PMT17-01285 City of Menifee Permit No.: PMT17-01285
29714 HAUN RD.
<Accr= /-> MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 04/25/2017
PERMIT
Site Address: 28985 BAYWATER DR, MENIFEE, CA Parcel Number: 340-190-086
92584 Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of CHANGE OUT EXISTING HVAC SPILT SYSTEM,5 TON A/C, 16 SEER, 100,000 BTU FURNACE
Work:
Owner Contractor
ARTHUR JENKINS WILLIAMS A/C SERVICE
28985 BAYWATER DRIVE 11010 ARROW ROUTE#107
MENIFEE, CA 92584 RANCHO CUCAMONGA, CA 91730
Applicant Phone:9094667777
ETON WILLIAMS License Number: 956433
WILLIAMS A/C SERVICE
11010 ARROW ROUTE#107
RANCHO CUCAMONGA, CA 91730
Fee Description Oft Amount(SI
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 carded 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_Pemiit Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the 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 ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and license is in full farce and effect. the following reason:
License Class go License S 3 By my signature below I acknowledge that,except for my personal residence
Expires r —ZO 95ignature 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
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed In its entirety by
❑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 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 Cade,for the performance of work for which this permit is issued. www.leeinfo.ca:¢ov/calaw.html.
/t 'ht
Policy# A�(AVrV-✓f Y,11,,S Date L4 te'-z5—
❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Cade,for the performance of the work for which ❑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
�(,6 C�� l with all applicable city and county ordinances and state laws relating to
Carrier q / building construction.I authorize representatives of this city or county to
Policy#�C 75r// 5Mxpires J2— I —17 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
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ any per in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compens aws California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wo cp pensation provisions of Section 3700 of the Labor
Code,I shall fo those provisions. r / 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 specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHALL 5UBJECTAN 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($100,000),IN occupant require a permit forthe construction or modification from South
ADDITION TO THE COMPENSATION,DAMAGESASPROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 37060FTHE THE LABOR
ABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑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 boundary of a school?
(Section 3097 Civil Code) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed nett to the applicable item(s)(Section 7031.5 oyes ❑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 Contractors State EPA RENOVATION,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
❑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.epa.gov/lead or contactthe National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-024-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of 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 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:
❑I,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.
SAFETYBUILDING & • • APPLICATION
Menifee
DATE Qt— Z — PERMIT/PLAN CHECK NUMBER —
TYPE: O COMMERCIAL RESIDENTIAL MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION 0 DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Q
ev;4j • /O9 City Df Menifee
ou'laPROJECT ADDRESS (6S � - e to mg & Safety Del
ASSESSOR'S PARCEL NUMBER b— `C+� LOT TRACT 25 2017
OWNER NAME 14
U (� eived
ADDRESS W��7 Jc O Q ( �PQ �}� �•9
PHONE 1 5-1- EMAIL to C�.
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME ory 4,xo 5-> OWNERBUILDER? O YES N�O7
BUSINESS NAME ' t9 S ,J QI
ADDRESS S n q2ta 73O
PHONE 1109 63o- 616 (, EMAIL I' 9;"3W k' �92 ' pyq-r
CONTRACTOR'S STATEpUCNUMBER / �CJ�V�� LICENSE CLASSIFICATION
VALUATION$ .�J FTJC D L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
-,
DEPARTMENT DI5TRIBUTION Y CITYOFMENIFEEBU5INESS LICENSENUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE
AMOUNT •ID PAID AMOUNT OCASH vCHECKH OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT vCASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O: YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityo finenifee.us Inspection Request Line 951-246-5213
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-04-E Revised 01116 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-04-E
Alterations-HVAC CZ 2,and 8-15 (Page 1 of 1)
Site Address C Enforcement envy: Date Prepared: _ Perm't#:
( 7
New Ducting or Lineset: Conditioned
toli
Equipment Type Equipment Efficiency Required R-value Floor Area(ft2) Thermostat
❑Packaged Evaporator Coil pFUE COP 0 R-6 (CZ 1-10,12&13)Ducts Served by system 0 Setback
System J�Condensing Unit t 2 (If not already
❑R-8 (CZ II,14-16)Ducts ft
Split System Compressor SEER HSPF ❑Z R-2.8 Lineset' present must
❑Mini Split )$'Lineset EER be installed)
❑Furnace )(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 forms are to be registered(no hand filled forms allowed)and a copy left on site.
1.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
All Equipment, - - CF1R-ALT-02-E gilding &Safety Dept.
Condenser Unit,Evaporator Coil, CF2R-MCH-01-E,MCH-20-H,MCH-(23 or 24)2-H,MCH-25-H2
Compressor,TXV,Lineset, CF3R-MCH-20-H,MCH-(23 or 24)-H2,MCH-25-H2 APR 2 5 2017
Air Handler/Furnace2(Can include new ducting)
Installer Requirement:Duct leakage(<15%,or s10%to outside,or seal all accessible leaks),Air Flaw>_300 CFM/ton,Refrigerant Charge.
Exempted from duct leakage testing if: ��"®
1.Duct system registered with HERS provider as previously sealed,or 0 2.There Is less than 40 linear feet of duct in un a e,
3.Existing duct systems are'constructed,insulated or sealed with asbestos(list manufacture date of building1
❑2.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-MCH-01-E,MCH-20-H,MCH-22-H,MCH-(23 or 24)-H2,MCH-25-H2
/ CF3R-MCH-20-H,MCH-22-H,MCH-(23 or 24)-H2,MCH-25-H2
OZL( Mini Splits require CFiR-ALT-02-E,CF2R-MCH-01-E,and(CF2R-CF3R)MCH-25-H
Ins lee equirement:Duct lea age<5%,Fan Efficacy(0.58W/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 CFSR-ALT-02-E
replaced:Condenser Unit,Evaporator Coil, CF2R-MCH-01-E,MCH-20-H,MCH-(23 or 24)-H,MCH-25-H
Compressor,TXV,Lineset,Furnace CF3R-MCH-20-H,MCH-(23 or 24)-H,MCH-25-H
Installer Requirement:Duct leakage<5%,Air Flow 2 350 CFM/ton(or alternative),Refrigerant Charge
Exempted from duct leakage testing if:0 1. 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-MCH-20-H,CF3R-MCH-20-1-1
Installer Required to:Duct leakage(s 15%or,510%to outside or,or seal all accessible leaks)
❑ EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos.
'All new ducting requires R-8 insulation when more than 40 ft installed in CZs 11&14-16 and R-6 in CZs 1-10,12&13,and R-6 insulation when less
than 40 ft installed.This includes In walls,between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MCH-(23 or 24),or Refrigerant Charge verification MCH-25
'All New Ducts is when at least 75%of the duct system is new duct material,and up to 25%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-2.8(1"thick insulation)for linesets 1"and less.
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 forthe 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,calculati ,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
11 ble Designer Na Responsible Designer Signature: Date Signed: Licens
n m Zs77 s6/f
Company: Address aty/statemp: �r /7p� Ph
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300