PMT18-04138 City of Menifee Permit No.: PMT18-04138
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 08/21/2018
PERMIT
Site Address: 27279 POTOMAC DR, MENIFEE, CA Parcel Number: 336-333-013
92586 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,REPLACEMENT OF 3 TON CONDENSER AND EVAP COIL ONLY
Work:
Owner Contractor
LISA CARON AIRMD MECHANICAL INC
27279 POTOMAC DRIVE 3389 SEQUOIA CT
MENIFEE, CA 92586 PERRIS, CA 92570
Applicant Phone:9516033224
LLAYCEE CRANDALL License Number: 1025795
AIRMD MECHANICAL INC
3389 SEQUOIA CT
PERRIS, CA 92570
Fee Description O_yt Amount($)
Forced-Air or Gravity-Type Furnace or Sumer 1 149.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 7.45
$184.46
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_Permit_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 0I am exempt from Iicensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
Ucense Class I✓—Z(:1) License No. IU ZFJ —7'R S By my signature below I acknowledge that,except for my personal residence
Expires �1 l j 9 Signature ,�- �Zz 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
0 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
this permit is issued. www.leginfo.ca.gov/calaw.html.
Policy# Date
01 have and will maintain worker's 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 my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carder 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-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
-/VkI certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. WIII the applicant or future building occupant handle hazardous material or a
Applicant Date G �7 ( ���$ mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAIL RE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes ❑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($300,000),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 oYes ONO
I hereby affirm that under the penalty of perjury there is a construction WIII 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 ONO
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
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 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes ❑No
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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 than($500)" required practices.This includes rental property owners and property
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
property who,through employees'or personal effort,builds or improves the ❑An EPA Lead-Safe Certified Renovatorwill be responsible for this project
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement 1s 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:
o 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 applyto an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: "" COMMERCIAL &RESIDENTIAL -' MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL * MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK oC 946n c bncAensev c? nct
U
PROJECTADDRESS '�7 � ,��nrrc.�. O(r ZIPtng Dept.
ASSESSOR'S PARCEL NUMBER .013 LOT TRACT AUG 1
OWNER NAME
ADDRESS p Pn Led
' "V
PHONE S62- EMAIL -�
APPLICANT NAME e
ADDRESS G 1 S
PHONE GS' $!�-��J Z 3 EMAIL P
CONTRACTOR'S NAME n,YN rn p (h hcinccc. l OWNER BUILDER? O YES O NO
W
BUSINESS NAME
ADDRESS 'GrGn
PHONE r- EMAIL r 7 6rbo I
I., to
CONTRACTOR'S STATE LIC NUMBER G ZS 5 LICENSE CLASSIFICATION `_Zcj
VALUATION$ i)�(-� SOFT Isso L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: ./7 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I►I�f�-��
INVOICE TOTAL I 1$1LI,L1,6 GREEN ,.- SMIP X
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE#1 NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us `m
ENIFE�
N6
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-04E Revised 01/16 CALIFORNIA ENERGY COMMISSION �r
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations-HVAC CZ 2,and 8-15 (Page 1 of 1)
Site Address• Enfor Date Prepared: Permit#:
f Z � fof>ta oI r mem: ry: G€ Z1 I
Equipment Type Equipment Efficiency New Ducting or Lineset: Conditioned 2 Thermostat
Required R-value Floor Area(ft)
❑Packaged Evaporator Coil AFUE COP O R-6 (CZ1-10,12&13)Ducts Served by system •E#ssetback
System EKCondensing Unit O R-8' (CZ 11,14-16J Ducts 5so ftZ (If not already
❑Split System ❑Compressor SEER HSPF ❑>R-2.8 Lineset° be installed)
must
❑Mini Split ❑Lineset be installed)
❑Furnace ❑TXV EER ,
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. �Rermm lia on this
form is allowed to be filled out by hand. For final inspection all forms are to be registered(no hand filled forms allowe hh55 icc ite.
