PMT16-01980 City of Menifee Permit No.: PMT16-01980
29714 HAUN RD.
�CCEL/� MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
06/2712016
PERMIT
Site Address: 27630 CAMDEN WAY, MENIFEE, CA Parcel Number: 335-232-022
92586 Construction Cost: $11,720.00
Existing Use: Proposed Use:
Description of REPLACE HEAT PUMP, CENTRAL AIR CONDITIONING SYSTEM
Work:
Owner Contractor
DAVID KEUBLER HUSH AIR
27630 CAMDEN WAY 7899 MISSION GROVE PRKWY
MENIFEE, CA 92586 STE. D
Applicant Phone: 9517894148 -
DARREN HUSHER License Number:630899
HUSH AIR
7899 MISSION GROVE PRKWY
STE. D
RIVERSIDE, CA 92508
Fee Description Ply Amount Ibl
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 14.10
$324.10
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_Perrnit_Template.rpt Page 1 of 1
CITY OF MENIFEE
ENSED DECLARATION property who builds or Improves thereon,and who contracts forthe projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
1 hereby affirm under penalty of perjury that 1 am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. 7hc the following reason:
License Class `LJ./ License No. V By my signature below 1 acknowledge that,except for my personal residence
Expire 10-31-20t7signature � in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
W KER'S COMPENSATION DECLARA 1L1N
have built as an owner-builder if it has not been constructed in its entirety by
o hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
ve and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Code,is available upon request when
ompensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following webshe:
y Section 3700 of the Labor Cade,for the performance of work for which www.leainfo.ca.zov/calaw.html.
this permit is issued.
Policy p Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑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 ❑By my signature below I certify to each of the following:)am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.1 agree to comply
���fC,.� yard -ru-g r with all applicable city and county ordinances and state laws relating to
Carder building construction.I authorize representatives of this city or county to
PolicyN �/E7� ��Expires_ ��0���7 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the ITY BUSINESS LICENSE q
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
su c the workers compensation ovisions of Section 3700 of the Labor
ode,I r cam a provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Ap leant Date amounts specified on the Hazardous Materials Information Guide?
WARM :FAILURE TO ECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes Po
UNIA FUL,AND LLSUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND SUP TOONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY Dyes ANo
hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes ❑'"
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist I understand my equirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
California Health&Safety C e on 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the
hazardous ortin .
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 0
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PR ERTYOWNEROR AORIZED AGENT
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 Contractors State PA RENOVATID ,REPAIR AND PAINTING(RRPI
License law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from Iicensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
o I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure Is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.if,however,the building or improvement is sold within one year of Firm Certification No:
completion,the Owner-Builder will have the burden of proving that it was
not built or Improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
01,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
,Menifee
DATE [ PERMIT/PLAN CHECK NUMBER Dl $V
TYPE: O COMMERCIAL R6,RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION 1;<ALTERATION O DEMOUTION O ELECTRICAL <MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES //���J
DESCRIPTION
,1OF'WORK &CL Q/ AL✓
PROJECTADDRESS - m&A 1
v
ASSESSOR'S PAR L
PARCEL�NUMBER 335-a3a'f�a' LOT �� TRACT
OWNER NAME ^7ICt� a-e-b Lev, /7 (�,-��-�/
ADDRESS Lr0 0j�Cde-n � '"'� vi C4 - YG'�c��.O,,�Jd
PHONE �-ts�-2 � -[725 - EMAIL D� lv4a - Ccvn
APPLICANT NAME
I - �� C (� y�
ADDRESS [//O}��Z--'��Z �L�CpG��SziC,* te-re R� I�,,/ / �'�10C C4
PHONE �['-2 7 L T�4 a EMAIL / a5,h Q[ice U C041
CONTRACTOR'S NAME , I uS (f CZ OWNER BUILDER? O YES O NO
BUSINESS NAME `
ADDRESS 7�y l 7 L? Ait,3,'j`l�`/
PHONE —LJ[- lIl `7 �`C EMAIL
CONTRACTOR'S STATE LICCNUMBER 6:368 9 LICENSE CLASSIFICATION
LI
VALUATION$ (c Q SO FT � � L SO FT
APPLICANT'S SIGNATURE DATE
C17Y STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS ULENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I $MIP
INVOICE O PAID AMOUNT
AMOUNT OCASH O CHECK# GCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK It OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
STATE OF CALIFORNIA
City of Menifee ° r
9 :_
t +.(J� " e-(./r {. Building & Safety Dept.
