifee, CA 92586 7 a3�ly
Phone: (951)672-6777 Amount: Amount: ro
Fax:(951)679-3843 Ck# C310
: k#:
Building Combination Permit
To Be Completed By Applicant
Legal Description: JCS I _7 1G2_� '2 Planning Case: F: L: Rt: R
Property Address: Assessor's Parcel Number. 3�_ f
IOS .' vn Ci� vl 3 a 1-013
Project/Tenant Name: .' I Unit#: Floor#:
Name: & 1 i n r Phone No. Fax No.
Property Address:
Owner Unit Number Zip Code
Email Address:
Name: Phone N Fax No.
qs( f Ig12-,q Yes si ems- 7
Applicant Address: 40 CG Unit Number Zip Code
13 o K'& pG•/ S+ C-103. U v ev�o Ito
Eny l Add ss: ,
r J4 1
ame: Phone No.
Fax No.
Contractor Address: City State Zip Code
ontractor s Ig�s'neynse O. Contractor's Cil State of California License No. Classification:
�/�J � -
Number of Squares:
Square Footage
Description of Work: Cost of Work:$
Applicant's Signature
6F._;,„v 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 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 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 Permit" Requlred7 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 Indicate all Geo-tech.Haz.Zane
At Project Spdnklered YES or NO that a I
Completion: Construction pp y: Coastal Zone
Type(s): Coto YES or NO Noise Zone
Required 7 rl Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elea Vehicle Charger Landmark Seismic Retrofit Speclal Case:Bldg.
Official A roval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safely I Permit Specialist City Planning Civil Engineering I EPWM-Achim Transportation Mgmt, I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
Simplified Prescriptive Certificate of Compliance: 2O08 Residential HVAC Alterations CF-iR-ALT-HVAC
Climate Zones 10- 15
Site Address: Enforcement Agency: Date:
28301 Los cielos rd Menifee, CA 92586 City of Menifee Jul 22, 2014 Dig&
Duct insulation Conditioned Floor
Equipment Typal List Minimum Efficiency2 requirement Area Thermostat
❑Package Unit
❑Furnace ❑AFUE_ ❑COP_ R 6(CZ 10-13) Served by system ®Setback
®Indoor Coil ®SEER 13.0 ❑HSPF If not already present, must be
®Condensing Unit ❑EER_ ❑Resistance R 8(CZ 14-IS) 977 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, 78%AFUE, 7.7HSPF 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-4R
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-5R shall also be on site for final inspection.
®I. HVAC Changeout Required Forms:
•All HVAC Equipment CF-6R forms: MECH-04, -'=_,�.e„ aj --r r EXEMPTED and (for split systems) MECH-25-HERS
replaced CF-4R forms: MRG14 2:EXEMPTED and (for split systems) MECH-25
•Condenser Coil and/or CF-6R forms: MECH-04, p4rogi 1 ;;1 1 FIP66 EXEMPTED and (for split systems) MECH-25-HERS
.Indoor Coil and/or CF-4R forms: ^^_Gll EXEMPTED and (for split systems) MECH-25
•Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA < 300 CFM/ton (Minimum Air Flow Requirement),TMAH
Exempted from duct leakage testing if:
❑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
❑4.The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge)
❑2. New HVAC System Required Forms:
•Cut in or Changeout with CF-6R forms: MECH-04, ^^=^ ,r EXEMPTED, and (for split systems) MECH-22-HERS, and
new ducts: (all new MECH-25-HERS
ducting Aad,all new CF-411 forms: ^f=^ PA EXEMPTED,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 CF-6R forms: MECH-04, P46GH-29-FiER&EXEMPTED, and (for split systems) MECH-25-HERS
condensing unit and/or indoor coil CF-4R forms: ;;wig EXEMPTED and (for split systems) MECH-25
and/or furnace. No or some
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton,TMAH
For Packaged Units: Duct leakage < 6 percent
[34. New Ducting over 40 feet Required Forma:
.Includes adding or replacing more CF-6R forms: MECH-04,:4r!Gl i ;ii; i PRr, EXEMPTED
than 40 linear feet of duct in CF-4R forms: M �21 EXEMPTED
unconditioned space.
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 Certincate 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: EDGAR VERDIN Signature: EDGAR VERDIN
Company: PERFECT AIR Date: Jul 22, 2014
Address: P O BOX 8056 License: 972661
City/State/Zip: MORENO VALLEY/CA/92552 Phone: (951)442-4825
Reg: 214-A0060041A-000000000-0000 Registration Date/Time: 2014/07/22 13:15:51 HERS Provider: Cd10ERTS, Inc.
2008 Residential compliance Forms duly 2010