PMT14-02289 I
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City of Menefee Permit No.: PMT14-02289
29714 HAUN RD. Type: Residential Mechanical
"�1CCEL 1.` MENIFEE, CA 92586
MENIFEE Date Issued: 0 812 6/2 01 4 j
PERMIT
Site Address: 29378 GILLETTE CIR, MENIFEE, CA Parcel Number: 336-192-017
92586 Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of REPLACE A/C, 80,000 BTU FURNACE, COIL, DUCTS, 14.5 SEER
Work:
Owner Contractor
JAMES HORN DESIGN AIR
29378 GILLETTE CIRCLE P 0 BOX 10014
MENIFEE, CA 92586 MORENO VALLEY, CA 92553
Applicant Phone: 9513690943
PAUL DAVIDSON License Number: 803433
DESIGN AIR
P 0 BOX 10014
MORENO VALLEY, CA 92553
Fee Description Q yt Amount($1
c ced--:iro �ifj �e F. e P=BUr 1e[ 4Qf
Air Handling/Condensing Units SFR 1 133.00
ul . gr s "M
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 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_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 C'2 a License No. PC;Y33 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
❑ 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
V" 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:htta'//www.leoinfo.ca.ciov/calaw.html.
permit is Issued.My workers'compensation insurance carrier and policy number are:
S f wH A Property Owner or Authorized Agent Date
Carrier �•+-1 t Gc
Expires 7 — &� _OS Policy#fd Z 1P��
11?? El By my Signature below, I certify to each of the following: I am the property
Name of AgentpYA&&/AS,r-*ev Phone# 99-t POO-G L 93 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-
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 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
subject to the workers'compensation provisions of Section 3700 of the Labor operty,Owner or Authorized 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 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 reasons)indicated below by the checkmark(s)I have placed LIVES 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 LNES 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 ($500).) CODE, SECTION 25505, 25533,AND 25534 CONCERNING
HAZARDOUS MATERIAL REPORTING.
El1, as owner of the property, or my employees with wages as their sole
compensation,will do( ) all of or ( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIFEUUty of Menifee PLCK No: Permit No:
3udding & Safety Dept. l _ a R
29714 Haun Road Date: Date:
Menifee, CA 92586 AUG 2 6 2014 (PO
Phone: (951)672-6777 AmOUnt. Amount:
Fax:(951)679-3843 Received Ck#: Ck#:
Building Combination Permit
o e Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R
0
Property Address: r Assessor's Parcel Number:
t77k slu —
Projectrrenant Name: Unit#: Floor#:
Name:jn)", , / /crAl Phone
gS No. 7 j 8 Fax No.
Property Address: 7 Unit Number Zip Cod
Owner
Email Address:
Name Phone No.F'R Fax No.
vL v cn751-00ya cSs
Applicant Atltlres .Q o /`2 S s Z Unit Number Zip Code
9Zs'SZ
Email Address /
7t/tC is ✓ . CO
Nam k 6AI f�( Phon�No G y j �3G9 sT�y
Contractor Addr O 'JC C c /Y M 1, �'� /z ss 2 City l Zi ssZ
ontractor s CRY tBusindeSS License NO. Contractor's City tate of
Call!
lifornia License No. Classification: —�
a
Number of Squares:
Square Footage C e
Description of Work: Cost of Work:$
41L �It� Cei� GcfS '�-a�'
Applicant's Signature Date:
B-2 4-1Y
To Be.Cornpleted 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 B%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 Ll New Construction Alteration' Addition' Means/Methods
Work Type: Repair' Retrofit' Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Ll
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 all Geo-tech.Haz.Zone
At Project Construction Sprinklered that apply: Coastal Zone
Completion: Type(s): C Of O Noise Zone
Required? YES or NO
Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. I Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger al Landmark Seismic Retrofit pOff.ci Case.Bldg,
BPeCl l roval
Expedite Projecl(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safel Permit Specialist Cily Planning Civil Engineering EPWM-Admen Transportation Mgmt I Rent Coniml
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
Sim fitted Prescriptive Certificate of Compliance: 2008 Residential HVACAIteradons CF-IR-ALT-HVAC
Climate Zones 10 to 15
Site Addr Enforcement Agency: Date: Permit#:
3 78 ' l l He ra 8-24-111 amu
Conditioned Floor
-Equipment Typel List Minimum Efficien Duct insulation requirement Area Thermostat
❑Packaged Unit
$Furnace - ❑AFUEk El COP Ova 40 of ducts added or etback
71ndoor Coil OSEER St.5- ❑HSPF replacee d i0- 3)unconditioned space Served by system (TV not already
Condensing Unit ❑EER 17. ❑Resistance 6 (CZ/0-1-jrR3) . sf present,must be
O Other I
❑R 8 (CZ 14-15) installed)
1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-1 R-ALZ-HVAC for each system.
2.Minimum Equipment Ef .kieneies:13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems.
TIERS 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 most 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-611 and registered CF-4R forms(no hand filled CF4Rs allowed)are filled out and
si it. Beginning October 1,2010,a registered copyof the CF-1R and CF-6R shall also be on site for final inspection.
1.EIVAC Changeout Required Forms:
• All HVAC Equipment replaced CF-6R forms: MECH-04,MECH-21-HERS and(for split systems)MECH-25-HERS
CF-4R forms: MECH-21 and fors fit stems MECH-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 for
m: MECH-21 and(for split systems) MECH-25 .t of McOifee
For Split Systems:Duct leakage< 15 percent; RC,CCA>300 CFM/ton(Minimum Air Flow Requirement),W(1fmg
For Packaged Units: Duct leakage<15 percent
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 linen feet in unconditioned space,or 9
O 3.Existingduct stems me constructed,insulated or sealed with asbestospiraGei d
❑2.New HVAC System Required Forms:
• Cut in or Changeout with new CF-6R forms: MECH-04,MECH-20-HERS,and(for split systems)MECH-22-HERS,and MECH-25-HERS
ducts:(all new ducting and all CF-4R forms: MECH 20-,and(for split systernaMECH-22,and MECH 25
new 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
r"v3.New Ducts with Replacement Required Forms:
• Includes replacing or installing all new dueling CF-6R forms: MECH-04,MECH-20-HERS,md(for split systems)MECH-25-HERS
and/or outdoor condensing wit 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 Packaged Units:Duct leakage<6 percent
❑4.New Ducting over 40 feet Required Forms:
• Includes adding or replacing more than 40 CF-6R forms: MECH-04,MECH-2I-HERS CF-4R forms: MECH-21
linear feet of duct in unconditioned space.
For split system or packaged units: Duct leakage<15 percent
❑ EXCEPTION:Existing duct system constructed,insulated or sealed with asbestos.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify dint this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for die 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 coutarn to the requirements of Title 24,
Parts I 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 royal with the permit application-
Name: A t/L r S C un Signature: ,
Company: N Date:ry—.r / /
Address:Pa 130 Licensee .,j q_?3
City/State/Zip: tjalretn. v/9,Ill IN et SSZ Phone: 9 - 1r O37 V3
2008 Residential Compliance Forms March 2010