PMT17-01646 City of Menifee Permit No.: PMT17-01646
29714 HAUN RD.
<-►CCEU/ MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
O5/24/2017
PERMIT
Site Address: 26208 ALBANY DR, MENIFEE, CA 92586 Parcel Number: 335-262-003
Construction Cost: $11,450.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, PACKAGE UNIT 14 SEER,3 TON
Work:
Owner Contractor
BARBARA POTTS AIR FORCE ONE HEATING AND AIR INC
26208 ALBANY DRIVE 31566 RAILROAD CANYON ROAD
MENIFEE,CA 92586 #682
Applicant Phone:9512440916
KATHERINE COUCH License Number: 955952
AIR FORCE ONE HEATING AND AIR INC
31566 RAILROAD CANYON ROAD
#682
CANYON LAKE, CA 92587
Fee Description aty 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
$324.10
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing building operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contacts for the projects
hereby affirm under penalty of perjury that 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class �License
1No.
,1-9 By my signature below I acknowledge that,except for my personal residence
Expires 7 31 20($ Signature �1�01=rW..C X)I-cA, in which 1 must have resided for at least one year priorto completion of
improvements covered by this permit.)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
V,dereby 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 www.Ieginfo_m.gov/caIaw.htmL permit is issued.
Policy If Date
.-rhave 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 ❑By mysignature 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: 1 application and the information I have provided is correct.I agree to comply
CarrierS�UJY'tF Nq-��a•1a� ,nSu 1^cw nc.¢_ Co.,n G✓c . with all applicable city and county ordinances and state laws relating to
P building construction.I authorize representatives of this city or county to
Policy#swo kit 5-) t Expires I 1 2-0 t"1 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
D I certify that in the performance of the work for which this permit is Issued,
I shall not emolov 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 rthwit comply whh those pr visions. Will the applicant or future building occupant handle hazardous material ora
� rj Z mixture containing a hazardous material equal to or greater that the
Applicant _ '`--CJ l Date ) amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes 0 No
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($100,000),IN occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE
ADDITION TO THE OF COST
LABOR CODE,INTEREST,AND ATTORNEYS FEESCOMPENSATION,DAMAGES AS PROVIDED FOR Coast Air quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ayes ONO
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) 0 Yes 0 No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
California Health al Safety Code,Section 25505 and 25539 concerning
Contractors License Law for the reason(s)indicted below by the
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 703LS
Business and Professions Code).Any city or county that requires a permit to OYes ❑Na -
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 Contactors State EPA RENOVATION,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 contactors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1979
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 orthrough their
Ol,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.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 0 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. 0 No EPA Lead-Safe Certified Firm is required for this project because:
o 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 RAP rule please fill out the RRP
Acknowledgement.
BUILDING i SAFETY PERMIT/PLAN APPLICATION
DATE �5 24 1-7 PERMIT/PLAN CHECK NUMBER —1 'Q UL AU
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: O ADDITION C ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK %( -
ll,kvi4 \n ck me. ko i . I L1
PROJECTADDRESS 2L91.0 A%)OOLpM br. rA 92
ASSESSOR'S PARCEL NUMBER 3?�- Lo - LOT TRACT City
aca) of Menif -.
Dept.
OWNER NArME 'a)( 0\rCA- _
ADDRESS 4LQ�-b00,,� pCAA Q S a.Q
PHONE 01Sl - Lelq -LeLl3o EMAIL Y\ C1 If11oce .�
APPLICANT NAME Q V1 G v\
ADDRESS 3 iS Le ug 1 1 rd u d C L2 2 n l.F1L'�R Q25F'i 1
PHONE qS i I Le EMAIL Ck j C. cam
CONTRACTOR'S NAME Chayjf l ^ OWNER BUILDER? 0- YES •NO
BUSINESS NAME \ ,, C l A"
ADDRESS 3kSLf?Le 1c(,\l1Y'Dadl.[�V\ n AkLxfrZ Qan f1 Lake CIA Q2S$
PHONE EMAIL Y\
CONTRACTOR'S STATE LIC NUMBER g5$95 2- LICENSE CLASSIFICATION C2.1O
VALUATION$ SQQ FT ^,; ISO d L SQ FT
APPLICANT'S SIGNATURE DATE 612
DEPARTMENT DISTRIBUTION �( CITYOFMENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE PAID AMOUNT �,
AMOUNT - ID •�D 0 CASH --CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT --CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
IVietlifee guilditig,S Safety Department 29714 Hatln Rd. iVienifee, CA 92530 951-b72-.; -%
!vww.cirvof+,7enifoe.us inspection Request'f ine 9�1-245-6213
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT4)4E Revised 01/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF111-ALT-04-E
Alterations-HVAC CZ 2,and 8-15 (Page 1 of 1)
Site Address: En r mentqg�en ate Prepared: Permit#:
I r Dr- k -I
New Ducting or Uneset• Conditioned
Equipment Type Equipment Efficiency Required R-value Floor Area(fe) Thermostat
Packaged ❑Evaporator Coil u� rWFUE COP 0 R-6 VI-10,12&13)Ducts Served by system 0 Setback
System ❑Condensing Unit 0R-81 (CZ 11,14-16)Ducts 1t50'D fe (if not already
❑Split System ❑Compressor SEER HSPF ❑2�R-2.8 Unesee 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 le fr on site.
