PMT15-01615 City of Menifee Permit No.: PMT16-01615
,�+. ��'''� ''''�^y 29714 HAUN RD. Type: Residential Plumbin
'A70CELJ' MENIFEE, CA 92586 9
MENIFEE Date Issued: 0611612015
PERMIT
Site Address: 26216 POTOMAC DR, MENIFEE, CA Parcel Number: 338-203-017
92586 Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL WATER AND FAU ONLY
Work:
Owner Contractor
JULIA KILLINGSWORTH RELIABLE ENERGY MANAGEMENT INC
26216 POTOMAC DR 7201 ROSECRANS AVENUE
MENIFEE, CA 92586 PARAMOUNT, CA 90723
Applicant Phone: 5629845511
ARMANDO FELIX License Number: 704414
RELIABLE ENERGY MANAGEMENT INC
7201 ROSECRANS AVENUE
PARAMOUNT, CA 90723
Fee Description Oft Amount
esi a toI a,er, ka g s 1 83 Q0
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
B`UiI ' PEhtT It ISs 2TR nc"c" had, ° a2L0
GREEN FEE 1 1.00
$260.00
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 Code and my license is in full fo ce and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class C icense N Lf who builds or improves thereon, and who contracts for the projects with a
Expires3 Signatur licensed contractor(s)pursuant to the Contractors State License Law).
3&7WORKERS'COMPENSATION DECLARATION
❑ lam 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 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
❑ 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.Ieginfo.cagov/caIaw.htmI.
permit is issued.My workers compensation insurance carrier and policy number are:
Carner5-ILLt2
Q0VAL0-TLNS. �a Property Owner or Authorized Agent Date
rv�l
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 rc,..
(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 it and county ordinances and state laws relating to building
construction. u o ze representatives of this city or county to enter the above-
identified❑ 1 certify that in the performance of the work for which this permit is issued, pr e r the inspection purposes.
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of Califomia, and agree that if I should become -
subject to the workers'compensation provisions of Secti 700 of the Labor property Owner or Authorized Agent D to
Code,I shall forthwith comply with those provisions ��
I 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, IOr/ES 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
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 B<ES 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
OWNER BUILDER DECLARATIONS PRINT NAME:�'hI N�(GL✓ 't
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 L�rr.a 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, ❑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 eyt-S 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($500).) HNARDOU9T�ON 25A 5 GPOR�ING D 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( )porting of the work, and the structure is PROPERTY O R AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,.Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
SAFETY • • APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER P (✓'OI 0115
TYPE: 0 COMMERCIAL `.✓RESIDENTIAL C MULTI-FAMILY �> MOBILE HOME 0 POOL/SPA ; SIGN
SUBTYPE: O ADDITION C)ALTERATION O DEMOLITION O ELECTRICAL Cl-MECHANICAL
ONEW t?'ISLUMBING ORE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESSl�Qy,Z/
ASSESSOR'S PARCEL NUMBER -J %b' d`yJ `'I� LOT �� TRACT
OWNER NAME I VYQluc f4k I
ADDRESS
PHONE __ JJ; EMAIL
APPLICANT NAME ar clC_J
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME j(� L OWNER BUILDER? "YES ONO
BUSINESS NAME
ADDRESS
PHONE Ir�Q,�� �Y'���� EMAIL
CONTRACTOR'S STATE LIC NUMBER __j()(44j4,/ LICENSE CLASSIFICATION
VALUATION$ 3�6np S L SO FT
APPLICANT'S SIGNATURE DATE l
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF M 1FEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP Q b�Q
INVOICE e (•D PAID AMOUNT
AMOUNT V 1CASH OCHECK# CeCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNTCASH ;;CHECK# iCREDITCARD VISA/MC
OWNER BUILDER VERIFIED i.%YES ") NO DL NUMBER NOTARIZED LETTER YES G NO
City of Menifee Building &Safety Department 29714 Houn Rd, Menifee, CA 92586 951-6 72-677 7
www.cityofinenifee.Lis Inspection Request Line 951-246-6213
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STATE OF CALIFORNIA �I
ALTERATIONS - HVAC auildl�tY of Menifee �1
CEC-CFIR-ALT-04-ERevised 06/14 g & CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE epf- CF1R-ALT-04-E
Alterations-HVAC CZ 2, and 8-15(formerly CF-IR-ALT-HVAC) 5201s (Page 1 of 1)
Site Address.
