PMT18-02104 City of Menifee Permit No.: PMT18-02104
29714 HAUN RD.<A CCELA MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
05/0 212 01 8
PERMIT
Site Address: 25880 PLUM HOLLOW DR, MENIFEE, CA Parcel Number: 339-101-034
92586 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE SAME LOCATION-14 SEER HVAC SYSTEM
Work:
Owner Contractor
BARBARA BROBST POLAR EXPRESS HEATING AND AIR
25880 PLUM HOLLOW DRIVE CONDITIONING
MENIFEE, CA 92586 502 CHANEY STREET STE E
Applicant Phone: 8009752654
POLAR EXPRESS HEATING AND AIR CONDITIONING License Number:995884
502 CHANEY STREET STE E
LAKE ELSINORE, CA 92530
Phone: 8009752654
Fee Description OOt y Amount f5)
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 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_Pernil_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter-9(commencing with section 7000)of Division 3 of the Business and o 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 CI a s )l Ucense No. -r / __ By my signature below I acknowledge that,except for my personal residence
Expires 7!-I ' Signature �'/� //� J� in which l must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION Improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in Its entirety by
❑1 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 Cade,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted Drat the following website:
by Section 3700 of the Labor Code,for the performance of work for which Ci
this permit is Issued. O,,%Tw.leginfo.ca.gov/calaw.html.
Policy# Date
,/ PROPEI�:Y OWNER OR AUTHORIZED AGENT
tri I have and will maintain worker's compensation insurance,as required tjG 'Y p
nsection 3700 of the Labor Code,forthe performance of the work for whirr ci By mfs`t(pature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and polisyrwner odelfthorized to act on the property owner's behalf.I have read this
number are: 'i CO-L' application and the information 1 have provided is correct.I agree to comply
Carrier +.4-�- ;} ( with all applicable city and county ordinances and state laws relating to
building construction.l authorize representatives of this city or county to
Policy It - _ Expires / - - enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($IDD)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
'shall not emolov 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 shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant - Date Gi_. I7 1-I mixture containing a hazardous material equal to or greater that the
amountss ed ied on the Hazardous Materials Information Guide?
WARNING'FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 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 applicant
modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District construction
t(SCtionor modification
permitting checklist
IN SECTION 37060E THE LABOR[ODE,INTEREST,AND ATTORNEYS FEES forguideligqes
CONSTRUCNON LENDING AGENCY _ ❑Yes .AMo
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 I permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 . pP hazardouses o No material reporting. G]- --- - - - 7
Business and Professions Code).Any city or county that requires a permit to _ - - Date l l!/I I !
construct,alter,Improve,demolish or repair any structure,prior to its \pROPERTY:OWNEROR 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 fRRPI
License Law(Chapter9(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
D 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 70",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. ❑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 RAP
Acknowledgement.
...BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION . MENIFEE
Alk
(A � I
DATE: `�—� CJ PERMIT/PLAN CHECK NUMBER T�(�� 19 -D D-
PLANNING CASE NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL *MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK U C
PROJECTADDRESS � 5��a /L/� �/0�� Yy'• ZIP l�?Sd 6
ASSESSOR'S PARCEL NUMBER 11 11�� LOT TRACT
OWNER NAME c(rbure( rVb54
ADDRESS City of Meni ee
06131,
PHONE EMAIL
APPLICANT NAME 0
ADDRESS `'0 i( [
PHONE qS f�Cfs I y7 EMAIL
CONTRACTOR'S NAME a OWNER BUILDER? O YES O NO
BUSINESS NA[MEE� c) Q(- 9Aff C1, ?/
ADDRESS toe S Cj Q
PHONE 06— 975-- .263q Qp (�(�I /EMAIL
CONTRACTOR'S STATE LIC NUMBER ( /S7J9 LICENSE CLASSIFICATION V
VALUATION$ J,C)d 5, SQ FT L SQ FfTT l Q
APPLICANT'S SIGNATURE DATE ✓ ^/ V
jCITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ) lJ�-/ P n eM 1
INVOICE TOTAL bQLA. Q. I GREEN 44, I SMIP
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# 1 NOTARIZED LETTER C YES D NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us �
"M_E�NIF_EE`
7-1
CERTIFICATE OF COMPLIANCE CF1R-AlT„-0?E
Alterations to Space Conditioning Systems(formerly CF-3R-ALT-HVAC) (Page 1 of 3)
Project Name: 25880 Plum Hallow Dr Date Prepared: 2018-05-02
A.General Information
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,use one
CFSR-ALT-02 document for each dwelling unit.
