PMT15-03734 City of Menifee Permit No.: PMT16-03734
29714 HAUN RD. Type: Residential Mechanical
4 ACCEL/_> MENIFEE, CA 92586
MENIFEE Date Issued: 1 210 212 01 5
PERMIT
Site Address: 26724 OAKMONT DR, MENIFEE,CA Parcel Number: 337-371-001
92586 Construction Cost: $1.300.00
Existing Use: Proposed Use:
Description of FAU CHANGE OUT, FAU ONLY 90,000 BTU'S LOCATED IN HALL
Work:
Owner Contractor
DELORES SCHULTZ INTER-CITY ENERGY SYSTEMS INC
26724 OAKMONT DR 1175 N DEL PLACE
MENIFEE,CA 92586 ONTARIO, CA 91764
Applicant Phone: 9097585075
TERESA DINTERMAN License Number:587709
INTER-CITY ENERGY SYSTEMS INC
1175 N DEL PLACE
ONTARIO, CA 91764
Fee Description O�(t Amount
Forced-Air or Gravity-Type Fumace or Burner 1 149.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 7.45
$184.45
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 ❑ lam exempt from licensure under the Contractors'Stale License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of fallowing reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence it
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion o
License Cl`` //ass P_ k) License No. LO improvements covered by this permit, I cannot legally sell a structure that I have
Expires 11 lli�- Signature Zbuilt as an owner-building If it has not been constructed in its entirety by licensee
contractors. I understand that a copy of the applicable law,Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application ie
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: httol/wvnv.leainfo.ca.aov/calaw.html.
I have and will maintain a certificate of consent of self-insurefor workers'
compensation,Issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner orAuthodzed Agent
Policy# ❑ By my Signature below, I certify to each of the following: 1 am the propeM
❑ have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read thil
ection 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct I agree to compll
permit is Issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildinc
construction.I authorize representatives of this city or county to enter the above
Carrier 7A4 1`G t, f1W,_a t�7 efoA_--- Identified prope for the inspection urposes.
d r 7te //, /' 2—z-�
Policy# u1GU2 DJ(, Expires 2/ ` � e Prop
, �— Date s
erty Owner orAuthorized Agent
(This section need not be completed if the permit is for City Business License# (e
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ 1 certify that in the performance of the work for which this permit is issued,1
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts speow on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those p% OYES
Applicant; Date, : 7�_ Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelin
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of�1hool?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist. I understand my requirements under the State of
agency for the performance of the work which this permit is issued(Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 CMI Code) hazardous mate al reporting.
OWNER BUILDER DECLARATIONS DYES
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 PROP OWNER OR AUTHORIZED AGENT
next to the applicable ftem(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION.REPAIR AND PAINTING(RRPI
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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firths and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
Violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the palnt-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPKs Renovation Program visit:
ro www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 1-SOD.424-LEAD(6323).
compensation,will do( )all of or( )porting of the work, and the structure Is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not Intended or offered for sale.If,however, Certified Firm Name:
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 Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
29714 Haun Road = ,
Oate: pate:I /
Men(fee, CA 92586
Phone: (951)672-6777 Amount: Amoun� g
Fax:(951)679-3843 ckn: ck#
Building Combination Permit
'ro Be Completed ByApplicant
Legal saipaon: O ,L Plann ng Case: F: L:
Proper'y Add : T Assessors Parcel Number.
0 t L t-�� 3 - t0 6 1—
ProjecuTanantName: Unit# Floor#:
Name: P one No. � - / Fax No.
Property LLSch WD
Owner Atl ress: C, Unit Number Zap Cotle
7 � � fir. S
EmallAtldress:
N r, Phone No. - 0-7 Fax No.
Address:
Applicant : i st . Unit Number ZPCode
412-5- Q�/ o 917�
Email Address: -
Name: Phone No. ax No.
y 2 L P ✓Y2 -1 Y C_ U - 7� �$���
Contractor Addres • 'ty Stat Zip Code ` 76
/ n L r
Conrrecmr's C u�ne§s License o" Conbac[or's d tale or gar role Llnense No. Claselacaaoic�
��ll
Number of Squares: !J
Square Footage
Description of Work: ''// �R_ /' Cost of Work:$
K t�'/(i 1 7'�i� (7,UO U CS/Z/s �h ��(,� � � O
Applicarirs Signature _ pate:
Z - z -/ J
-.. T.q Be Completed By"City Staff Only 1
Indicate As R-Recewed or WA-NotAppiicable
5 Completes sets of fully dimensioned.dravm to sale plans which include: l set of documentswhich include
❑ Title Sheet ❑ Elevations ❑ Etectrical Plan I ❑ Geo TechlSolls Report(on cd only)
❑ Plot/Site Plan [I Roof Plan ❑ Mechanical Plan 1 ❑ Title 24 Energy(on 8'h x 11)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for elec.services over400 AMP
❑ Floor Plan ❑ SNidurai Forming Plan✓£Delds ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Miami! n` Addition' MeanslMethods
Work Type. Repair Retrofit' ReM5lon to Etsfing PerrM'Requkedl YES NO
Proposed Building Use(s): Existing Bulling Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate if YES orNO Indicate alt Geo-leeh.Haz.Zone
At Project Construction Sprinklered thatapply: Coastal Zane
Completion: Type(s): Coto Noted Zone
Required? YES or NO 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 Elec.Vehicle Charger Landmark Seismic Retrofi Oamalt spade' vdl
Case: l
Expedite Project(s): Child Care City Project Green Building I I Landmark Affordable Housing
For Staff Use Only
6uiidinq/SolelyI Permit Specialist I Transportation M, ftenl Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
CITY OF MENIFEE
Department of Building and Safety
MENI1.. ---,EI
'7 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 license its In full force and effect.
