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PMT15-01696 I City of Menifee Permit No.: PMT16-01696 29714 HAUN RD. '.. MENIFEE, CA 92586 Type: Residential Mechanical W" , MENIFEE Date Issued: 06/18/2015 PERMIT Site Address: 27161 WENTWORTH DR, MENIFEE, CA Parcel Number: 336-062-005 92586 Construction Cost: $1,300.00 Existing Use: Proposed Use: Description of FAU CHANGE OUT, HEATER ONLY, 70,000 BTU, SAME LOCATION HALL CLOSET Work: Owner Contractor MARIA BARBA INTER-CITY ENERGY SYSTEMS INC 27161 WENTWORTH DR 12252 MC CANN DRIVE MENIFEE, CA 92586 SANTA FE SPRINGS, CA 90670 Applicant Phone: 5627771142 TERESA DINTERMAN License Number: 587709 INTER-CITY ENERGY SYSTEMS INC 12252 MC CANN DRIVE SANTA FE SPRINGS, CA 90670 Fee Description O_yt, Amount Building Permit Issuance 1 27.00 $177.00 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_Templatarpt 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 (r�"(, License No/ 5��7 _ who builds or improves thereon, and who contracts for the projects with a Expires �Jj9 to Signature ' -;f-.— 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 Cade, for the performance of work for which this improvements covered by this permit, cannot legally sell a structure that 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 �-7 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:/Iwww.leginfo.ca.gov/calaw.htmi. permit is issued.My workers'compensation Insurance carrier and policy number are: Carrier l,/�Co/i '"1^c. �,(,'ln%^--/ ✓uP Cam"""` Property Owner or Authorized Agent Date Expires �j // S'-- Policy# 0�C'�.�.��7..a ❑ 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- El I certify that in the performance of the work for which this permit is issued,I identifed prope -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 Code,I shall forthwith comply with those provisions., Property Owner or Authorized Agent Date `j City Business License# 03 6 Q Date; /7 /'j Applicant; l --�--�.7�— 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 HANDLE A HAZARDOUS MATERIAL OR DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE /MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES rYO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY ..7 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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name EYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS GUIDE LINES 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 EYES!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, O 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 EYES 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($500).) CODE, SECTION 25505 25533,AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIALF EPORTING. compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY O NER OR AUTHOR A T' not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's Stale License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). CITY OF MENIFEE PLCK No: 29714 Haun Road 15'01 b Date: Date: Menifee, CA 92586 (0 I� ig Phone: (951)672-6777 Amount: Amount 6D Fax:(951)679-3643 Ck#: Ck# Building Combination Permit To Be Completed BY Applicant Legal Description: Planning Case: gNumber Property Address: Assessor's Parcel U Floor#: Name: 4- P o�[e N - S Fax No. Property q r Owner V s n unit Number Zip Code Email Address: If sS N •r, ; 1_ Phone No. rat Fax No. Address: T -- Applicant tQ Unit Number Zip Code mail Adam= - - ---- 917� Name: Phone No. Fax No. e 1 L d - 7� - �07, Contractor Add 'ty ✓ ` Stat Zip Coda ! 7� 1ontrac4oYs Bustne 6 License o. Contractor's Ci rate of Coal omia Lioanse No. CIa55ificat(on:� Number of Squares: �l Square Footage De cription Wcork: r pet of Work.$ e f si 41 7o Soo b s �o� 1 HeC�Ldp Applicant's Signstu r Date: l> _ -TCBe Completeo 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: t set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo TechlSolls Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ® Mechanical Plan ❑ Title 24 Energy(on S'f,x 11) .I ❑ Foundation Plan ❑ Structural Calculations ❑ Cross Section ❑ Plumbing Plan ❑ Single Line dlagram for also.services over 400 ANIP ❑ Floor Plan ❑ SWcturalPmmingPlan&Details ❑ Shoring Plan ❑ SoundReport-Residential Class Code: Indicate New Cdnstwction Alteration" Addition' MeansiMethods Work Type. Repair' Retrofit' Ddsting Peradr Requlred? YES NO Proposed Building Use(s): I Existing Building Use(s): #Buildings: #Units: #Stories: Will the Building Have a Basement? Y of N Bldg.Code Occupancy Group Indicate Indir2te if YESdorN.0 Indicate al4 Geo-tech.Haz.Zane Bi Project Construction pnerethat apply1Completion: Type(s): C Of O YES 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 Pee.Vehicle Charger Landmark Seismic Retrofit spectai Casa:slag. dPical Ao hovel Expedite Prolect(s): Child Care City Project Green Building I I Landmark I Affordable Housing For Staff Use Only Suildingl5alely Permit Specialist Cily Planning I Civil Engineering I Mgmt Re�--w THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY STATE OF CALIFORNIA ALTERATIONS - HVAC 1 CEG-CFI R-ALT-04-E Revised M14 CALIFORNIA ENERGV COMMISSION CERTIFICATE OF COMPLIANCE CFSR-ALT-04-E Alterations-HVAC CZ 2,and 8-15(formerly CF-iR-ALT-HVAC) (Page 1 of I) Site Address:II Enforcement Agency:' y .G Date Prepared: Equipment Type Equipment fficiency New Ducting,Plenums,Lineset: Conditioned Required R-value - Floor Area(sq ft) Thermostat ❑Packaged System ❑Evaporator Coil Q ❑R-6 (CZ 2,8-13)Ducting Served b ❑Split System _ UrCondensing Unit `� FUE COP by system CSetback ❑R-9 (CZ I1,14,15)Ducting sqft (If not olreody I ❑Mini Split ❑Compressor _SEER HSPF ❑R-6(oil CZ's)Plenums present,must Furnace ❑Lineset �TXV _EER ❑R-5 or R7.51 Lineset" be instoiled) _ HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form is 2pvvffifo e i e and. For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site. k HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All pment, CFIR-ALT-02-E Condenser Unit,Evaporator Coil, CF2R: MECH-01,MECH-20-HERS,MECH-(23 or 242-HERS,MECH-25-HERS' Compressor,TXV,Lineset, CF3R: MECH-20-HER5,MECH-(23 or 24)-HERS2,MECH-25-HER52 Air Handler/Furnace2(Can include new ducting) Installer Requirement:Duct leakage(<15%,or<10%to outside,or seal all accessible leaks),Air Flow 2 300 CFM/ton,Refrigerant Charge. Exempted from duct leakage testing if: 0 1.Duct system registered with HERS provider as previously sealed,or 13 2.