PMT18-05442 City of Menifee Permit No.: PMT18-05442
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 11/15/2018
PERMIT
Site Address: 27575 POTOMAC DR, MENIFEE, CA Parcel Number: 336-350-024
92586 Construction Cost: $6,739.13
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 3.0 TONS, 14 SEER, 70K BTU
Work:
Owner Contractor
JAN HASEGAWA AND ANN H. BISHOP MONK'S AIR CONDITIONING
27575 POTOMAC DR P O BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONK'S AIR CONDITIONING
P O BOX 128
SUN CITY, CA 92586
Fee Description QtV Amount($)
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_Perm it—Tern plate.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law foi
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
Chapter 9 (commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residenc
Professions Code license is in full force and eff t. which I must have resided for at least one year prior to completior
License Class C7 Licens No. 1Zl improvements covered by this permit,I cannot legally sell a structure that I t
Expires _3 Signatu built as an owner-building if it has not been constructed in its entirety by liter
contractors. I understand that a copy of the applicable law, Section 7044 of
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this applicatic
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: http://www.leginfo.ca.gov/calaw.him[.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the prop
V_ I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to cor
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buit
C construction.I authorize representatives of this city or county to enter the abi
Carrier Jclh/� J Q �f identified property for the inspection purposes.
Policy#1 2^�tJU� / � Expires U — I _Date
Property Owner or Authorized Agent
nj� - /� 6
(This section need not be completed if the permit is for City Business License# v"��� O
one-hundred dollars($100)or less)
I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material c
workers' compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts s ecified on the Hazardous Materials Information Guide?
Code,I shall f hwi mply with those provisions.
❑YES NO
Appli ant Date; I — Will the intended.use of the building by the applicant or future building
occupant require a permit for the constructior or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting check
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES <NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the oL
DAMAGES AS PROVIDED FOR 11N SECTION 3706 OF THE bounda of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES VNO
CONSTRUCTION LENDING AGENCY 1 have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health A Safety C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mateplol re orti
OWNER BUILDER DECLARATIONS M
NO,
I hereby affirm under penalty of perjury that I am exempt from the Contractor's _Date
License Law for the reasons)indicated below by the checkmark(s)I have placed PRO O N AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
or repair any structure, prior to its issuarnce, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractor.,
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the•Businpss and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from.licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 703;1.5 by any Applicant fora permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's.Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
❑ 1, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work, and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this proje(
who, through employees' or personal effort; builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name: •
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale). •
❑ I, as owner of the property-an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project•(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply td'an owner of a property
who builds or improves thereon. and who contracts for the oroiects with a
BUILDING & SAFETY • A. •
"Wenifee
DATE l - 1 �5- I PERMIT/PLAN CHECK NUMBER
Z
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES_____..,.
^
DESCRIPTION OF WORK PfC D ` -0 ' c'T 1 1
PROJECTADDRESS J _\Oc
ASSESSOR'S PARCEL NUMBER _33 (x,3 S_D LOT TRACT Z 3o G)
OWNER NAME a Ayul
�l
ADDRESS
PHONE EMAIL �•;��� �I �A18
APPLICANT NAME C_J(�)ry Q�
ADDRESS 3�53o M u rr� e-i�► erg e, CA C1_259:
PHONE (`�Jl ) 'Pl�'�S - EMAIL 11'�0/'1�CjU l 1'"r� YY1Gt,1.� • Loon
CONTRACTOR'S NAME O OWNER BUILDER? O YES JNO
BUSINESS NAME M i t Cnd I b n I'
ADDRESS S CA ct�25 T
PHONE (C151 �77q-:7� 4,502- EMAIL moni-sa'Ir Z Gin-ta;_L • G0rr,
CONTRACTOR'S STATE LIC NUMBER C112 r qL4 LICENSE CLASSIFICATION CZ o
VALUATION$ 7 SQ FT 1 L SQ FT
APPUCANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS'.ICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN '• SMIP
INVOICE M IQ PAID AMOUNT O
AMOUNT O CASH CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd, Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 1 of 3)
Project Name: Hasegawa Date Prepared: 2018-11-14
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
CF1R-ALT-02 document for each dwelling unit.
01 Project Name Hasegawa 02 Date Prepared 2018-11-14
03 Project Location 27575 Potomac Dr 04 Building Type Single family
05 CA City Menifee 06 Dwelling Unit Name Hasegawa
07 Zip Code 92586 08
Dwelling Unit Conditioned
Floor Area(ftZ) 1550
Number of Space
09 Climate Zone 10 10 Conditioning(SC)Systems in 1
this Dwelling Unit:
B. Space Conditioning(SC)System Information
iJJ
01 02 03 04 05 06 07� a 08 09 10
4 3
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 1550 Yes Yes Yes No No No Altered space
conditioning system
C. Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib) ,
� o
This section does not apply to this project. `
G1 C�
a-- o L+L�2- 00
Registration Number:218-A020309314A-000-000-0000000-0000 Registration Date/Time: 2018-11-14 1701:58 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2018-11-14 17:01:53
Schema Version:rev 20180426
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 2 of 3)
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
01 02 03 04 05 06 07 08 09 10 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required !Newor
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
All new All new This field or This field o
AC r
System 1 Central gas heating AFUE 80 Central split cooling SEER 14 Setback section is not section is not
furnace components components 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 CF311-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 ky.
c
E. Entirely New or Complete Replacement Duct System,with or without.Equipment Changeout(Sectionst150.2(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.
Registration Number:218-A020309314A-000-000-0000000-0000 Registration Date/Time: 2018-11-14 17:01:58 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2018-11-14 17:01:53
Schema Version:rev 2018C426
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-IR-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: �� ,�A�
Monk,Gary /`(
Company: Signature Date:
MONK'S AIR CONDITIONING 2018-11-14 17:01:58
Address: CEA/HERS Certification Identification(if applicable):
30530 Murrieta Road
City/State/Zip: Phone:
Menifee CA 92584 951-679-4502
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 of the 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.
S. I will ensure that a registered copy of this Certificate,of Cottpllance shall be made available with the building permits)issued for the building,and made available to the"'enforcement agency for all applicable
inspections.I understand that a registered copy of this CeUhiflcate 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:
Monk,Gary a r/���
Company: Date Signed: O
MONK'S AIR CONDITIONING 2018-11-14 17:01:58
Address: License:
30530 Murrieta Road 912194
City/State/Zip: Phone:
Menifee CA 92584 951-679-4502
Easy to Verify 21 M
at CaICERTS.com
L
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document,and in no way implies
Registration Provider responsibility for the accuracy of the information. a
Registration Number:218-A020309314A-000-000-0000000-0000 Registration Date/Time: 2018-11-14 17:01:58 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2018-11-14 17:01:53
Schema Version:rev 20180426