PMT18-05121 City of Menifee Permit No.: PMT18-05121
29714 HAUN RD.
AV MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 10/24/2018
PERMIT
Site Address: 28694 WOODCHESTER WAY, MENIFEE, Parcel Number: 336-502-006
CA 92584 Construction Cost: $1,600.00
Existing Use: Proposed Use:
Description of REPLACE 2.5 TON CONDENSER 14 SEER
Work:
Owner Contractor
JODIE ROY AIR QUALITY SPECIALIST INC
28694 WOODCHESTER WAY P O BOX 105
MENIFEE, CA 92584 SAN JACINTO, CA 92583
Applicant Phone:9514876700
RON SMITH License Number: 929419
AIR QUALITY SPECIALIST INC
P O BOX 105
SAN JACINTO, CA 92583
Phone:9514876700
Fee Description Qty Amount($)
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 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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full for and effect. the following reason:
License Classy ense No.
By my signature below I acknowledge that,except for my personal residence
Expires gnature 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
o 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 w v w.leginfo.ca.gov/calaw.htm1.permit is issued.
Policy# Date
❑I 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 compensatio insurance carrier 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
Carrier �/ Ci� ` with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# C. Expires Z ! 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
o I certify that in t p orma ce of the work for which this permit is issued,
I shall not em I person n manner so as to become subject to the CITY BUSINESS LICENSE#
worker's co sation laws alifornia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subj t t worker s c pe ation provisions of Section 3700 of the Labor
Co ,I all forthwith ith those provisions. Will the applicant or future building occupant handle hazardous material or a
�Y J! mixture containing a hazardous material equal to or greater that the
ant Dat amounts spec ed on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes o� O
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 guidel' s
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
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 boun of a school?
(Section 3097 Civil Code) ❑Yes No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting ch list.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California th&Saf Code,S tion 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazar us erial r rt' Dat�
/)
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ❑Y
Business and Professions Code).Any city or county that requires a permit to
construct,alter,improve,demolish or repair any structure,prior to its ROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant forthe 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(RRP)
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
❑1,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 o 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 RRP
Acknowledgement.
City of Menifee
Det
BUILDING & SA ETY PERMIT/PLAN CHECKAPPILICATION MENIFEE
I Aft
FD_ATE: ' ✓ ` P R P A CHECK NUMBER I '
PLANNING CASE NUMBER
TYPE: COMMERCIAL RESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL ;MECHANICAL
NEW PLUMBING RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
ls- �Iz
PROJECT ADDRESS ld ZIP S
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS
PHONE 1,2 2
7 ?� EMAIL
APPLICANT NAME
ADDRESS � zAl, \"J ! � Ve/5K
Y5
PHONE �iS'l- �4�)- 62 EMAIL
CONTRACTOR'S NAME AIX- � OWNER BUILDER? i YES ::T10
BUSINESS NAME
ADDRESS r� J C C
1
PHONE /- T?(/�,i 6 26d EMAIL
CONTRACTOR'S TATE6 LAIC NUMBER LICENSE C4/4 LASSIFICATION CI
e
VALUATION$ � SQ FT L SQ FT
APPLICANT'S SIGNATU DATE
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY l CENSE NUMBER
BUILDING PLANNING ENGINEERING FIE _jj�/�'��((//��// //
INVOICE TOTAL GREEN SMIP
OWNER BUILDER VERIFIED OYES ' NO DRIVERS LICENSE# NOTARIZED LETTER YES NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 --,-
fio"www.cityofinenifee.us
FE
CERTIFICATE OF COMPLIANCE
city of Nienifee CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) Building e • (Page 1 of 3)
Project Name: Jodie Roy Date Prepared: ®C 2018-10-23
ffim
A. General Information ME
CF111-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented, use one
CF1R-ALT-02 document for each dwelling unit.
01 Project Name Jodie Roy 02 Date Prepared 2018-10-23
03 Project Location 28694 Woodchester Way 04 Building Type Single family
05 CA City Menifee 06 Dwelling Unit Name Jodie Roy
Dwelling Unit Conditioned
07 Zip Code 92584 08 1250
Floor Area(ft2)
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 04 05 06 07 08 09 10:
Is the SC Installing a
SC System SC System CFA served system a refrigerant Installing new SC Installing Installing Installing
Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new
Name Served System(ft) system? component? components? feet of ducts? duct system? SC system? Alteration Type
System 1 Location 1 1250 Yes Yes Yes No No No Altered space
conditioning system
C. Extension of Existing Duct System,Greater Than 40 Feet(Section 150.2(b)1Diib)
This section does not apply to this project. 0-1 nug; tour T
fFAAT I 0 2
Registration Number:218-A020287595A-000-000-0000000-0000 Registration Date/Time: 2018-10-23 16:48:20 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2018-10-23 16:48:13
Schema Version: rev 20180426
CERTIFICATE OF COMPLIANCE City of Menifee CF111-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) Budding Bept. (Page 2 of 3)
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
0
01 02 03 04 05 06 07 08 09 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required New or
Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct
or Name Type Components Type Value System Type Components Type Value Type Duct Length R-Value
Central as No Heating This field or This field or Outdoor This field or This field or
g
System 1 Central split furnace Component section is not section is not AC condensing SEER 14 Setback section is not section is not
Altered applicable applicable unit applicable applicable
Required Documentation;
CF2R-MCH-01-E-Space Conditioning Systems
-Duct insulation requirement for the new portions of supply-air and return-air ducts or plenums:R6(CZ 1-10,12 and 13)and R8(CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H-Duct Leakage Test required when heating or cooling components are installed in ducted systems,or when more than 40 ft of duct length is replaced
-Leakage rate compliance:<=15 percent or<=10 percent leakage to outside,or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CF2R and CF3R-MCH-23 Airflow Rate>=300 CFM per ton required when MCH-25 is required.
Exceptions:
Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage Testing requirements.
Heating-only systems and Air Handler Furnace changes do not require verification of Air Flow MCH-23,or Refrigerant Charge MCH-25.
-Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout(Sections 150.2(b)1Diia 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)1C)
This section does not apply to this project.
12AATif- o9ILI
Registration Number:218-A020287595A-000-000-0000000-0000 Registration Date/Time: 2018-10-23 16:48:20 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2018-10-23 16:48:13
Schema Version: rev 20180426
City of Menifee
211ildipQ Dept
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 3 of 3)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
Smith, MichaelGGlIRe�/���GGGfY
Company: Signature Date:
Air Quality Specialist Inc 2018-10-23 16:48:20
Address: CEA/HERS Certification Identification(if applicable):
1000 N State St Unit 119
City/State/Zip: Phone:
hemet CA 92543 714-476-0522
Responsible Person'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 Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance(responsible designer).
3. 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 ofthe California Code of Regulations.
4. 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.
5. 1 will ensure that a registered copy ofthis Certificate of Compliance shall be made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable
inspections.I understand that a registered copy ofthis Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: Responsible Designer Signature:
Smith, Michael
Company: Date Signed:
Air Quality Specialist Inc 2018-10-23 16:48:20
Address: License:
1000 N State St Unit 119 929419
City/State/Zip: Phone:
hemet CA 92543 714-476-0522
Easy to Verify %. 1
at CaICERTS,com
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document,and in noway implies
Registration Provider responsibility for the accuracy of the information.
Registration Number:218-A020287595A-000-000-0000000-0000 Registration Date/Time: 2018-10-23 16:48:20 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2018-10-23 16:48:13
Schema Version: rev 20180426