PMT15-01764 City of Menifee Permit No.: PMT15-01764
29714 HAUN RD.
i�CCEL—A>, MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 0 612 5/2 01 5
PERMIT
Site Address: 29167 BLACKHILLS CIR, MENIFEE, CA Parcel Number: 339-461-003
92584 Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of REPLACING OUTDOOR A/C ONLY 5 TON
Work:
Owner Contractor
JEFFREY REILLY ATLAS H VA C INC
29167 BLACKHILLS CIR 16016 BABCOCK STREET#29
MENIFEE, CA 92584 SAN DIEGO, CA 92127
Applicant Phone: 8774528527
EVGENY LI License Number: 955327
ATLAS H V A C INC
16016 BABCOCK STREET#29
SAN DIEGO, CA 92127
Fee Description City Amount
Building Permit Issuance 1 27.00
$161.00
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 force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class C J-9 License No.__�rr Z who builds or improves thereon, and who contracts for the projects with a
Expires 2 Signature licensed contractor(s)pursuant to the Contractors State License Law).
IT-
WORKERS'COMPENSATION DECLARATION
❑ [am exempt from licensure under the ContraM "!ate 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 acknowlen^n r`�t, except for my pers,^ """in
compensation,issued by the Director of Industrial Relations as provided for by which I must have '.,,,,,ued fu: at least one year prior to completoi u,
Section 3700 of the Labor Code, for the performance of work for which this improvements --t ed It, this permit, I cannot legally sell a structure that I have
permit is issued. built a� .,,,uwner-owlding if it has not been constructed in its entirety by licensed
Policy# ountraN:- s, i understand that a copy of the applicable law, Section 7044 of the
❑ I have and will maintain workers' compensation insurance, as required by "lousiness 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,t/www.leuinfo.ca.ciov/calaw.htmi.
permit is issued.My workers'compensation insurance carder and policy number are:
Property Owner or Authorized Agent Date
Carrier
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 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 oomply
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-
,y11 I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes.
�Rall 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 Property Owner or Authorized Agent Dat
Code, I shall forthwith comply with those provisions.
_ // City Business License#
Date; OD� f Applicant; r✓L,-��- r�l.
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL D LARATION
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, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
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 PQNO 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 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, M 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 /-1YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any C 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($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation,will do( )all of or( )porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZEDAGEN
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year Of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
•F Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: _+ COMMERCIAL KRESIDENTIAL -) MULTI-FAMILY O MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: O ADDITION ALTERATION 0 DEMOLITION ,.' ELECTRICAL AMECHANICAL
NEW :% PLUMBING % RE-ROOF
APPLICATION NAME n /
DESCRIPTION OF WORK /'S IG atl
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 3 J� ' LAW'CD✓ LOT TRACT
OWNER NAME e/
ADDRESS Z
PHONE (_ZJ�� 51,P - ZZ f EMAIL
APPLICANT NAME q
ADDRESS od.�Z /1` I O Z
PHONE ��>7, } I/fZ �rU� EMAIL
CONTRACTOR'S NAME Ja4l,4C f e- OWNER BUILDER? O YES X NO
BUSINESS NAME r
ADDRESS 2 L./ 92 74-
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 9ST_T Z 7- LICENSE CLASSIFICATION C -
VALUATION$ _ .3 cen O SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE Z
CITY S_.., . Y
DEPARTMENT DISTRIBUTION CITY OF MENIFE USINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE SMIP l GREEN
INVOICE 6'V PAID AMOUNT
AMOUNT C%CASH 0CH ECKtt :CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH CHECK# C>CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO LICENSE NUMBER NOTARIZED LETTER ;Y YES NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFI R-ALT-04-E iRevised 06114 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE I y G enifee CF1R-ALT-04-E
Alterations-HVAC CZ 2,and 8-15(formerly CF-IR-ALT-HVAC) (Page 1 of 1)
Site Address: Enforcement Agency: Date Prepared: it
6 5- J
Equipment T e Equipment Efficient New Dustin , .�e�I- Conditioned
Type y Required R-value ' V Floor Area(sq ft) Thermostat
❑Packaged System ❑,J, Evaporator Coil AFUE COP R-6 (CZZ 8-13)Ducting Served by system ❑Setback
V-Split System 0 Condensing Unit ❑R-8' (CZ 11,14,15)Ducting 2f-� sgft (If not already
❑Mini Split ❑Compressor SEER HSPF ❑R- (all CZs)Plenums present,must
❑Furnace ❑ Lineset ' be installed)
TXV _EER ❑R-5 or R7.5)Lineset'
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. Forfinal 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, CF1R-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R: MECH-01,MECH-20-HERS,MECH-(23or24)'-HERS,MECH-25-HERS'
Compressor,TXV,Lineset, CF3R: MECH-20-HERS,MECH-(23 or 24)-HERS',MECH-25-HERS2
Air Handler/Furnace'(Can include new ducting)
Installer Requirement:Duct leakage L15%,or<10%to outside,or seal all accessible leaks),Air Flow z 300 CFM/ton;Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1.Duct 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 Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CF1R-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)-HERS2,MECH-25-HERS2
Mini Splits require CF1R-ALT-02-E,CF2R-MECH-01,and (CF2R-CF3R)MECH-25-HERS
Installer Requirement:Duct leakage<6%,Fan Efficacy(.58W/CFM),Air Flow a 350 CFM/ton(or alternative),Refrigerant Charge
❑3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts'and one or more of the following CF1R-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-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:1111. 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 Ductsa CF1R-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.
t 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 Iinesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2a%",2.5-3T-2Y..",3.5 to 4T-2W,5T-4Y."
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.
S. 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: Responsible Designer Signature: Date Signed: License:
v C.
4N` 2 d
Company: Address: City/State/Zip: a Phone:
ofn Yd
For assistance or questions regardin the Energy Standards,contact the Energy Hotline at:1-800772-3300