F. I�(F�( CAI FORNIA ENERGY COINJISSIOPI
CEC-CFI z-ALT.04-E IRensed 0"-.114i CFIR-ALT-04-E
CERTIFICATE OF COMPLIANCE JUN 2 (page 1 of 1)
Alterations HVAC CZ 2 and 8 15(formerly CF 1R ALT HVAC) CLIMATE)MATE ZONE (O I
Site Address: ^^ afo ement egn;Y; -+r ; Datg Pr21 I .{ill t
�V 11 t Wlwl i-G(L no
1 Nz:•r Ducting,Plenums,Cinese[: Conditionzd Thermostat
Equipment Type Equipment Efficiency I Required R-value Floor Area(sq ft) I I
Setback
(,packaged System ❑Evaporator Coil AFUE COP R-6 (Q Z,8-23)Ducting Served by system (if not already
U split System I ❑Condensing Unit ( P�, i Cl F.-8' (C7 11,1-,15)Ducting sgft Present,must
❑Mini Split ❑Compressor SEER t =I—iSpF 113 R-S(all Q's)Plenums be installed)
❑Furnace_ ❑Uneset i t 3__b EER 0R-5 or R7.5)Uneset'
El )
TXV I
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application eft on sithis
form is allowed to be filled out by hand. Far Prnal inspection all forms are to be r egistered(no hand Riled forms aJlawed)and a cagy
it 1.HVAC Changeout/Repair I Required Compliance Documents to be left on site for Final:
All Equipment, CF1R-AL71-02-E
Condenser Unit,Evaporator Coil, CF2R: MECH-01,MECH-20-HERS,MECH-(23 or 24)=-4ERS,MECH-25-HERS'
Compressor,TXV,Uneset, CF3R: MECH-20-HERS,MECH-123 or24}HERS=,MECH-25-HERS=
Air Handler/Furnace include new ducting)
Installer Requirement:Duct leakage(�15%,or<10:S to outside,or seal all accessihle leaks},Air Flow t3O0 CFMlton.Refrigerant Charge.
Exempted from duct leakage testing if:
❑1.Duct system regist=_red with HERS provider as previously sealed,or❑2.There is less than 401inear feet of duct in unconditioned space,or
0 3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building I
❑2.New HVAC System Required Compliance Documents to be left on sitefor Final:
All new equipment and All New Ducts' I CF1R-ALT-02-E
4 CF3R: NiECH-Ol N1EQt-20-HERS,MECH-22-:dERS,MECH-(23 car 24)•HERS=.tv7ECH-25-HERS
Including Mini Split ,
CF3R: MECH-2O-HERS,IVIECH722-HERS,MECH-(23 or 24)-HERS',MECH-25-HERS'
Minl Splits require CF1R-ALT-02-E,CF2R-MECH-0l,and (CF2R-CF3R)MECH-25-HERS
Installer Requirement Duct leakage<6%,Fan Efficacy(.SSW/CFi'4),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 CF1R-ALT-02-E
replaced:Condenser Unit,Evaporator Coil, CF2R: MECH-01,MECH-20-HER5,MECH-(23 or 24)-HERS,MECH-25-HERS
Compressor,TXV,Uneset,Furnaces
CF30.: MECH-20-HERS,MECH-(23 or 24)-HERS,MECH-25-HERS
p Installer Requirement:Duct leakage<'095,Air FIZw!:350 CFM/ton(or alternative),Refrigerant Charge
I Exempted from duct leakage testing if:Cl 1. Existing duct systems are constructed,insulated or sealed with asbestos i
Cl4.New Ducking over 40 feet Required Complianca Documents to be left on site for Final:
New ducting but less than All New Ducts' CF1R-ACT-02-E,CF2R: tv7ECH-20-HERS,CF3R: MECH-20-HERS
_ installer Required to:Duct leakage(<1595 or,<10`ro 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-oft installed. This include in walls,bet:veen floors etc.
'Heating only systems and Air Handler/Furnace changes do not require Air Floe:MECH.(23 or 24),or Refrigerant Charge verification MECH-25
'All New Ducts is when at least 75 percent of the ductsystem is new duct material,and up to 25 percent may consist of reused parts fromthe
dwelling unit's existing duct system[a.,-_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. Nlost Mfg will require Suction line Diameter
with insulation as the following 1.S-2T-2%.",2.5-3T-214",3.5 to 4T-2-r_",5T-4/"
Contractor(Documentation Author's/2esponsible Desi;;tter's Declaration Statement)
I certify the following under penalty of perjury,under the laws of the State or California:
1. The information provided on this Certificate of Compliance is true and correct
2. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility far 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 Tide 24,Parts 2 and 6 of the California Code of Regulations(CCR).
4. That the energyfeatures 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 ofTtle 24,Part 1 and Part 6 of the CCR.
S. The building design features or system design features identified on'his Certificate of Compliance are consistent with the information
provided on other applicable compliance documents,worksheets,cal ulations,plans and specifications submitted to the enforcement
agency for approvai:with this building permitappi I oaresigned: uspy C,rS
aes sihte oesYprsn`e`r of R •-� a esr
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?ddrw- OR •altop: L,V P'nanpe�fr-,r+'
cpmvaav: W� / r 19- /o l� r.� l&iC'w( r 4 *D `-lJ
assistance or questions regarding the Energy Standards,contact a Energy Hotline at:1-800-772.9300