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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 ❑ Trustee(s) acknowledgment is not misused or attached to a different document. 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.