PMT17-03236 City of Menifee Permit No.: PMT17-03236
29714 HAUN RD. Type: Residential Mechanical
47%CCELA> MENIFEE, CA 92586
MENIFEE Date Issued: 09/1412017
PERMIT
Site Address: 23575 ELSINORE LN, MENIFEE, CA Parcel Number: 350-191-009
92587 Construction Cost: $4.300.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE CONDESING UNIT ONLY. SAME SIZE, SAME LOCATION(WEST SIDE OF
Work: HOME-OUTSIDE)
Owner Contractor
GAUDENCIO JARMILLO POLAR EXPRESS HEATING AND AIR
23575 ELSINORE LANE CONDITIONING
MENIFEE,CA 92587 502 CHANEY STREET STE E
Applicant Phone:8009752654
ANTHONY DIERINGER License Number: 995884
POLAR EXPRESS HEATING AND AIR CONDITIONING
502 CHANEY STREET STE E
LAKE ELSINORE, CA 92530
Fee Description gyt Amount I$
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 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
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 staled,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 alicensed 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 ❑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 Cl a s 7,O Ucense No. -( qS e q By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
7 improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARAT N
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 Code,for the performance of work for which �4w%.ww.IeRinfoca.gov/caIaw.htrnl.permit is issued. ,ipjf
i
Policy If �n �n'�, Date
V PRU,EEW OWNER OR AUTHORIZED AGENT
1J�/I have and will maintain worker's compensation insurance,as required t% U' q
ttion 3700 of the Labor Code,for the performance of the work for whir�(�S By `&attire below I certify to each of the following:I am the property
this permit Is issued.My workers compensation Insurance carrier and polioyx oner oWa orized to act on the property owner's behalf.I have read this
number are: 1 0 a pplicationUtird the Information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relatingto
Carrier TTT �7 building construction.l authorize representatives of this city or county to
Policy# is w CZ �� Expires - /p'- I(4 +�,,.,enterthe above identified propertyfor inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZEDAGENT
❑I 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 worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply wi r those provisions. / �7 Will the applicant or future building occupant handle hazardous material or a
Applicant �� Date "I` I mgturecontaining a hazardous material equal to or greater that the
r amounts1specifiied on the Hazardous Materials Information Guide?
WARNIN O SE E WORKER'S COMPENSATION COVERAGE IS ❑Yes ,p 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
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 guide i s
CONSTRUCTION LENDING AGENCY ❑Yes Ao
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 4 A.
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 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
azardous material reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 es ❑No/1 " : -N-17
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 pROPE ERR1 T 0 IZED AGENT
issuance,also requires the applicant for the permit to file a signed statement 6
that he or she is licensed pursuant to the provisions of the Contractor's State = OVATION.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 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 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 ❑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. D 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 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 RRP
Acknowledgement.
BUILDING : , . . w- -
� Menife� }.
D rZ
DATE: - -1 7 PERMIT/PLAN CHECK NUMBER T MT 1-1-b32 5W o
TYPE: 0 COMMERCIAL O RESIDENTIAL O MULTI-FAMILY E MOBILE HOME O POOL/SPA C%SIGN
SUBTYPE: O ADDITION O ALTERATION "DEMOLITION O ELECTRICAL *MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK C �t_ a
arl,it wnnY�4� GU YtiCJ V (11
d an •
PROJECTADDRESS 3 S73 C r(/S/NOre Ly) ZIP q25Q7
ASSESSOR'S PARCEL NUMBER 35 d• I o1 j 'b ICM LOT TRACT
OWNERNAMEE cctIC1f '0 Qa` ,1
l
ADDRESS d`3�_ fT 15/ 1t L ,
PHONE _7O0-y(.JQ-0,�qS EMAIL
APPLICANT NAMEEN,,
ADDRESS J� LI1G�
PHONE q5 f-q(j5-j(47 EMAIL
CONTRACTOR'S NAME rf OWNER BUILDER? 0 YES X NO _
BUSINESS NAME 36 far S A /p -�,/ I_ I 1:
ADDRESS 512 -7`� ` N2 e / C 253c)
PHONE 8CO- q7S-2�5 EMAIL 1
CONTRACTOR'S STATE LIC NUMBER qq Sg q LICENSE CLASSIFICATION
VALUATION$ L4 300 SOFT 0 L SQ FT
APPLICANT'S SIGNATURE /�__ DATE ' ►4. I-
CITYSTAFFUSEONLY -
44
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
D �
BUILDING PLANNING ENGINEERING FIRE ACCEPTE BY: K*%4-t-J v/
PERMIT FEE I �� QS_ SMIP GREEN
-4
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE if NOTARIZED LETTER O YES 0 NO
city,
Building Building & Safety Dept.