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_1 ❑2.New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CFIR-ALT-02-E including Mini Split CF2R: MECH-01,MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS2,MECH-25-HERS' CF3R: MECH-20-HER5,MECH-22-HERS,MECH-(23 or 24)-HERS2,MECH-25-HEW Mini Splits require CFIR-ALT-02-E,CF2R-MECH-01,and (CF2R-CF3R)MECH-25-HERS Installer Requirement:Duct leakage<6%,Fan Efficacy(.58W/CFM),Air Flow 2 350 CFM/ton(or alternative),Refrigerant Charge ❑3.All New Ducts 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,Furnace2 CF3R: MECH-20-HER5,MECH-(23 or24)-HERS,MECH-25-HERS Installer Requirement:Duct leakage<6°%,Air Flow 2 350 CFM/ton(or alternative),Refrigerant Charge Exempted from duct leakage testing if:❑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. '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 2 All New Ducts 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-2s/",2.5-3T-2'/.",-3.5 to 4T-27W%5T-4%" 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,calculations,plans and specifications submitted to the enforcement agency for approval with this building permit application. Responsible Designer Name: Respon' Designer Signature: t Date Signed: License: i -✓� 5V77�9 Company: Address: city/ /Zp pFone: rG' / l%7e 9 758�- 7 For ssistant5r qLf6stions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300 I CITY OF MENIFEE r Department of Building and Safety MENIF•EE - Contractor Declaration LICENSED CONTRACTORS DECLARATION: I hereby affirm under penalty of perjury that I am licensed under the provisions of Chapter 9 (connecting with Section 7000)of Division 3 of the Business and Professions code and my l-iiceennse is infull force and effect. License Class:_ if I License No: 1S Exp.Date Jy.; /4 Contractor: _TA 1W r-L4 C.NO US �r OWNER BUILDER DECLARATION: I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: (Sec 7031.5 Business and Professions code. Any City or County which requires a permit to construct,alter,improve, demolish or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(chapter 9[commencing with Section 7000] of Division 3 of the Business and Professions Code)or that he or she is exempt there from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars[$500.00]: 1,as the owner of the property,or my employees with wages as their sole compensation,will be the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions code: The Contractor License Law does not apply to the owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees, provided that such 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 he/she did not build or improve for the purpose of sale). ❑I,as owner of the property,am exclusively contracting with license contractors to construct the project(Sec.7044 Business and Professions Code: The Contractor License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)license pursuant to the Contractors License Law). ❑ I am exempt under Sec. B&P.C.for the reason Date: Owner: WORKERS COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a certificate of consent to self-Insure for worker compensation,as provided for by Section 370 of the Labor Code, for the performance of the work for which this permit is issued 1 have and will maintain workers compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and policy Number are: Carrier:�C���t'1taX ��N iP'L /-C L_y). Policy Number: d 3G3 3,31J7� (This section need not be completed if the permit is for one hundred dollars($100.00)or less. I certify that in the performance of the work for which this permit is issued,I shall not employ any person 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 Sec.3700 of the Lab/or Code,I shall forthw' comply with those provisions Date: V' / Applicant: WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SEC.3706 FOR THE LABOR CODE,INTERST,AND ATTORNEY FEES. CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction-lending agency for the performance of the work for which this permit is issued(Sec.3097,Civic C.). Lender's Name: Lender's Address: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify that I have read this application and state that the above information is correct. I agree to comply with all City ordinances and state laws relating to building construction,and hereby authorize representatives of the City to enter u on the above mentioned property for inspection purposes. X �✓tri! non lCi ntcL� /�—/ Signature of Applicant/Agent Print Applicant/Agent Name Date INSPECTION INFORMATION:Work may proceed only at the direction of the field inspector. To request an Inspection of work completed,call the number(951)672-4777. Inspection request must be called in the day before to assure next day inspections.