PMT16-03238 City of Menifee Permit No. PMT1 6-03238
29714 HAUN RD. Type: Residential Mechanical
-t;kcciELA> MENIFEE,CA 92586
MENIFEE Date Issued: 10/0312016
P E R M I T
Site Address: 28270 E WORCESTER RD, MENIFEE, CA Parcel Number: 337-090-035
92586 Construction Cast: $2,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 3.5 TON
Work:
Owner Contractor
MARY CHANCELLOR SENERGY HEATING AND AIR CONDITIONING
28270 E WORCESTER RD 9085 MISSION BLVD PMB 145
MENIFEE,CA 92586 RIVERSIDE, CA 92509
Applicant Phone: 9512046454
ANTHONY TORRES License Number: 978933
SENERGY HEATING AND AIR CONDITIONING
9085 MISSION BLVD PMB 145
RIVERSIDE, CA 92509
Fee Description Qtv 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
spedfications 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 oommenmd is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA._I31dg_Pemit Template.ript 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 o I a m 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 C— Z J U N By my signature below I acknowledge that,except for my personal residence
Expires Signature �T7 in which I must have resided for at least one year prior to completion of
Improvements covered by this permit.I cannot lega Ily sell a structu re that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
o 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
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.leginfo.ca.grovicalaw.hmil.
this permit is issued.
Date
Policy If PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensation Insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which c 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
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-h undred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
a]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#
worker's tompensati wso al forn a,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjecttothewo er's mpensation provisions of Section 3700 of the Labor
Code,I shall fo with omply with those provisions Will the applicant or future building occupant handle hazardous material or a
Applicant Date/d, 3,J 1"4 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE 15 n Yes _�No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future build Ing
AND CIVIL FINES UP TO ONE 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 nYes &AD
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 boundary of a school?
(Section 3097 Civil Code) o Yes YNo
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
Contractor's License Law for the reason(s)indicated below by the hazardous mate
cbeckmark(s)I have placed nextto the applicable item(s)(Section 7031.5 uYes 4900 "porting.
Business and Professions Code).Any city or county that requires a permit to /�1-11t, —Date
construct,alter,improve,demolish or repair any structure,priarto 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 REN ON,REPAIR AND PAINTING(RRP)
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 exem pt from licensure receiving compensation for most work that disturbs paint in a pre-1978
a nd 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 Applica nt for a permit subjects the ap plicimt to a civil penalty of nut more required practices.This includes rental property owners and p roperty
than($500). managers who do the paint-disturbing work themselves or through their
o 1,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.epa.govIlead 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 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 a re not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
com pletion,the Owner-Builder will have the bu rden of proving that it was o No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
c 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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 RAP
Acknowledgement.
A M e n i f e e
k
ldmft��
DATE q)' S 'k ,D PERM IT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL YRESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME POOL/SPA SIGN
SUBTYPE: OADDITION D(ALTERATION ODEMOLITION 0EUEC7rRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK AJrA(- Wr
z\(,qf 6\,A
-roA)
PROIECTADDRESS '782/_:P
ASSESSOR'S PARCEL NUMBER 3157-01L'7056P LOT TRACT LH
OWNERNAME VAW"�
ADDRESS "2,%2--46J D w0,r- r_ IzSAqr-,
PHONE Clc5t EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRAcroR'S NAME 7S QA Q (-blu QWNERBUIUDER? OYEStVRO
BUSINESSNAME
ADDRESS %3LP V,�
PHONE "�LiO EMAIL
CONTRACTOR'SSTATE LIC NUMBER LICENSE CLASSIFICATION
'2 __0_'
VALUATION $ -0 j SO,FT troo L SO FT
APPLICANTS SIGNATURE DATEe--3,1 Lp
CITY STAFF USE ONLY ANA—m—L,
DEPARTMENr D15TKIBU I IUN CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING EfiGINEERING FIRE GREEN SMIP
INVOICE I :t;6ALjV I
AMOUNT PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED UMER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 gSl-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CF1 R-ALT-04-E(Remsed 06114) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-*04E
Alterations-HVAC CZ 2,and 8-15(formerly CF-1R-ALT-HVAQ city OT='I")ePt. (Page 1 of 1)
buti—I.. &
SiteAddress: -7 o Enforcemeoj�pVB Date Prepared: . P r -h-me
WorLo\ K r"N110- C 3AZY4
New Ducting,Plenums,Lineset, Conditioned
EquipmentType �AIJAL, Equipment Efficiency Re uir�d id Floor Area(sq ft) Thermostat
0 Packaged System Evaporator Coil COP Ducting Sirved zb system 0 Setback
e Split System -9 Condensing Unit AFUE 0 R-81 (CZ 1 15)Ducting f qft (if not already
0 Mini Split R compressor SEER —HWr 0 R-6(oil M)Plenums present,must
CI Furnace P Uneset 0 R-5 or R7.5)Lineset4 be installed)
0 TXV EER I I I
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 forms are to be registered(no hand filled forms allowed)and a copy left on site.
�9U.HVAC 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-(23or24)-HERSMECH-25-HERS2
Compressor,TXV,Uneset, CF3R: MECH-20-HERSMECH-(23or24)-HERS,MECH-25-HERS2
Air Handler/Fumace 2(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:
0 1.Duct system registered with HERS provider as previously sealed,or 2.There is less than 40 linearfeet of duct in unconditioned space,or
-4hL2 Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building
0 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-(23or24)-HER52,MECH-25-HERS2
CF3R; MECH-20-HERS,MECH-22-HERS,MECH-(23or24)-HERS2,MECH-25-HERSI
Mini Splits require CFIR-ALT-02-E,CF2R-MECH-01,and (CF2R-CF3R)MECH-25-HERS
Installer Requirement:Duct leakage<6%,Fan Efficacy(.SSW/CFM),Air Flow 2�350 CFM/ton(or alternative),Refrigerant Charge
0 3.All New Ducts with Replacement I Required Compliance Documents to be left on site for Final:
All New Ducts3 and one or more of the following CF1R-ALT-02-E
replaced;Condenser Unit,Evaporator Coil, CF2R: MECH-01,MECH-2G-HERS,MECH-(23or24)-HERS,MECH-25-HERS
Compressor,TXV,Lineset,Furnace 2 CF3R: MECH-20-HERSMECH-(23or24)-HERSMECH-25-HERS
Installer Requirement:Duct leakage<6%,Air Flow 2t 350 CFMAon(or alternative),Refrigerant Charge
Exempted from duct leakage testing if:0 1. Existladuct systems are constructed,insulated or sealed with asbestos
114.New Ducting over 40 feet 7 Re;Eed Compliance Documents to be left on site for Final;
New ducting but less than All New DUCtS3 I CFlR-ALT-02-E,CF2R: MECH-20-HERSCF3R: MECH-20-HERS
Installer Required to:Duct leakage L<15%or,�.10%to outside or,or seal all accessible leaks)
Q EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos.
I All new clucting 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 verification 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 handier,coil,plenums,duct material)
*R-S(1"thick insulation)for linesets 1"and less. R-7.5(1.5"thick Insulation)for linesets over I inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%",2.5-3T-2%",3.5 to 4T-2Y.",5T-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 I 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 I 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 an other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this bullifina permit-altr0cation. Tt— 19�51z?
Res a Designer Name, Rw��.ture:
ct Istate m: Ph
7d3ep /71/ *v , CA " 90,091 9/�;Ily
Fotdssl�tance or questions regarding the Energy StandaMs,contact the Energy Hotline at:I-BOD-772-3300