PMT16-02914 City of Menifee Permit No.: PMT16-02914
29714 HAUN RD. Type: Residential Mechanical
MENIFEE,CA 92586
MENIFEE Date Issued: 09101/2016
P E R M I T
Site Address: 25681 DORVAL CT, MENIFEE, CA 92587 Parcel Number: 339-304-005
Construction Cost: $2,500.00
Existing Use: Proposed Use:
Description of REPLACE EVAP COIL IN CLOSET
Work;
Owner Contractor
ROBERT GIVENS BEAR CREEK HEATING AND AIR CONDITIONING
25681 DORVAL COURT INC
M ENIFEE, CA 92587 24069 CHATENAY LANE
Applicant Phone:9516002882
BARRY DUNGAN License Number: 779461
BEAR CREEK HEATING AND AIR CONDITIONING INC
24069 CHATENAY LANE
MURRIETA, CA 92562
Fee Description Oty Amount
Air Handling/Condensing Units SFIR 1 133.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 6.65
$167.65
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifimlions or from preventing builicling operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Mentfee, 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 BIdgPe"it-Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts ficurthe projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractor's State license Law for
Professions Code and my license is in full force and effect. the following reason:
License Class a No. L By my signature below I acknowledge that,except for my personal residence
Explres3:731 Signature in which I must have resided for at least one yea r prior to completion of
improvements covered by this permit.I cannot lega Ily sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
ri I 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 worker's 7044 of the Business and Professions Code,is available upon request when
compensatlon,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 wwwJegInfi:.ca.gov/caIaw.htmL
this permit is issued.
Policy# PROPERTY OWN ER OR AUTHORIZED AGENT Date
o I have and will maintain workees compensation insurance,as required by
section 3700 of the La bor Code,for the performance of the work for which a By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
n umber are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances a nd state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires enter the above ide ed property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PRd-PERTY OWNEI OR AUTHORIZED AGENT
AS certify that in the performance of the work for which this permit is issued,
Ishallnotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I sh9TI Tb ial or a
_1thwith comply with those provisions. Will the applicant or future building occupant handle hazardous mater
amounts specified on the Hazardous Materials Information Guide?
Applicant Date_ mixture containing a hazardous material equal to or greater that the
I
AARNING.FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes oNo
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applimnt or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),1 N 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 forguldelines
CONSTRUCTION LENDING AGENCY in Yes o No
I hereby affirm that under the penalty of perjury them 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) c:Yes oft
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&Safety Code,Section 25505 and 25534 concerning
Contractoes License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ciYes o No
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 PROPERTY OWNER OR AUTHORIZED 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING JRRP)
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
a nd the basis for th e alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
a n Applicant for a permit subjects th e 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
a 1,as owner of the property,or my employee with wages as their sole employees.For mom information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.Roy/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 Contractor's State license Law does not apply to an owner of a a 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 offemd 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. a No EPA Lead-Saft Certified Firm is required for this project bemuse:
ci 1,as owner of the property a m exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Low does not apply to an owner of a If Your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
Men if ee
DATE PERM IT/PLAN CHECK NUMBER
TYPE: C)COMMERCIAL /RESIDENTIAL C) MULTI-FAMILY OMOBILEHOME OPOOL/SPA CSIGN
SUBTYPE: CADDITION OALTERATION CIDEMOLITION OELECTRICAL CIVIECHANICAL
ONEW OPLUMBING Q RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK j
��Y Menifee
"rely uept.
PROJECT ADDRESS SEP 01 2016
ASSESSOR'S PARCEL NUMBER ��- 2;04-005 LOT TRAcReceivea
OWNER NAME (,,%VC*j)S
ADDRESS PQ Qv-
n,p
PHONE EMAIL
APPLICANT NAME
\j
ADDRESS �2N(I-tt-Pt ��j MXXTIO�\ CN
PHONE q!Tj—(M-ZWZ EMAIL
CONTRACTOR'S NAME OWNERBUILDER? CYES/NO
BUSINESSNAME QM��X
ADDRESS o,% g-�-
PHONE CjSj-- EMAIL
CONTRACTOR'S STATE LIC NUMBER -7--7q\-k LICENSE CLASSIFICATION
VALUATION $ L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFFUS EO NLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING EN GINEERING FIRE � GREEN SMIP
INVOICE
AMOUNT PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
Yinu - Oa?1ILk
CERTIFICATE OF COMPUANCE CF1R-AVF-02-E
Alterations to Spam Conditioning Systems(formerly CF-IR-ALT.HVAC) (Page I of 3)
Project Name: Givens I Date Prepared: 20164M-30
A.General Information
CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,
use one CF1R-ALT-02 document for each dwelling unit.
