PMT15-00681 City of Menifee Permit No.: PMT16-00681
29714 HAUN RD.
' CwEi.A> MENIFEE, CA92586 Type: Residential Electrical
MENIFEE Date Issued: 04/08/2015
PERMIT
Site Address: 27655 PLEASANT GROVE CT, MENIFEE, Parcel Number: 336-451-001
CA 92585 Construction Cost: $33,600.00
Existing Use: Proposed Use:
Description of INSTALL ROOF MOUNTED SOLAR PV SYSTEM 28 MODULES, 28 INVERTERS, 7.7KW
Work:
Owner Contractor _
KAREN LUGINBUHL PETERSEN-DEAN INC
27655 PLEASANT GROVE CT 39300 CIVIC CENTER DRIVE
MENIFEE, CA 92585 FREMONT, CA 94538
Applicant Phone: 5103716500
JENNY ENCISO License Number:468117
PETERSEN-DEAN INC
1820 CONTAINER CIR
RIVERSIDE, CA 92509
Phone: 9095227180
Fee Description
Qy Amount 1$1
Solar, Residential or$mall Commercial 1 9
Building Permit Issuance 1 27.00
Additions-Plan Fteviety Electrical f
15$ a 1znj
GREEN FEE 1 2.00
SMtIP J2ESIDEiJTIAL mm ,.r r,.__ . _.. r y 500;
$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 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 slated,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
r
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 and my license is in full force ndiffect. Code:The Contractor's License Law does not apply to an owner of a property
License Class�License No. ....�(,„, who builds or improves thereon, and who contracts for the projects with a
Expires_'31 - I Signatures - licensed contractor(s)pursuant to the Contractors State License Law),
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from Iicensure under the Contractors'Stale License Law for the
❑ I 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, cannot legally sell a structure that 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 requestwhen this application is
s ction 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:bttp://www.leginfo,ca,aov/calaw,htmi.
permit is issued.My workers'compensation insurance carrier and policy number are:
�/t �` ,�f,,t..j��� Property Owner or Authorized Agent
Carrier," oI �,�—� A Date
Expires Ch P74ks / 7 %fcye �e Yl1 4. go-)5
y 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
(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 repjasentatil f this city or county to enter the above-
❑ I certify that in the performance of the work for which this permit is issued,I identified pr pertMrdhe F,lnspection pyap6ses.
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become bt
subject to the workers' compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Property'Owne �ACthorize¢�'}} an,t�/� Q'� Date
c Date; Applicant;
City Business License
g i5
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 ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES _C60 EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY TT�� 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 EiYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address O FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
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, V40 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
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 AYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from Iicensure 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 �,�v0 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 F EPORI'ING.
Y O
compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY OR AU(T ORIZFD- GENT
not intended or offered for sale.(Section 7044,Business and Professions Code; if
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).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION if
5
Menifee
DATE PERMIT/PLAN CHECK NUMBER P 5- 9l
TYPE: ❑COMMERCIAL RESIDENTIAL []MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
`� SUBTYPE: ADDITION []ALTERATION []DEMOLITION []ELECTRICAL []MECHANICALV` NEW []PLUMBING [I RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ,. 6
21 micw �nitAeYS i
PROJECTADDRESS -
may/ 'G ..�1 I�
ASSESSOR'S PARCEL NUMBER _ ' 1 001 LOT _ TRACT
-39% L% •�S�
OWNER NAME
ADDRESS
PHONE"5
- ` EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? [:]YES[i
BUSINESS NAME --e l:l / -e
ADDRESS
PHONE qbII] 022 -11 % EMAIL e Q Q -e ((44
CONTRACTOR'S STATE LIC NUMBER40111 LICENSE CLASS( (CATION C
VALUATION $h 33 . lP®V SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
- c
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP ��
INVOICE 60 PAID AMOUNT AMOUNT Cj CASH ':✓CHECK# CCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH !."CHECK# iCREDIT CARD VISA/MC
OWNER BUILDER VERIFIED '.'YES , NO DL NUMBER NOTARIZED LETTER YES {% NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
EsGil Corporation
In(Partnership with Government for Buirding Safety
DATE: 03/31/2015 ❑ APPLICANT
❑ JURIS.
JURISDICTION: City of Menifee ❑ PLAN REVIEWER
❑ FILE
PLAN CHECK NO.: PMT15-00681 SET: I
PROJECT ADDRESS: 27655 Pleasant Grove Ct.
PROJECT NAME: LUGINBUHL 22 @ 250 Watts Micro-inverters 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: Morteza Beheshti (SA) Enclosures:
EsGil Corporation
❑ GA ❑ EJ ❑ PC 03/24/2015
9320 Chesapeake Drive, Suite 208 ♦ San Diego,Califomia 92123 ♦ (858)560-1468 ♦ Fax(858)560-1576
I
City of Menifee PMT15-00681
03/31/2015
[DO NOT PAY— THIS IS NOT AN INVOICE]
I
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Menifee PLAN CHECK NO.: PMT15-00681
PREPARED BY: Morteza Beheshti (SA) DATE: 03/31/2015
BUILDING ADDRESS: 27655 Pleasant Grove Ct.
BUILDING OCCUPANCY: TYPE OF CONSTRUCTION:
BUILDING F-77—EA-7 Valuation Reg. VALUE ($)
PORTION ( Sq. Ft.) Multiplier Mod.
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code mnt Manualinput
Bldg, Permit Fee by Ordinance ►'
Plan Check Fee by Ordinance
Type of Review: ❑ Complete Review ❑ Structural Only
❑r�Repetitive Fee Other
Repeats ❑ Hourly 1.51 Hrs. @
ESG1I Fee 1 $105.00 $157.50
Based on hourly rate
Comments: 1 1/2 hours plan review.
Sheet 1 of 1
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