D embrIgment Agency: Date P epar d: r /�7
New Ducting,Plenums,Lineset: Con ition d '
Equipment Type Equipment Efficiency Required R-value Floor Area(sq ft) Thermostat
❑Packaged System ❑Evaporator Coil ��^FUE COP 11 R-6 (CZ 2,8-13)Ducting Served by system ❑Setback
Id Split System ❑Condensing.Unit ZI0* ❑R-8' (CZ 11,14,15)Ducting sgft (If not already
Rm Split ❑Compressor _SEER _HSPF ❑R-6(all CZ's)Plenums present,must
mace ❑ Lineset EER ❑R-5 or R7.5)Lineset° be installed)
❑TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form (lowed to be filled out by hand. For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site.
1.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
All Equipment, CF111-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R: MECH-01,MECH-20-HERS,MECH-(23 or 24)'-HERS,MECH-25-HERS'
Compressor,TXV,Lineset, CF3R: MECH-20-HERS,MECH-(23or24)-HERS2,MECH-25-HERS'
Air Handler/Furnace'(Can include new ducting)
Installer Requirement:Duct leakage(:c15%,or<10%to outside,or seal all accessible leaks),Air Flow Z 300 CFM/tan,Refrigerant Charge.
Exempted from duct leakage testing if:
111.Dud system registered with HERS provider as previously sealed,or 112.There is less than 40 linear feet of duct in unconditioned space,or
❑3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building
❑2.New HVAC System I Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts3 CFIR-ALT-02-E
including Mini Split CF2R: MECH-01,MECH-20-HERS,MECH-22-HERS,MECH-(23 or24)-HERS',MECH-25-HERS'
CF3R: MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS',MECH-25-HERS2
Mini Splits require CFIR-ALT-02-E,CF2R-MECH-01,and (CF2R-CF3R)MECH-25-HERS
Installer Requirement:Dud leakage<6%,Fan Efficacy(.58W/CFM),Air Flow_350 CFM/ton(or alternative),Refrigerant Charge
113.All New Duds with Replacement I Required Compliance Documents to be left on site for Final:
All New Ducts'and one or more of the following CFIR-ALT-02-E
replaced:Condenser Unit,Evaporator Coil, CF2R: MECH-01,MECH-20-HERS,MECH-(23 or 24)-HERS,MECH-25-HERS
Compressor,TXV,Lineset,Furnace' CF3R: MECH-20-HERS,MECH-(23 or 24)-HERS,MECH-25-HERS
Installer Requirement:Duct leakage<6%,Air Flow?.350 CFM/ton(or alternative),Refrigerant Charge
Exempted from duct leakage testing if:0 1. Existing duct systems are constructed,insulated or sealed with asbestos
❑4.New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts' CFIR-ALT-02-E,CF2R: MECH-20-HERS,CF3R: MECH-20-HERS
Installer Required to:Duct leakage(<15%or,<10%to outside or,or seal all accessible leaks)
❑ EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos.
1 All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls,between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24),or Refrigerant Charge verification MECH-25
3 All New Duds is when at least 75 percent of the duct system is new duct material,and up to 25 percent may consist of reused parts from the
dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,coil,plenums,duct material)
4 R-5(1"thick insulation)for linesets 1"and less. R-7.5(1.5"thick insulation)for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%",2.5-3T-W',3.5 to 4T-2Ya",ST-4Y4"
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts 1 and 6 of the California Code of Regulations(CCR).
4. That the energy features and performance specifications,materials,components,and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents,worksheets,cal? lati s,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
R bnsible Designer aroma Responsible Designer Signature: Date Si ed: License:
O
p n�: Address: 1 ity/State/Zip: Phone:
Ad ackaC1cF 1L 2 -SS/(
For assistance odqbestiods regarding the Energy Standards,contact the Energy Hotline at: -800-772-3300