SEP 14 /w
RprtaivPid
STATE OF CALIFORNIA City of MenifeD
ALTERATIONS - HVAC Building &Safety Dept.
CEC-CFIR-ALT-04-E Revised 01/16. -� CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations-HVAC CZ 2,and 8-15 (Page 1 of 1)
Ci
Site Address: /'� l SHx1rP Enforcement Agency: Date Prepared: Permitq:
Equipment T e 7 Equipment Er�:: New Ducting or Lineset: Conditioned
Re wired R-valueFloorArea(ft2Thermostat
❑Packaged ❑Evaporator Coll pFUE. COP 0 R-6 (CZ1-10,12&13)Ducts Se e b system S stem Condensin Unit Setbackyg ❑R-81 (CZ 11,14-16)Ducts (% f (If not oUeadysplit System ❑Compressor SEERHSPF
❑>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, CF2R- E
Condenser Unit,Evaporator Coil, CF2R-MCH-0MCH-OS-E,MCH-20-H,MCH-(23 or 24)2-H,MCH-25-H' (`A`1` ♦J
Compressor,TXV,Lineset, CF3R-MCH-20-H,MCH-(23 or 24)-H2,MCH-25-H2
Air Handler/Furnace2(Can Include new ducting)
Installer Requirement:Duct leakage(515%,or<10%to outside,or seal all accessible leaks),Air Flow z 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 unconditioned space,or
❑3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building-....1
❑2.New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ductsa CF1R-ALT-02-E
including Mini Split CF2R-MCH-01-E,MCH-20-H,MCH-22-H,MCH-(23 or 24)-H2,MCH-25-1-1'
CF3R-MCH-20-H,MCH-22-H,MCH-(23 or 24)-H2,MCH-25-H2
Mini Splits require CF1R-ALT-02-E,CF2R-MCH-01-E,and(CF2R-CF3R)MCH-25-H ,(✓\
Installer Requirement:Duct leakage<5%,Fan Efficacy(0.58W/CFM),Air Flow 2 350 CFM/ton(or alternative),Refrigerant Charge I
❑3.All New Ducts with Replacement I Required Compliance Documents to be left on site for Final:
All New Ducte and one or more of the following CF2R- E
replaced:Condenser Unit,Evaporator Coil, CF2R-MCH-0MCH-O3-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
114.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-H
Installer Required to:Duct leakage(515%or,510%to outside or,or seal all accessible leaks)
❑ EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos.
t All new ducting requires R-8 insulation when more than 40 It 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
3 All New Ducts is when at least 75%of the duct system is new duct material,and up to 2S%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 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). 0-
4. That the energy features and performance specifications,materials,components,and manufactured devices for the building design or O
system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the OCR.
S. The building design features or system design features identified on this Certificate of Compliance are consistent with the information V
provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application. Uj
Respond le �r Name: r n r Responsible De ' ner sig - Date Signed�`J'r_/� Ecenw q ISa
r l CJ 7
Come (j`Ctlr SS / Add s: Ylt1 5 C /s th'PP S Plf)df C 41$ Phonj S(-qua7/� r LL
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300 O