.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: •
All Equipment, CFSR-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R-MCH-01-E,MCH-20-H,MCH-(23 or 24)2-H,MCH-25-1-12 AUG 21 2018
Compressor,TXV,Lineset, CF3R-MCH-20-H,MCH-(23 or 24)-H2,MCH-25-1-12
Air Handler/Furnace'(Can include new ducting)
Installer Requirement:Duct leakage(515%,or 510%to outside,or seal all accessible leaks),Air Flow>_300 CFM/t
Exempted from duct leakage testing if: Received
❑1.Duct system registered with HERS provider as previously sealed,or 112.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 Ducts2 CF1R-ALT-02-E
including Mini Split CF2R-MCH-01-E,MCH-20-H,MCH-22-1-1,MCH-(23 or 24)-H2,MCH-25-H2
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
❑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,Lineset,Furnace2 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:❑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' I CF1R-ALT-02-E,CFZR-MCH-20-H,CF3R-MCH-20-H
Installer Required to:Duct leakage L15%or,510%to outride 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
2 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)
<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,underthe 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).
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,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Responsible 0esigner Name: L_ Responsible Des' er5i pate Signed: l9�sp�rT7 as
0 I
C mpany: Address: Oty/State/Tip: Phone:
rr e han j Z Ca S -
For assistance or questions regarding the nergy Standards,contact the Energy Hotline at:1-800-772-3300
AIR MD Mechanical
Vanessa DeShazer, Owner
3389 Sequoia Ct.Perris, CA 92570
16 July 2018
I,Vanessa DeShazer, owner of Air MD Mechanical give Llaycee DeShazer permission to do business in
obtaining permits and business licenses on behalf of Air MD Mechanical.
City of Menifee
ram%' Building Dept.
aness )=eSaz er AUG 21 2018
Air MD Mechanical Received
c�
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
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 11 }
County of �i11lP4�SlC1� f� }
On l Oi$ before me, �I t i�t�' �r/1pr`e Na1"�i1,�e'Inry IP061 .
t ere Insert name an o l e o ice
personally appeared �nrlPSSa 17 'shazer
who proved to me on the basis of satisfactory evidence to be the personCwrwhose
name�are subscribed to the withiri instrument and acknowledged to me that
he/Q/they executed the same in his/�e /their authorized capacityjjesj;and that by
his/ a /their signatureWon the instrument the personja*r or the entity upon behalf of
which the personjsfiacted, executed the instrument.
s
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
411HEATHEIR RENEE NAREY
WI NEI my hand and official seal. Comfrl R No. NARI 9
NOTARY PUBLIC-CALIFORNIARIVERSIDE COUrp
y Canm Egwim APRIL 10.7071 .�
rotary Public Signature (Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM
This form complies with current California statutes regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT fneeded,should be completed and allached to the document.Acknowledgments
from othersiates may be completed for documents being sent to that stale so long
Aj��Or lrl 1pOr as the wording does not require the California notary to violate California notary
iA'[ rzaliD F-d-�1l+ law.
(Title or`d`efscription of attached document) State and County information must be the State and County where the document
VLl l l li 1C1 signer(s)personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s)personally appeared which
(Title or descriptlin of attached document Continued) must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
Number of Pages Document Date 7 tP commission followed by a comma and then your title(notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e.
Wshellhey—is/are)or circling the correct forms.Failure to correctly indicate this
❑ Individual (s) information may lead to rejection of document recording.
❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges,re-seal if a
Title sufficient area permits,otherwise complete a different acknowledgment form.
O Partner(s) • Signature of the notary public must match the signature on file with the office of
the county clerk.
❑ Attomey-in-Fact Additional information is not required but could help to ensure this
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Indicate title or type of attached document,number of pages and date.
Other
❑ Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer,indicate the title(i.e.CEO,CFO,Secretary).
2015 Vemion w,ww NotaryC:lasseb.ccm R00-8734)865 • Securely attach this document to the signed document with a staple.