01 Project Name 25880 Plum Hollow Dr 73 C !G l & ),I! @ Date Prepared 2018-05-02
03 Project Location 2SS80 Plum Hollow Dr 04 Building Type Single family
05 CA City Menifee 06 Dwelling Unit Name 25880 Plum Hollow Dr
07 Zip Code 92586 08 Dwelling Unit Conditioned 1300
Floor Area(ftt)
Number of Space
09 Climate Zone 10 10 Conditioning(SC)Systems in 1
this Dwelling Unit:B.Space Conditioning(SC)System Information
01 02 03 B4 05 06 07 08 09 10
Is the SC Installing
SC System SCSystem CIA served system refrigerant Installing new SC Installing Installing Installing
Identification or Location or Area by this SC ducted containing system morethan40 entirelynew entirelynew 1
Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type
System 1 House 1300 Yes Yes Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section150.Z(b)1Dilb)
n!
This section does not apply to this project.
Registration Number:218-A02012566DA-000-000-0000000-0000 Registration Date/Time: 201 M5.02 07:":28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2018-05-02 07:":31
Schema Version:rev 10/16
City of Menifee
Building Dept.
MAY 0 2 2018
Received
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 2 of 31
D.Altered Space Conditioning System(Sections 150.2(b)SE and F)
01 02 03 04 05 06 07 08 09 30 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required New or
Identification System Heating Efficiency Efficiency Coaling Cooling Efficiency Efficiency Thermostat Replaced New Duct
or Name Type Components Type Value System Type Components Type Value Type Duct Length R-Value
Central gas All new Central split All new Less than or
System 1 furnace heating AFUE at AC coaling SEER 14 Setback equal to 40 R-6
component, components feet
Reouked Documentation:
CF2R-MCH-01-E-Space Conditioning Systems
-Dud insulation requirement for the new portions of supplNair and return-air duffs or plenums:R61Q 1-10,12 and 13)and Re(Q 11 and 14-16)
CF2R and CF311-MCH-20-11-Duct Leakage Test required when heating or cooling components are installed in ducted systems,or when more than 40 R of dud length is replaced
-Leakage rate compliance:<=15%or<=m%leakage to outside,or seal all araessible leaks.
CF2R and CBR-MCH-25-11 Refrigerant Charge verification required when refrigerant curtaining eamponenn are installed or altered(appliwhle in Q 2,8-15).
CF2R and CF311-MCH-23 Airflow Rate>=300 CFM per ton inquired when MCH-25 is required.
Exception,:
-Dud systems registered with HERS provider as previoust sealed are exempt from MCH-20 Dud Leakage Tening requirements.
-Heating-only systems and Air Handler Furnace changes do not require verification of Air Flow MCH-23,or Re6lgeant Charge MCH-25.
-Existing dud systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing mqulrements.
E.Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150.2(b)iDlia and 150.2(b)1E,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 project.
Reglemition Number:218-A02012566OA-000-000-OOD0000-0000 Registration Date/Time: 2018-05-02 0744:28 HERS provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2018-05-02 07:44:31
Schema Version:rev 10/16
CERTIFICATE OF COMPLIANCE CFSR-ALg02F
Alterations to Space Conditioning Systems(formerly CF-SR-ALT-HVAC) (Page
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature: �
Dieringer,Anthony610y O✓
Comparry: Signature Dale:
POLAR EXPRESS HEATING AND AIR CONDITIONING 2016-05-02 07:44:28
Address: CEA/HEM CertlBatlan Identification(R appgcable):
500 W GRAHAM AVE#222
❑ty/Sfm/ZiP: Phone:
LAKE ELSINORE CA 92531 951-445-7147
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the sate of California:
L The Information provlded on this Certificate of Compliance is true and correct.
2. I am eligible under Division 3 of the Business and Professions Code to accept respoodbility for the building design or system design Identified on this Certifate of Compliance(responsible designer).
3. That the energy features and petformancespecifiations,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 Csllbornla Code of Regulations.
4. The building design features or system design features identified an this CerROcate of Compliance are consitent with the lnfomaton provided on other applicable compliance documents,worksheets,
alatlations,plans and specifications submitted to the enforcement agency for approval with this building permit application.
S. I will emure that a registered copy of this Certifate of Compllana shall be made avallable with the building permlt(s)Issued for the building,and made avallable to the enforcement agency for all applicable
Inspections 1 understand that a registered copy of this Certificate of cempiter.Is required a be Included wish the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: Responsible Designer Signature: /']y,
Dieringer,Anthony ✓1
Company: Date Signed:
POLAR EXPRESS HEATING AND AIR CONDITIONING 2018-05-02 07:44:28
Address: Uama:
500 W GRAHAM AVE#222 995884
C1ty/Sat-14c Phora:
LAKE ELSINORE CA 92531 951-045-7147
Easy to Verify O
at CINCERTS.com s
Dipialrysymdby CeICENTS.rnisdHigeigesmerion Provide. nn pana ibNiwg far
Nuera rocyn title
oinfiarm eagsiiosnte.reddacummt arMinm wayimyL'es �k
Registration Number:218-A020125660A-000-000-OD00000-0ODO Registration Date/Time: 2018.06-02 07.44:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Genemted:2018-05-02 07:4431
Schema Version:rev 30/16