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PMT14-03111 City of Menifee Permit No.: PMT14-03111 '^�.�, 29714 HAUN RD, Type: Residential Mechanical 4WOCE MENIFEE, CA 92586 MENIFEE Date Issued: 11/24/2014 PERMIT Site Address: 27600 GROSSE POINT DR, MENIFEE, Parcel Number: 335-241-020 CA 92586 Construction Cost: $5,300.00 Existing Use: Proposed Use: Description of HVAC REPLACEMENT Work: Owner Contractor RUSSELL GILBERT AIR FORCE ONE HEATING AND AIR INC 27600 GROSSE POINT DR 31566 RAILROAD CANYON ROAD MENIFEE, CA 92586 #682 Applicant Phone: 9512440916 LINDA DIERINGER License Number: 955952 AIR FORCE ONE HEATING AND AIR INC 31566 RAILROAD CANYON ROAD #682 CANYON LAKE, CA 92587 Fee Description Qtv Amount 1$) Air Handling/Condensing Units SFR 1 133.00 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_eldg_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 License No. 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 ❑ ]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 issue4. Policy# S G ( C b 1-)S L built as an owner-building if has not been constructed in its entirety by licensed 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:htto'//www leginfo ca aov/calaw html. permit is issued,My worker�s'rcompe/n1sation insurance carrier and policy number are: Carrier�LWu (Y a-Xa-eel' Property Owner or Authorized Agent pate Expires 10 /a J b1 Policy# 5 W G 1 03 17 5� ❑ By my Signature below, I certify to each of the following: I am the property Name of Agent:_U!{n� TLT� Phone# — owner or authorized to act on the property owner's behalf. I have read this ��� ��<<-zyj'� application and the information I have provided is correct. I agree to comply (This section need not be completed if the permit is for one-hundred dollars($100)or less) with all Iicable city and county ordinances and state laws relating to building const clip .I authorize representatives of this city or county to enter the above- El I certify that in the performance of the work for which this permit is issued, I identifie$pipperly for the inspection purposes. shall not employ any persons in any manner so as to become subject to the 22 workers' compensation laws of California, and agree that if I should become subject to the workers'compensation prov' ion of Section 3700 of the Labor =ass Authorized Agent Date Code, I shall forthwith comply with those p ovi i ns. se# Date;`(-ZZ-I ik Applicant; WARNING: FAILURE 'f0 ECU E RKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE NLAWFUL, D 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, OYES 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 4 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address NO FROM THE SOUTH COAST AIR QUALITY MANAGEMENT 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 DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable items)(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, 19NO 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 T+1E STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZA DOU IA�L REPOR't'ING. compensation,will do ( )all of or( ) porting of the work, and the structure is PR P NER 0 AUTHORIZED AGENT not Intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). BUILDING i SAFETY PERMIT/PLAN CHECK APPLICATION ,y;'s yy' L AdA °` Menifee DATE - 2,2 L4 PERMIT/PLAN CHECK NUMBER TYPE: 0 COMMERCIAL % RESIDENTIAL 0 MULTI-FAMILY (I MOBILE HOME "D' POOL/SPA 0 SIGN SUBTYPE: :>ADDITION ":% ALTERATION 0 DEMOLITION 0 ELECTRICAL <% MECHANICAL NEW C• PLUMBING 'D RE-ROOF-N UMBER OF SQUARES DESCRIPTION OF WORK E r-C C4, PROJECTADDRESS d-_7 (P (70 r�SS���- l 9a52- �( ASSESSOR'S PARCEL NUMBER 335 • LOT ._ TRACT OWNER NAME RIkS%,P_U I6C� ADDRESS LP PHONE (407 :Z- ''��A r4- EMAIL ,/ APPLICANT NAME r (-�rc..E ��L—,/{- -Z l.�y d Aril ADDRESS PHONE 9S L -2-gV-0 9(to EMAIL CONTRACTOR'S NA. _ '- OWNER BUILDER? �>YES NO BUSINESS NAME �ytrl EbJ� ADDRESS e PHONE EMAIL �) Y CONTRACTOR'S STATE LIC NUMBER �TSS �j S Z, LICENSE CLASSIFICATION -2. P VALUATION$ -3©O SQ FT L SO /FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEEEBBUSINESS LICEIJSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP fl 65 0( INVOICE AMOUNT _6tO� PAID AMOUNT CASH '.)CHECK# 0CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH Ci CHECK# C3CREDITCARD VISA/MC OWNER BUILDER VERIFIED O YES C NO DL NUMBER NOTARIZED LETTER <.> YES C, NO City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92596 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 STATE OF CAUFORNIA - 2008 RESIDENTIAL HVAC ALTERATIONS: CLIMATE ZONES 8 CEC-CF-IR-ALT-HVAC Revised 03/10 CAUFORNIA ENERGY COMMISSION Sim Itfied Prescri five Certificate of Com fiance:2008 Residential nvACAlteratiolts CF-IR-AL'T-HVAC Climate hones 0 City ot TV Building & Safety Dept. S1teAddress: n EreforcemeatAgency: Z 4 e' 1 b + bSSL NOV1, I Equipment Type' List Minimum Efficien Conditioned Floor Area Thermostat ElPackaged Unit fl❑Furnace ❑AFUE RC e 1_ ❑COP ❑Indoor Coil OSEER ❑HSPF Served by system ❑Setback ❑Condensing Unit ❑EER ❑Resistance sf (I nor already present,must be installed) ❑Other I.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 SUP/IMARV Listed below are three 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-1R and CF-611 shall also be on site for final inspection. ❑ I.HVAC Changeout Required Forms: o All HVAC Equipment CF-6R forms: MECH-04,MECH-25-HERS replaced CF-4R forms: MECH-25 e Condenser Coil and/or e Indoor Coil and/or CF-6R forms: MECH-25-HERS e Furnace CF4R forms: MECH-25 For Split Systems: RC,CCA>_300 CFM/ton,TMAH For Packaged Units: No testing required 132.New HVAC System Required Forms: e Cut in or Changeout with CF-6R forms: MECH-04,MECH-25-HERS and_d all newequipment) new ducts:(all new CF-4R forms: MECH-25 For Split Systems:RC,CCA>_300 CFM/ton,TMAH. For Packaged-Units:No testis required ❑3.New Ducts with Replacement Required Forms: ® Includes replacing or installing all new ducting and/or outdoor condensing unit CF-6R fors: MECH-25-HERS and/or indoor coil and/or furnace. Not all CF-4R forms: MECH-25 equipment changed, For Split Systems: RC,CCA>300 CFM/ton,TMAH For Packaged Units:No testis uired Contractor(Documentation Author's/Responsible Designer's Declaration Statement) m I certify that this Certificate of Compliance documentation is accurate and complete. e 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. a 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 I and 6 of the California Code of Regulations. o 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 ermit lication. Name: Signatur Company: yY (� Date: Address: License: /=Zb - gSSc�SL City/State/Zip:CL� �tpt� G\- Phone: c S<- 2008 Residential Compliance Forms March 2010