PMT16-02543 City of Menifee Permit No.: PMT16-02543
29714 HAUN RD.
'�A_CCELX_> MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
OB/08/2016
PERMIT
Site Address: 27439 POTOMAC RD, MENIFEE, CA Parcel Number: 336-333-001
92586 Construction Cost: $7,200.00
Existing Use: Proposed Use:
Description of INSTALL NEW HVAC SYSTEM
Work:
Owner Contractor
GEORGETTE BROWN M&M AIR CONDITIONING INC
27439 POTOMAC DR 33812 ZEIDERS ROAD
MENIFEE,CA 92586 MENIFEE, CA 92584
Applicant Phone:9516726232
MITCH KOBZEFF License Number: 628341
M&M AIR CONDITIONING INC
33812 ZEIDERS ROAD
MENIFEE, CA 92584
Fee Description Qtvtr Amount($)
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_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects
With a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and D I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class 6'—X& Lien 2 -'3�/ By my signature below I acknowledge that,except for my personal residence
Expires 3a-alJl.bignatur 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
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑1 hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.Ieginfo.ca.Rov/calaw.htmI.permit is issued.
Po�licy# Date
.erf ave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which D By my signature below I certify to each of the following:I 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.I agree to comply
Carrier �/1J/C� //> with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# //o S'.? .23 Expires 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
D 1 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 CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts speciified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE Is D Yes
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,0(10),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 ❑Yes ci'No
I 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 boundary9f 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 requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&S ty Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardou ater' a rtin .
checkmark(s)I have placed next to the applicable items)(Section 7031.5 es ❑N Business and Professions Code).Any city or county that requires a permit to Date 2&--?0lf'
construct,alter,improve,demolish or repair any structure,prior to its Pllh RHORIZEDAGENT
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 EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 licensure 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($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as theirsole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
AIIIA1211iit
DATE /d PERMIT/PLAN CHECK NUMBER 6 7-
TYPE: O COMMERCIAL A- SIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 4/S72s/y
PROJECTADDRESS =27'139 &//-V �je v "( 269zT
ASSESSOR'S PARCEL NUMBER �j3 LE" 3'S3 - 00 LOT —1 ✓ TRACT 23 0"1e
' 2—
OWNERNAME B�dc✓/L7 �'csS/�1�,�,��e1
ADDRESS
PHONE �9�/��OIo—$�}�D EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES a Nn
BUSINESS NAME /� /✓! �#//L C4e✓Jly/On/�il/� /.y/L.
ADDRESS 3Ss�. Z�i��✓_s ��vi�nz�, �.lt. 9'2.��
PHONE 9/S% �,S 3 /�/D EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ X;7CIO Z;7e LSQFT
APPLICANT'S SIGNATURE DATE
l DEPARTMENT DISTRIBUTION 1 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 2 /.� PAIDAMOUNT
AMOUNT JZ�• ' V OCASH UCHECKH UCREDIT CARD VISA/MC
PLANCHECKFEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 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 l��lr1
ALTERATIONS - HVAC
CEC-CFiR-ALT-04E Revised 06/14 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: Enforcement Agency: Date Prepared: Permit#:
16,97-VtiFj G cSUn/ e. fW Gr�7
Equipment Type Equipment Efficiency New Ducting,Plenums,Lineset., Conditioned Thermostat
Required R-value Floor Area(sq ft)
❑Pa ged System 12 vaporator Coil 2'0' gFUE COP R-6 (CZ 2,8-13)Ducting Served by systemEr- etback
Split System ondensing Unit ❑R-8' (CZ 11,14,15)Ducting 1700 sgft
(!foot already
❑Mini Split ❑Compressor SEER HSPF ❑R-6(all CZ's)Plenums present;must
❑Furnace ❑Lineset /EER R-5 or R7.5)Uneset° be installed)
63-TXV
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. For final Inspection all farms are to be registered(no hand filled forms allowed)and a copy left on site.
AC Changeout/Repair Required Compliance Documents to be left on site for Final:
All Equipment, CFIR-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R: MECH-01,MECH-20-HERS,MECH-(23 or 24)'-HERS,MECH-25-HERS'
Compressor,TXV,Uneset, CF3R: MECH-20-HERS,MECH-(23 or 24)-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 2 300 CFM/ton,Refrigerant Charge.
Exempted from duct leakage testing if:
❑1.Duct system registered with HERS provider as previously sealed,or CI 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-HERS'
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 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 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,Uneset,Furnace' CF3R: MECH-20-HERS,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:Cl 1. Existing duct systems are constructed,insulated or sealed with asbestos
❑4.New Ducting over 40 feet Required Compliance Documents to be left an 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 L15%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.
'Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24),or Refrigerant Charge verlfication MECH-25
'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)
°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-2%',2.5-37--2Y",3.5 to 4T-2Y",ST-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 forthe 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 applica ' n.
Responsible Designer Name: Responsible 0 ig 5' a Date Signed: license:
I Y-/-1,6 -793YI
Company: Address. City/State/Zip: Phone:
11!/M,4i2 11/e �/s s q S" 6 lv
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300