01 Project Name Givens 02 Date Prepared 2016-08-30
03 Project Location 25691 Dorval Ct 04 BuIldingType Single famli Wnlee,
01ty
L--2
05 CA City Menifee 06 Dwelling Unit Name GivensBUilding e, a
07 Zip Code 92584 08 Dwelling Unit Conditioned
Floor Area(ftZ) 1098 S;:p n1 2016
Number of space conditioning
og aimate Zone 10 10 (SC)systems in this dwelling I
unit. Received
13.Space Conditioning(SC)System Information
01 02 03 04 (IS 06 07 08 09 10
Is the SC installing a
SC System SC system CRA served system a refrigerant Installing new SC installing installing Installing
Identification or Location or Area by this sc ducted containing system morethan4O entirelynew enthelynew
Name served System jft2) System? component? components? feet of ducts? duct system? SC system? AfterarthanType
System 1 entire home 1098 Yes Yes Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(SectIcm1S0.2(b)1DPb)
This section does not apply to this project.
Registration Number:216-AO323747A-000000DOD-0000 Registration Oatefl-ime: 201MB�3015:37:55 HERS ProMder.QICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 RepartGenenned:2016-08-30 25.-38-,08
Schema Version:0.555SDD
CER11FICATE OF COMPLIANCE CFIR-AtT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 2 of 3)
D.Altered Space Conditioning System(Sections ISO.2(b)IE and F)
01 02 03 Go 05 06 07 09 09 10 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required Nifty or
Identification System Heating Efficiency Efficiency Cooling Coaling Efficiency Efficiency Thermostat Replaced New Duct
orName Type Components Type Value System Type Components Type Value Type Duct Length R-Value
Centralgas No heating This field or This field or This field or This field or
System I Central split 13 Setback section Is not section is not
furnace component Section Is not section Is not AC Indoorcoil SEER
altered applicable applicable applicable applicable
RemulmdDocumentabsit;
CRIL-NICI-Space Conciftloaln,Systems Ducts and Fans
-Duct Insulation requirement for new Plenums:Fig.
CHR-WICH-20-H Is U31t-MICH-20,11-Dud I-eakne hall matured when heating or cooling components am installed In ductme!inefteares,or when mom than W It of dud length is replaced.
.l.ollogs.rate compli.n.:s 5%,or s 10%leakage to outaide,or sea]all accessible leaks.
CRII-MCH-25-H&MRWCH-�H Refrigerant Charge Varification required when reffigerent containing components am Installed or altered(applimbit,In a 2,8.15).
U211CF311-AACH-23 8,U31t-MCH-41 Mr Flow�30)UNI/ton required when MO-25 Is required.
Exc,DIWr,:
�Duut syshams�reglumeres!win HEM mander,as previously sealed am earimpt from MM-20 Dud Leake Tems,reqWrenvents.
�Heatlng.only systems and Ar Handler/Fumace changes do not re,uire verificulan of Mr Flow MCH-B,or Refrigerant charge MECH-25.
-Eauth,duct systems constandled,insulated or seakel with astmoms am suarrWrom MCW20 Dud Leakage Testing riaulnerrients.
E.Entirely New or Complete Replacement Duct System,with or without Equipment Changeourt(Sections 150.2(b)ID!ia and 150.21b)IE,F)
This section does not apply to this project.
F.Entirely New or Complete Replacement Space Conditioning System(Section 150.2(b)IC)
This section does not apply to this pmlect.
Registration Number.216.AO323747A-000000000-0000 Registration Dame/Turne: 20164W30 1&.37:55 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rea,L008 Report Genemted:2016-08-30 15:38:08
Schema Version:0.555SDD
CERTIFICATIECIF OMPLIANCE CFIR-ALT-02-E
Alterations to Spam Conditioning Systems(formerly CF-lR-ALT-HVAC) (Page 3 of 3
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature!
Dungan,Barry VA��
Company: Signature Data�
Bear Creek Heating and Air Conditioning Inc 2016-08-30 15:37:55
Address; CW HEM certification Identification(if applicable):
24069 Chatenary Lane
OW/Statemp; Phone:
Murrieta CA 92562 951-600-2882
Responsible Person's Declaration statement
I tertify the following under penalty OF Perjury,under the laws of the State of California:
1. The Information provided on this Certificate Off Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Profiesuons Code to accept responsibility for the building design Or system design identified on this Certificate of Compliance(rearacruible doilimarl.
3. �hat the energy features and performance specifications,materials,components,and manufactured deiiicer for the building design or system design identified on this Cartificalue ofCompliance confician to due
requirementoof role 24,Pan I and Pan 6 of the California Code of Regulation,.
4. Inse building design features or system design features identified on this Certificate of Compliance are consistent with the information provided On other applicable compliance docurnerro,worlOOmers,
calculations,plans and specifications submitted to the enforcement agency far approve with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance swill be made available with the building pennitfs)issued far the building,and made available to the enhancement agency for all applicilble
Impactors.I understand that a registered copy of this Certificate of Compliance Is required to be included with the documentation the builder Provides,to the building owner at cocupanc,,
Responsible Designer Name: Responsible Designer Signature:
Dungan,Barry 5"Y va'vil
company: DOW Signed:
Bear Creek Heating and Air Conditioning Inc 2016-08-30 15:37:55
Add.r ucama:
24069 Chatenay Lane 779461
citw'state/LP: Phone
Murrieta CA 92562 951-600-2882
DigalshysignedbyGrICERTS,
Registration Number;216-A0323747A-000000000-01001) Registration Date/rime; 2016-08-30 15:37:55 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Ret,1.008 Report Generated:2016-08-30 15:38:08
Schema Version:0.555SDD