PMT14-02677 i
City of Menifee Permit No.: PMT14-02677
29714 MENIFEE,
CA 92586 Type: Residential Electrical
�4' 1-Ake" C' 92 i
MENIFEE Date Issued: 10/21/2014
I
PERMIT
Site Address: 28853 BROKEN ARROW CIR, MENIFEE, Parcel Number: 388-053-008
CA 92584 Construction Cost: $31,250.00
Existing Use: Proposed Use:
Description of INSTALL ROOF MOUNTED SOLAR PV SYSTEM 25 MODULES 25 MICROINVERTERS
Work:
Owner Contractor
DALE BUCHINGER VIVINT SOLAR DEVELOPER LLC
28853 BROKEN ARROW CIR 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 O_yt Amount
Building Permit Issuance 1 27.00
Ad i P a. . e e =Ele-rig a 5 57:
GREEN FEE 1 2.00
$443.50
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 building operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise staled,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_Templatesirt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
1 hereby affirm under penalty or perjury that I am licensed under provisions of Cl 1, 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 and my license is in full force an a ecC Code:The Contractor's License Law does not apply to an owner of a property
License Class G'�Ip License No. who builds or improves thereon, and who contracts for the projects with a
Expires ?JU Signature � licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from[!censure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of 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 have
permit!s 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
I have and will maintain workers' compensation Insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code,for the performance of the work for which this submitted or at the following Web site:httpi//www.leginfoxa.aov/calaw.html.
permit is Issued.My workers'compensation
insurance carrier and policy number are:
Carrier_I"1 bl7/I IJIl lX 11V6 ,p I/ '7�2�[/ Property Owner or Authorized Agent Date
Expires� �i' l q - Policy# y(6z"t 54z36S—
Name of Agent Phone# '(� By my Signature below, I certify to each of the following:1 am the property
ner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit Is for application and the Information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
El I certify that in the performance of the work for which this permit is issued,I identified property for the inspecJ.on purposes.' : //
shall not compemploy any persons in any manner so s to become subject to the 's„` `'T
workers' compensation p laws of California, and agree that o I should become
subject to the workers'compensation provisions of Section 3700 of the Labor
Code,I.shall forthwith comply with those provisions. ... Property Owner or Authorized Agent Date
Date; a (,
I Applicant; D �
s � City Business License# Zri
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, AYES OCCUPANT HANDLE.A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORN EYS FEES NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY i /� SPECIFIED- ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending. INFORMATION GUIDE?
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
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address 1„O FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
\'mow DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed ❑YES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5, Business and Professions Code: ' BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, Aft N0 SCHOOL? r
or repair any structure, prior to its issuance, also requires the applicant for the '''CCC..
permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractor's State License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from icensure 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($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation, will ( )all of or( ) porting of the work, and the structure is PROPERTY O�N AUT ZED AGENTr1
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or Improved for the
purpose of sale).
CITY OF ME YFY.E PLCK No: P rm%
29714 Haun Road ®off 7�
Date: Date:
Menifee, CA 92586 (c/ I
Phone: (951)672-6777 Amouy; � Amount:
Fax:(951)679-3843 Ck#:ok 8 to Ck#:
Building Combination Permit 61 a SS
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R
Property address: 28853 Broken Arrow Circle Assessor's Parcel Number.36G —053 AMR
Project/Tenant Name: Unit#: DD Floor#:
w
Name: Dale Buchinger Phone No-951-522-557 Fax No.
Property Address: 28853 Broken Arrow Circle Unit Number zip Code92584
Email Address:
alaxie o s verizon.net
Name: Nicole Powell Pho°e No.951-719-3795 Fax No.
Applicant Address' 27449 Colt Court Temecula, CA Unit Number Zip Code
92590
Email Address:
nicole.powell@vivintsolar.com
Name. Vivint Solar Developer LLC Phone"°. 951-719-379 Fax No.
Contractor Address: 27449 Colt Court city Temecula IS4..A zp°ode 92590
Contractor's City Business cense o. Contracto�rJ's7C3�51,�te of California License No. Classification:
Number of Squares: bb
Square Footage
Description of work: Solar Roof Mount o Panel Upgrade Cost of Work:$ 31,250.00
Applicant's Signature
Date: lO to /
o Be Completed By City Staff Only 1�
Indicate As R-Received or NIA-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 Tech/Soils Report(on cd only)
❑ Plat/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
❑ Foundation Plan ❑ Cross Section ❑ Structural Calculations
❑ Plumbing Plan ❑ Single Line diagram for else.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition. Meansimethods
Work Type: Repair* Retrofit* Revision to E1dsling PermiN Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate ii Indicate all Geo-tech.Haz.Zone
At Project Spdnkleretl 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 Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit special Case:Giati.
Omdalkpiprovai
Expedite Project(s): Child Care City Project Green Building Landmark Apoidahie Housing
For Staff Use Only
Building/Safety I Permit Specialist k City Planning Civil Engineering EPWM-Admin Transportation Mgmt. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
EsGil Corporation
In Partnership with Government for ouifding Safety
DATE: 10/09/14 ❑ APPLICANT
❑ JURIS.
JURISDICTION: Menifee ❑ PLAN REVIEWER j
❑ FILE
PLAN CHECK NO.: PMT14-02677 SET: I
PROJECT ADDRESS: 28853 Broken Arrow Circle
PROJECT NAME: 25 Modules 6,250 Watts Solar Photovoltaic System
® The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
❑ The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department staff.
❑ The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
❑ The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
❑ The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
❑ The applicant's copy of the check list has been sent to:
Esgil Corporation staff did not advise the applicant that the plan check has been completed.
❑ Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Telephone #:
Date contacted: (by: ) Fax #:
Mail Telephone Fax In Person E-mail:
❑ REMARKS:
By: Eric Jensen (SA) Enclosures:
EsGil Corporation
❑ GA ❑ EJ ❑ PC 10/07/14
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858)560-1468 ♦ Fax(858) 560-1576
Menifee PMT14-02677
10/09/14
[DO NOT PAY— THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: Menifee PLAN CHECK NO.: PMT14-02677
PREPARED BY: Eric Jensen (SA) DATE: 10/09/14
BUILDING ADDRESS: 28853 Broken Arrow Circle
BUILDING OCCUPANCY: R-3 TYPE OF CONSTRUCTION: V-B
BUILDING AREA Valuation Reg. VALUE ($)
PORTION ( Sq. Ft.) Multiplier Mod.
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code imnf Manual Input
Bldg. Permit Fee by Ordinance
Plan Check Fee by Ordinance
Type of Review: ❑ Complete Review ❑ Structural Only
El Repetitive Other Repetitive Fee �
Repeats u Hourly 1.5 Hrs. @
EsGil Fee $105.00 $157.50
" Based on hourly rate
Comments: 1 1/2 hours plan review.
Sheet 1 of 1
macvalue.doc+