PMT15-01769 City of Menifee Permit No.: PMT15-01769
29714 HAUN RD.
j1r> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 06/2512015
PERMIT
Site Address: 29423 PEBBLE BEACH DR, MENIFEE, Parcel Number: 338-073-007
CA 92586 Construction Cost: $1,300.00
Existing Use: Proposed Use:
Description of FAU CHANGEOUT, HEATER ONLY, 70,000BTU, INSIDE CLOSET
Work:
Owner Contractor
GOLDIE BURRIS INTER-CITY ENERGY SYSTEMS INC
29423 PEBBLE BEACH 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 t3,ty Amount
o7ced,.. Igr_or Gravigp> Furna a pr Burner
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_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that 1 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 effe . Code:The Contractor's License Law does not apply to an owner of a property
License Class C01.) License No. �77� who builds or improves thereon, and who contracts for the projects with a
Expire/ Signature ✓ licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ 1 am exempt from icensure 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
permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have -
Policy# built as an owner-building if it has not been constructed in its entirety by licensed
/. contractors. I understand that a copy of the applicable law, Section 7044 of the
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 leglnfo ca oovlcalaw html.
permit is issued.\My workers'compensation insurance carrier and policy number are:
Carrier 14 GcLl`),cD UI-L _ Property Owner or Authorized Agent
Date
Expires q // /�� Policy#
Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property -
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 identified property for the inspection purposes,
shall not employ any persons f 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 Proner�Ow thorized A
Code,I�hall forth with those provisl - Y gent Date
�„ //,�.. City Business License# o_�cf ('
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, AYES OCCUPANT HANDLEA 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
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 THE3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
f FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address .�e�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 PRIMP NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed ❑YES 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 Slate 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 AYES 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 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505, 25533, AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING,
compensation, will do ( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZ AG TY
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or Improved for the
purpose of sale).
CITY OF MENIm•x:.E° PLCKNII n
29714 Haun Road
Data: �Date:
Menifee, CA 92586
Phone: (951)672-6777 Amount: Am n
W
Fax:(951)679-3843 Ck#1 ck#
Building Combination Permit
To Be Completed ByAppli�nt
Legal Oescnplion: Plannng Case: F: L: Rt: R:
Property Address: Assessor's Parcel Number.
o? C 1ZCa��r I '�� - 013 on
Proje t/Ienant ame: �D Y Unit#. Floor#:
Name: i r P ne No.� •G07 Fax No.
Property Ad re s n
Owner /6yY It Number I Zip Code /
Small Address:
- Phone No. Fax No.
IM
Applicant Address: ^ to Unit Number Z Code
dG p 917�
mailAddress:
Name: Plane No.
Contractor Atldr`e s• 'ty State Zip Gode
/ n
Cont2ctof'S Ci Bus n s dense O. Contractor's Ci tare of¢al'amie License No. Classincalion:�
Number of Squares:
Square Footage
Applicant'ccant' f Work: I at of Work:$ /3 O
r D DOD,�S IAC� aQ /hS'/
Signatu
Dale:
- --- `_ -- ToBe GPmpleted By:City Stafr Only- `- _ - :
Indicate As R•Recetved or NIA-Not Applicable
5 Completes sets of fully dimensioned.drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan 0 Goo Tech/gaits Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ® Mechanical Plan ❑ Tine 24 Energy(on 8'%x 11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan
❑ Single Line diagram for elec.services over 400 AMP
® Floor Plan [] Structural Framing Plan&Derek ❑ Shoring Plan ❑ Sound Report•Residential
Class rode: Indicate New Construction Alteration' Addition' MeanalMa[hcds
Work Type: Repair' Retrofit' Revislon to E'd---PemvY Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
V of N
Bldg.Code Occupancy Group Indicate Indicate it YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction spdnklered that apply: Coastal Zone
Completion: T e s
YP O Coro YES or NO Noise Zone
Required? 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 Else.Vehicle Charger Landmark Seismic Retrofit spedal Case:Bldg_
Offdal ravel
Expedite Project(s): Child Care _fly
Project Green Building Landmark AnaName Heusln9
For Staff Use Only
euildinglSalelyI Permit Specialist Cily Planning Civil Engineering EPWM•Admin Transpodaiion Mgmt. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
CITY OF MENIFEE
`` rt
Department of Building and Safety
ENIFE
Contractor Declaration
LICENSED CONTRACTORS DECLARATION: I hereby affirm under penalty of perjury that I ant licensed under the provisions of Chapter 9
(connecting with Section 7000)of Division 3 of the Business and Professions code and my license is infull force and effect.
License Class: e, /� License No:� �
Exp.patep�a" Contractor:_ i�-Fr
OWNER BUILDER DECLARATION: I hereby affirm under penalty of perjury that I am exempt from thactors 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 halshe did not build or improve for the purpose of sale).
1,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:
® 1 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
I 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 its issued. My Workers Compensation Insurance carrier and policy Number are:
Carrier:_/11g4 }h a,X aiy--'f-.Y.t �.� Policy Number:
(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 Labor Code,I shall forthwith comply with those provisions.
Date: 0 Applicant: sA— n
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
represseennt"soIves of the City to enter u on the above mentioned property for inspection purposes.
Signature o /pplieanUAgent print A licant/pp 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.
i n I c s,r.,nurvnrvw
-yT-
ALTERATIONS - HVAC q)'
CEC-CFIR-ALT-04-E Revised 06174 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-04-E
Alterations-HVAC CZ 2,and 8-15(formerly CF-IR-ALT-HVAC) (Page 1 of 1)
Site Address; ,t r G Enforcement Agency:�' v .G Dpjpf red; r 't -
Equipment Type Equipment Efficiency
New Ducting,Plenums,Linesret. Conditioned
Required R-value - Floor Area(sq ft) Thermostat
❑Packaged System ❑Evaporator Coil �y�Q" ❑R-6 CZ2,8-13 Dustin
❑split System GCondensing Unit y FUE COP ( 1 g Served by system Setback
❑R-8 /CZ Il,14,15)Ducting s (If not already
}❑Mini Split ❑Compressor _SEER HSPF ❑R-6(all CZ's)Plenums qft present,must
Furnace ❑Lineset
0 TXV _EER ❑R-5 or R7.5)Lineset" be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is al o e f e o and. For final inspection all farms are to be registered(no hand filled forms allowed)and a copy left on site.
VAC Changeout/Repair Required Compliance Documents to be left on site for Final:
AI ment, CFSR-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-(23 or24)-HERS,MECH-25-HERS'
Air Handler/Furnace'(Can include new ducting)
Installer Requirement:Duct leakage(<15%,or<10%to outside,or seal all accessible leaks),Air Flow a 300 CFM/ton,Refrigerant Charge.
Exempted from duct leakage testing if:
❑1.Duct system registered with HERS provider as previously sealed,or 0 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
❑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)-HERS',MECH-25-HERS'
CF3R: MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS',MECH-25-HERSt
Mini Splits require CFiR-ALT-02-E,CF2R-MECH-01,and (CFIR-CF3R)MECH-25-HERS
Installer Requirement:Duct leakage<6%,Fan EfOcacy(.58w/CFM),Air Flow_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 CFIR-ALT-02-E
replaced:Condenser Unit,Evaporator Coil, CF2R: MECH-01,MECH-20-HER5,MECH-(23 or 24)-HERS,MECH-25-HERS
Compressor,TXV,Lineset,Furnace' CF3R: MECH-ZO-HERS,MECH-(23 or 24)-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:01. Existing duct systems are constructed,insulated or sealed with asbestos
❑4.New Ducting over 40 feet Required Compliance Documents to he left on site for Final:
New ducting but less than All New Ducts' I 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 it installed and R-6 when less than 40 ft installed. This includes in walls,between floors etc.
3 Heating only systems and Air Handfer/Fumace changes do not require Air Flow MECH-(23 or 24),or Refrigerant Charge verification MECH-25
3 All New Ducts is when at Ieast.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)
`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-25%",2.5-3T-23/.",3.5 to 4T-2Y..",ST-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.
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' D¢Sign¢r Signature: t Date Signed:110 I B a ,�z License, 77v 17
Company: Address: 'city/ a 1 i G phone
rL. 117S17.aeloo �'/ 0) 7e 9- 75-j- §V 7 S
-800-772-3300
For ssistan r q stions regarding the Energy Standards,contact the Energy Hotline at:5