I.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: ftjldopt.
All Equipment, CF1R-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R-MCH-01-E,MCH-20-H,MCH-(23 or 24)4,MCH-25-1-1'
Compressor,TXV,Uneset, CF3R-MCH-20-H,MCH-(23 or 24)-Hz,MCH-25-Ha MAY 2 4 201
Air Handler/Furnace'(Can include new ducting) yy
Installer Requirement:Duct leakage(:-S1591,or<l0%to outside,orseal all accessible leaks),Air Flow_300 CFM/ton,if., Refrigerant�ee.. ��
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 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-MCH-01-E,MCH-20-H,MCH-22-H,MCH-(23 or 24)-H2,MOH-25-H'
CF3R-MCH-20-H,MCH-22-H,MCH-(23 or 24)-H2,MCH-25-1-12
Mini Splits require CF1R-ALT-02-E,CF2R-MCH-01-E,and(CF2R-CF3R)MCH-25-H
Installer Requirement:Duct leakage<5%,Fan Efficacy(O.SSW/CFM),Air Flow>_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-MCH-01-E,MCH-20-H,MCH-(23 or 24)-H,MCH-25-H
Compressor,TXV,Uneset,Fumacea CF3R-MCH-20-H,MCH-(23 or 24)-H,MCH-25-H
Installer Requirement:Duct leakage<5%,Air Flow z 350 CFM/ton(or alternative),Refrigerant Charge
Exempted from duct leakage testing if.01. Existing duct systems are constructed,insulated or sealed with asbestos
❑4.New Ducting over 40 feet 1 Required Compliance Documents to be left on site for Final:
New ducting but less than All New DuctO CFIR-ALT-02-E,CF2R-MCH-20-H,CF3R-MCH-20-H
Installer Required to:Duct leakage L15%or,51.0%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.
a Heating only systems and Air Handler/Furnace changes do not require Air Flow MCH-(23 or 24),or Refrigerant Charge verification MCH-25
a 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 units
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)
1 certify the fallowing under penalty of perjury,under the laws of the State of California:
L 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 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 application.
Respowlble0esigner Name: ns I Oesigne nature: Date signed: License:
2 C20-tisS952-
mpanY: Address: $tee-2 OtY/State/ip: Phone:
1 �6caF� o.d i 3usuie Raarac ( La Cp925$ qsi -2 ,l 9114
For assistance or questions regarding the Energy Stan ards,contact the Energy Hotline at:1-800-772-3300
* .
v I3559S3
31566 Railroad Canyon Rd#682
Canyon Lake CA.92587
951-244-0916
May 1,2017
City of Menifee State License#C20-955952
Permit Department City of Menifee#035548
To Whom It May Concern
Katherine Couch has permission to pull permits on behalf of Air Force 1 Heating&i Air
Conditioning Inc.
Thank you for your cooperation.
Respectfully,
c
Linda Dieringer
Owner,Vice-President
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California ,�//I' �, )
County of R1 yerStCX , )
On before me� t �1 fV hN kkje a /, C
Date Here Insert Name and Title of t Officer
personally appeared
goers
who proved to me on the basis satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
JENNIFER J.KINGMAN is true and correct.
Notary Public -California a
Riverside County > WITNESS my hand and official seal.
Commission N 2161822
M Comm.Expires Pu 1.2020+
Signature
Signa of Not blic
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached DocumenitLt�' j
Title or Type of Document: �Q q c 'Al �i� �k� t r tL41�
Document Date: ___ Number of Pages: _
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑Corporate Officer — Title(s): ❑Corporate Officer — Titie(s):
❑Partner — ❑Limited ❑General ❑ Partner — ❑Limited ❑General
❑Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact
❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator
❑Other: ❑ Other:
Signer Is Representing: Signer Is Representing:
02016 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item tf5907