PMT15-00978 i
i
City of Menifee Permit No.: PMT15-00978
29714 HAUN RD.
q�CCEII- MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 04117/2016
PERMIT
Site Address: 28090 ASPENWOOD WAY, MENIFEE, Parcel Number: 372-021-003
CA 92584 Construction Cost: $6,500.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 70,000 BTU FURNACE, 14.5 SEER, 3.5-TON A/C
Work:
Owner Contractor
ROBERT BEWERNICK AIR FORCE ONE HEATING AND AIR INC
28090 ASPENWOOD WAY 31566 RAILROAD CANYON ROAD
MENIFEE, CA 92584 #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
$T'W?'{RSm'nrd'm.`wR 'M 1wT.4"' "yS'-g+^Y'c"�R
Fo ded= Irior Gravl .ype Furnace o,Burr , ,v,..,. n e
Air Handling/Condensing Units SFR 1 133.00
B UIlding®P2rfj7lf lS'U (1Cs „irw t�sY`'�SF`,c G's ruuyrsz "t r' , + '�'` .7'.OQ .
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_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 Co a and m license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class '02- License N 9S.y who builds or improves thereon, and who contracts for the projects with a
Expires 3 Signature - licensed contractor(s)pursuant to the Contractors State License Law).
WORKE S'COMPENSATION Dr L ION
❑ lam exempt from licensors 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
P0lic # 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
ection 3700 of the Labor Code, for the performance of the work for which this submitted or at the fallowing Web site:http'//www.IeqInfo.ca.ocv/caIaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
,� Gam- p Properly Owner or Authorized Agent Date
Carrier
Expires to I Z o 16 Policy#-5 WG SOS L4 gI S j
El By my Signature below, I certify to each of the following: I am the property
Name of Agent�DF(v-�✓l 10rL� Phone# ('`' oZ l( " -( 'J3 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 1 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 employ any persons in any manner so as to become subject to the
workers' compensation laws of California, an jgree that if I should become
subject to the workers'compensation provisi n5§/ tion 3700 of the Labor Property Owner or Authorized Agent Date
Code, I shall forthwith comply with those p o isTo
_ r City Business License#
Date; ( Applican)rz
4
WARNING: FAILURE ,TO S R WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVE RAG .IS NLAWFUL, 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, EYES 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 Li 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 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 OYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensors 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($500).) COZDAFtDSECTION
U3 M N 25505RIALF}E5533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044, Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECKAPPLICATION
15t,
..... 'Menifee
DATES —I _ PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL , RESIDENTIAL % MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA r-SIGN
SUBTYPE: ()ADDITION ' ALTERATION ID DEMOLITION C>ELECTRICAL AMECHANICAL
Ci NE W O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK NV N"L.
i
CD o L
PROJECTADDRESS 2� e) -W do
ASSESSOR'S PARCEL NUMBER
" J M'Qt -Mj `-005 LOT TRACT
�L�L
OWNER NAME -eA kj r"tt
ADDRESS ��� W-zj- � 1�e City of Menifee
PHONE -J 4" a 3 5- t'j 4 3 EMAIL
APPLICANT NAME
ADDRESS Received
PHONE EMAIL
CONTRACTOR'S NAME C1'10-r I I I-e.-f a OWNER BUILDER? `%YES K,"NO
BUSINESS NAME k r �Z Q
ADDRESS 7J L S(v LP {-v J
PHONE 9 S l 2.9 9 -y 1 y EMAIL -�,. .L- IG(J -�v ✓ ,L.n-�
r Kl
CONTRACTOR'S STATE LIC NUMBER �155 �I'S y / �n) LICENSE CLASSIFICATION
VALUATION$ j-(jl� SO FT Cp V" L SO FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE �l� PAIDAMOUNT �-�
AMOUNT 1 �/� ii CASH %CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED "'YES NO DL NUMBER NOTARIZED LETTER O YES C% NO
City of Menifee Building&Safety Department 29714 HOLIn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
STATE OF CAUFORNIA
2008 RESIDENTIAL HVAC AL!�E TEONS. CUM TE ZONES a �?
CEC-CF-7 R-ALT-HVAC Revisetl 03/7 `
Sl®t lefied Press de
ta !five Certiatcate os Com !lance: 200d Peside afial17 PACAYranons NE��i� ALT SAC'
Climate Zones 0
�as. vJ e r n I K
SiteAddress; / Ee orcetrrentAgency: D
290 h W W l�p C4�\t e f° Permit#:
E ui men[T e List Minimum❑Pac Unit or Are.
ties Conditioned Flo A T
kaged Thermostat
❑Furnace
❑AFUE ❑COP
Indoor Coil MSEER/y.t; ❑HSPF Served by system
❑condensing Unit [3EER III 1- ❑Resistance � I tec sf �of at-adypreren;court be installed) 111
Other
1.Equipment Type:Choose Inc equipment being installed if more than one system use another(T III ALT-HVA(;for each system.
2.Minimum Equipment Efficiencies:13 SEER 78%AFUE,7.7HSPF for typical residential systems.
HERS t/ERIFnCATI�RI 9IJtl/d1V(ARY Listed below are three HVAC alteration done and picks one of what work is bei
the appropriate Options. Each Option lists the HERS measures that must be conducted.A decides
py of the forms s aall
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 1,20I0,a registered copy of the CF-1R and CF-611 shall
also be on site for final ins ectioo.
I.Ha/AC Chan Bout Required Forms:
e All HVAC Equipment 1-F-6Rforms: MECH-04,,,.." 5-HERS
re laced CF-4R forms: MECH-25 City o en1 ee
e Condenser Coil and/or Building & Safety Dept.
o Indoor Coil and/or CF-6R forms. MECH-25-HERS APR ZO15
a Furnace CF-4R forms: MECH-25
For Split Systems: RC CCA>_300 CFN/ton,Ti1riAH
For Pacltaged Units: Notestingrequired
❑2.New EIVAC Systems Required Forms:
o Cut in or Changeout with
new d CF-6R forms: MECH-04,MECH-25-HERS
ucts:(all new ducting CF-4R forms: MECH-25 an all new ui men0 ,
For Split Systems:RC,CCA_>300 CFMfton,TMAH.
For Packaged Units:No testing required
❑3.New!Duets with Replacement Requited forms:
® Includes replacing or installing all new
ducting and/or outdoor condensing unit CF 6R forms: MECH-25-HERS
and/or indoor coil and/or furnace. Not all CF-4R Forms: MEC14-25
e ui ment than ed.
For Split Systems: RC,CCA>_300 CFM/ton,TMAH
For Packa ed Units.No testisrequired
Contractor(Documentation Authoes/Responsible flDesignees!Declaration Statement)
C I certify that this Certificate of Compliance documentation is accurate and complete.
o lam eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on
this Certificate of Compliance.
o 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 forts,workshcets,calculations,plans and specifications submitted to enforcement agency for approval with the
ermitt lication.
Name / °har-
ly / 'G �/Pfi/✓2 Si
Company:
Date:
Address: ;J 3 //lsir6 /�p Le rt lie d Avt (42- License: C/5-Y`I5 2-
VS 1 Z V4-0 7 0
2006 Residential Compliance Forrlts
March 2010