License Class:- e -1.D License No:
Exp.Date_/a 19 JD/lO Contractor:2nf,2✓'�, '�-NN4u
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[$500.00]:
❑I,as the owner of the property,or my employees with wages as their sole compensation,will be the work,and the structure Is not Intended
or offered for sale(Sec.7044,Business and Professions code: The Contractor License Law does not apply to the owner of property who
builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such
improvements are not intended or offered for sale. If,however,the building or improvement is sold within one year of completion,the
owner-builder will have the burden of proving that he/she did not build or Improve for the purpose of sale).
❑I,as owner of the property,am exclusively contracting with license contractors to construct the project(Sec.7044 Business and
Professions Code: The Contractor License Law does not apply to an owner of property who builds or improves thereon,and who
contracts for such projects with a contractor(s)license pursuant to the Contractors License Law).
❑ I am exempt under Sec. .B$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
WI 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: �/ (0 Carrier: �.L lei ffLi-icLu'l r,' 5 4). Policy Number: 0 d3,0 VG Q6)
(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: L 2 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 upon the above mentioned property for inspection purposes.
Signature of Applicant/Agent Print ApplicantlAgent 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.
STATE OF CALIFORNIA �
ALTERATIONS - HVAC
CEC-CFIR-ALT-04-E Revised 06f14 Clty Of MBrIIlee CAUFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE ul Ing CFSR-ALT-04-E
Alterations-HVAC CZ 2,and 8-1S(formerly CF-iR-ALT-HVAC) (Page 1 of 1)
Site Address• ^ C Enforcemen Date Prepared: - �
Z�1 r Y1
New Ducting,Plenums,Lineset: Conditioned
Equipment Type Equipment Efficiency Required R-value Floor Area sq ft) Thermostat
❑Packaged System ❑Evaporator Coil 7S9 COP R-6 (CZ2,8-13)Ducting Served by system Setback
❑Split System _ [],Condensing Unit ❑R-8' (CZ 11,14,15)Ducting sqf[ (if not already
❑Mini Split ❑Compressor _SEER HSPF ❑R-6(all Q's)Plenums present,must
Furnace ❑Lineset be installed
0 _EER ❑R-5 or R7.SJ LlneseN )
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is 9,J10 to a fi e o and. For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site.
10"VAC ChangeoutJRepair Required Compliance Documents to be left on site for Final:
All ment, CF1R-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R: MECH-01,MECH-20-HERS,MECH-(23 or 24)2-HERS,MECH-25-HERS'
Compressor,TXV,Lineset, CF3R: MECH-20-HERS,MECH-(23or24)-HERS2,MECH-25-HER52
Air Handler/Furnace'(Can include new ducting)
Installer Requirement:Duct leakage(<15%,or<10%to outside,or seat all accessible leaks),Air Flow-300 CFM/ton,Refrigerant Charge.
Exempted from duct leakage testing if:
❑1.Duct system registered with HERS provider as previously sealed,or❑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
112.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 or 24)-HERS2,MECH-25-HERS'
CF3R: MECH-20-HERS,MECH-22-HERS,MECH-(23 or24)-HERS2,MECH-25-HERS2
Mini Splits require CF111-ALT-02-E,CF2R-MECH-01,and (CF2R-CF3R)MECH-25-HERS
Installer Requirement:Duct leakage<6%,Fan Efficacy(.58W/CFM),Air Flow_350 CFM/ton for alternative),Refrigerant Charge
❑3.All New Ducts with Replacement Required Compliance Documents to he left on site for Final:
All New Ducts'and one or more of the following CFSR-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,FurnacO CF3R: MECH-20-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:111. 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' CF1R-ALT-02-E,CF2R: MECH-20-HERS,CF3R: MECH-20-HERS
Installer Required to:Duct leakage(<15%or,c 10%to outside or,or seai 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 Handier/Furnace changes do not require Air Flow MECH-(23 or 24),or Refrigerant Charge verification MECH-25
a All New Ducts is when at Ieast7S 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.S-2T-2%d',2.5-3T-2YV,3.5 to 4T-2w',ST4%"
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 OesignerN 1m/ Respn Designersignature: t Date S(pred: License:
a-� SV 27o9
Como.rrv: address: �oty a:- vbene:
�.2e 2"` G'/ 6L r,.9 lc?r7C 15
For ssistand�5r q scions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300