PMT18-05531 City of Menifee Permit No.: PMT18-05531
AV 29714 HAUN RD. Type: Residential Mechanical
,ff MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 11/20/2018
PERMIT
Site Address: 23541 CASA BONITA AVE, MENIFEE, CA Parcel Number: 351-096-023
92587 Construction Cost: $6,015.00
Existing Use: Proposed Use:
Description of R-8 DUCTWORK, 7 SUPPLIES 1 RETURN
Work:
Owner Contractor
ROCHELLE WILLIAMS A R S AMERICAN RESIDENTIAL SERVICES OF
23541 CASA BONITA AVE CALIFORNIA INC
MENIFEE, CA 92587 965 RIDGE LAKE BLVD.#201
Applicant Phone: 9512769744
KENNY PEERY License Number: 765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNI/
965 RIDGE LAKE BLVD.#201
MEMPHIS, TN 38120
Phone: (800)660-0675
Fee Description Qtv Amount($)
Building Permit Issuance 1 27.00
Inspections not specified 153 152.60
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 7.63
$188.23
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 force and effect. the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature 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
❑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
❑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 compensation 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
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
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ 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 a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified 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 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 ❑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 boundary of a school?
(Section 3097 Civil Code) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes ❑No
Business and Professions Code).Any city or county that requires a permit to 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 IRRP)
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
❑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 ❑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
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 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 force and effect.. � the following reason:
License Clan G(Q�r✓Zp iC 3(a—License No. C����� By my signature below I acknowledge that,except for my personal residence
Expires - �5(i:/0ignature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARASTIONimprovements covered by this permit.1 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
J,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 vA-Av.1eginfo.ca._gov/calaw.html.permit is issued. .v
Policy it Date
❑I have and will maintain workers 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 carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information 1 have provided is correct.I agree to comply
Carrier
L(' with all applicable city and county ordinances and state laws relating to
building construction.1 authorize representatives of this city or county to
Policy#701 5Q$(, "Expi -. 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
❑1 certify that in the performance of the work for which this permit is issued, (�7 �f
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# I
workers compensation laws of California,and agree that if I should become ZARDOUS MATERIAL DECLARATION
subject to the worker " 0.
s compensation provisions of Sectic- ^ of the Labor
Code,I shall forthwith comply with those provisions. > J ill the applicant or future building occupant handle hazardous material or a
Applicant De �l fy[ e containing a hazardous material equal to or greater that the
--� amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO 5 RE WORK US COMPENSATION COVERAGE IS ❑Yes .8'N-o
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES i
Will the intended use of the building by the applicant
icant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construct modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC ion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
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 boundary of a school?
(Section 3097 Civil Code) ❑Yes o�
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements underthe State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Ely ❑No /
Business and Professions Code).Any city or county that requires a permit to ._QQ�ifn Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR ORI ED
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the in a preracto
rs
s contractors
The EPA Renovation,Repair and Painting(RRP)Rule requiree
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint
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
th -1978
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($500). managers who do the paint-disturbing work themselves or through their
❑1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is wtnv.eoa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a
property who,through employees'or personal effort,builds or improves the An EPA Lead-Safe Certified Renovator will he responsible for this project
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION y ME1 ,E;
DATE: PERMIT/PLAN CHECK NUMBER
YW
PLANNING CASE NUMBER
TYPE: COMMERCIAL RESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL MECHANICAL
NEW PLUMBING RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS 03S7q Co�SA nt}q ve, ZIP I ZS�7
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME o r_ke,
ADDRESS Ave, UIIF -f- Ci9 R25$�
PHONE (q S 02-q - ZS Sy EMAIL
APPLICANT NAME City of 1'0,onRfee
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME � L o G rvi 2 R5 OWNER f r ` a
BUSINESS NAMES r e owie, 26��ce
ADDRESS 030 rn e{S 5t, q2503
PHONE (�O) 66 D ' 0 6 7 5" EMAIL
CONTRACTOR'S STATE LIC NUMBER 5C).7 LICENSE CLASSIFICATION G Ia i C20 G3 6
VALUATION$ �j O S SQ FT 11901 L SQ FT
T APPLICANT'S SIGNATURE DATE I Z6/).
1
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY:at!�__T CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL 3 GREEN SMIP
OWNER BUILDER VERIFIED YES D NO DRIVERS LICENSE# NOTARIZED LETTER YES NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us
ENIF
OWNER Rocb.t.] e. wlt�igYn5
ADDRESS 235y ( Ave.,
CITY ZIP -9 2S$7 PHONE
LOT NO. TRACT APN#
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CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: WILLIAMS,ROCHELLE�DatePreparecl: 2018-11-12
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 WILLIAMS, ROCHELLE 02 Date Prepared 2018-11-12
03 Project Location 23541 CASA BONITA AVE 04 Building Type Single family
05 CA City Sun City 06 Dwelling Unit Name WILLIAMS, ROCHELLE
Dwelling Unit Conditioned
07 Zip Code 92587 OS 1401
Floor Area(ft)
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 1401 Yes No No "sNo No Extension of existing
duct system
C. Extension of Existing Duct System,Greater Than 40 Feet(Section 150.2(b)1Diib) C:� p=»
K
01 02 z —e
System Identification or /� ..�.
Name New Duct R-Value / � 0
T 0 5 � r", (D
System 1 R 6 ✓ / eV
Registration Number:418-A020089256A-000-000-0000000-0000 Registration Date/Time:2018-11-12 07:08:50 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2018-11-12 07:08:50
Schema Version:rev 20180426
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 2 of 3)
Required Documentation:
CF211-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 MR-MCH-20-H Duct Leakage Test
-Leakage rate compliance:<=15%,or<=10%leakage to outside,or seal all accessible leaks
Exceptions:
Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 duct leakage testing requirements
D.Altered Space Conditioning System (Sections 150.2(b)1E and F)
This section does not apply to this project.
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.
Registration Number:418-A020089256A-000-000-0000000-0000 Registration Date/Time:2018-11-12 07:08:50 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2018-11-12 07:08:50
Schema Version:rev 20180426
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:
Christina Calhoun Chr4 nwCaUiou v
Company: Signature Date:
Rightime Home Services 2018-11-12
Address: CEA/HERS Certification Identification(if applicable):
965 Ridge lake Blvd,Suite 201
City/State/Zip: Phone:
Memphis TN 38120 951-276-9744
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.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s)issued for the building,and made available to the enforcement agency far all applicable
inspections.I understand that a registered copy of this 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:
Christina Calhoun 0W6 ttna.CaULoun.
Company: Date Signed:
Rightime Home Services 2018-11-12
Address:
License:
965 Ridge lake Blvd,Suite 201 765074
City/State/Zip: Phone:
Memphis TN 38120 951-276-9744
Digitally signed by CHEERS'". 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.
Registration Number:418-A020089256A-000-000-0000000-0000 Registration Date/Time:2018-11-12 07:08:50 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2018-11-12 07:08:50
Schema Version:rev 20180426