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PMT14-01929 City of Menifee Permit No.: PMT14-01929 29714 HAUN RD. ' Type: Residential Electrical �GIw',1.,A�. MENIFEE, CA 92586 I MENIFEE Date Issued: 0 7/2412 01 4 PERMIT Site Address: 33220 BELLAMY LN, MENIFEE, CA 92584 Parcel Number: 388-060-020 Construction Cost: $300.00 Existing Use: Proposed Use: Description of ELECRICAL DERATING TO 175 AMP FOR SOLAR PERMIT PMT14-01928 Work: Owner Contractor GARY ENTREKIN VIVINT SOLAR DEVELOPER LLC 33220 BELLAMY LN 4931 N 300 W MENIFEE, CA 92584 PROVO, UT 84604 Applicant Phone: 8012346399 NICOLE POWELL License Number: 973756 VIVINT SOLAR DEVELOPER LLC 4931 N 300 W PROVO, CA 84604 Fee Description Ot_y. Amount f$1 e ptac a ,c "e"�- Building Permit Issuance 1 27.00 $144.00 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 bulliding 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 I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed '.. Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions Professions Code a my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class License No. 7S who builds or Improves thereon, and who contracts for the projects with a Expires� �. Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for the ❑ 1 hereby affirm under penalty perjury one the following declarations: following reason: I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is ection 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http�//wqM.leginfo.ca.gov/calaw.htmi. permit is Issued.My workers' ncompensation insurance carrier and policy number are: Carrier N1�� G t1l��'[[Y lJ /V.li 1�,, 2/� Property Owner or Authorized Agent Date Expires i11 i l I"1 Policy# UVICO2V_ y�33�` /By my Signature below, I certify to each of the following: I am the property Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply (This section need not be completed if the permit is for with all applicable city and county ordinances and state laws relating to building one-hundred dollars($100)or less) construction. I authorize representatives of this city or county to enter the above- 0 1 certify that y the performance of the work for which this permit is issued, identified property for e inspection n�purposes. shall not employ any persons in any manner so as to become subject to the ✓c..�/,of "(AuAi'f',A"/,U�// workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent Date Code, I shall forthwith comply with those provisions. /q � / / �,/Q City Business License Date; Applicant; p CAA/�V WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A DAMAGES 6 OF THEMIXTURE ABOR CODE, INTEREST,AND ATTORNE S FEES . NO EQUAL TO OR CONTAINING HAZARDOUS HAD MATERIAL N THE AMOUNTS 9� SPECIFIED ON THE HAZARDOUS MATERIALS CONSTRUCTION LENDING AGENCY INFORMATION GUIDE? I hereby affirm that under the penalty of perjury there is a construction lending agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE 3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE AYES Lender's Name FROM THE CONSTRUCTION IT HE SOUTH COAST QUALITYY MANAGEMENT Lender's Address 116NO DISTRICT (SCAQMD) SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS PRINT NAME: I hereby affirm under penalty of perjury that I am exempt from the Contractor's AYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY License Law for the reason(s)indicated below by the checkmark(s)I have placed next to the applicable item(s)(Section 7031.5. Business and Professions Cade: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A Any city or county that requires a permit to construct, alter, improve, demolish, NO SCHOOL? or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the I HAVE READ THE HAZARDOUS MATERIAL provisions of the Contractor's State License Law (Chapter 9 (commencing with INFORMATION GUIDE AND THE SCAQMD PERMITTING Section 7000)of Division 3 of the Business and Professions Code)or that he or YES she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than ($500).) HOD, SCMN255533WND 25534 CONCERNING R t ❑ I, as owner of the property, or my employees with wages as their sole PROPERTY OWNER OR AUTHORIZED A� compensation,will do ( ) all of or ( )porting of the work, and the structure is not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). CITY OF MENIFEE PLCK No: P�Ity 29714 Haun Road Date: OatNr t f q� Menifee, CA 92586 '. Phone: (951)672-6777 Amount: Amount:q LA cv Fax:(951)679-3843 Ck#: Ck#: I11C) 4 a Building Combination Permit t To Be Completed By Applicant Legal Description: , Planning Case: F: L: Rt: R Property Address: 33220 Bellamy Ln Menifee CA 92584 Assessor's Parcel Number. 388- lo(cb-Oao Project/Tenant Name: Unit#: Floor#: Name: Gary Entrekin Phone No.951-679-7674 Fax No. _ Prope Ownerty Address:33220 Bellamy Ln Menifee CA Unit Number Zip Code 92584 Email Address: Name:Nicole Powell Phone No.951-719-3795 Fax No. Applicant Address:27449 Colt Court Temecula CA Unit Number Zip Code 92590 Email Address: nicole.powell@vivintsolar.com Name: Vivint Solar Developer LLC Phone No Fax No. P 851-719-3795 Contractor Address:P7449 Colt Court City Temecula State CA Zip Cade 92590 Contractors City Business License o. Contractor's Ci t of California License No. Classification: 037308 9 - C-46 Number of Squares: Square Footage Description of Work: derate to 175 amp T14 ost of Work:$ 300 Applicant's Signature 1 Date: 7 To Be Completed By.City Staff Only Indicate As R-Received or N/A-Not Applicable 5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo TechlSoils Report(on cd only) ❑ Plot!Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11) ❑ Structural Calculations ❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration' Addition' Means/Methods'Work Type: Repair' Ll Retrofit' Revision to Existing PertniY Required? YES NO Proposed Building Use(s): Existing Building Use(s): #Buildings: #Units: #Stories: Will the Building Have at Basement? Y of N Bldg.Code Occupancy Group Indicate Indicate if Indicate all Geo-tech.Haz.Zone At Project Sprinkleretl YES or NO Completion: Construction that apply: Coastal Zone Type(s): C of O YES or NO Noise Zone Required? Listed on Historic Resources Inventory CITY PLANNING STAFF ONLY APPROVALS: Costal Central Arch.Review Board Landmark Comm. Planning Comm,Zoning Administrator Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retroft Special Case:BI g. OfficialApproval Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing For Staff Use Only Building/Safety Permit Speccalm I City Planning I Civil Engineering I PWM-Admin I Transportation Mgmt. I Rent Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY