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PMT15-00774 City of Menifee Permit No.: PMTIS-00774 29714 HAUN RD.` MENIFEE, CA 92586 Type: Residential Electrical Gwen ABrdt� MENIFEE Date Issued: 0411412015 PERMIT Site Address: 29970 CALLE SAN MARTINE, MENIFEE, Parcel Number: 340-081-012 - CA 92584 Construction Cost: $24,000.00 Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 200AMP ; SOLAR PERMIT PMT15-00773 Work: Owner Contractor IVETTE BARNETT CAMPBELL ELECTRIC 29970 CALLE SAN MARTINE 17741 SAMPSON LANE MENIFEE, CA 92584 HUNTINGTON BEACH, CA 92647 Applicant Phone: 7143962740 CESAR MIGUEL License Number: 302863 SMART SOLAR MARKETING 17542 E 17TH ST SUITE 175 TUSTIN, CA 92780 Fee Description ON Amount ;�Serylces SwitcbboaYds�Eon an,,,,tro Genter�s&.Pa els , - ° 1 ^ s-� 116:00 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 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 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 and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class of-10 License No. 3 02863 who builds or improves thereon, and who contracts for the'projects with a Expires IZ131LIS 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 ❑ 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 Section 3700 of the Labor Code, for the performance of work for which this which I must have resided for at least one year prior to completion of permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have Policy# .built as an owner-building if it has not been constructed in its entirety by licensed 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:http://Mw,ieqinfo.ca.gov/calaw.htmi. permit Is issued.My workers'compensation insurance carrier and policy number are: Carrier S�A Property Owner or Authorized Agent Date J Expires Policy# ALD7s(�� "`�7I Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property 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 representatives of this city or county to enter the above- 0 1 certify that in the performance of the work forwhich this permit is issued, I identified property for the inspection purposes. 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 -, subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. r po caner or Authorized Agent Date _ City Business License# Date;` Applicant; -_— � _-`---_ � WARNING: FAILURE O✓SECUREy 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 AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES ONO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY 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 FROM THE SOUTH COAST AIR QUALITY MANAGEMENT ElNO 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 reasons)indicated below by the checkmark(s)I have placed DYES 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, ❑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 provisions of the Contractor's Slate 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. DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING 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 Or CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than ($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING El I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING. compensation, will do ( )all of or( ) parting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT 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). I CAMPBELL ELECTRIC 17741 Sampson Lane Huntington Beach, CA 92647 (714)396-2740 Tom Cambell Lic. (C-10#302863) TO WHOM IT MAY CONCERN: This letter is to authorize CESAR MIGUEL from ENVIER Solar to obtain a building permit on behalf of Campbell Electric(C-10#302863). Valid through 12/31/2015. Sincerely, Campbell Electric Tom Campbell Notarized below: State of California, County of Subscribed and sworn to (or affirmed) before me on this day of A e)4 2015 B v OAS ' Aforesaid is personally known to me or proved to me on the basis of satisfactory evidence to be the person(s) who a peared before me. h ' Signature: �1rw J tA�/IVI (Seal) RAN,ZARI )ATTALA (� n, itsu I CAU4 gwsrn i A notary public dr other officer completing this certificato t�--\ aw� r+orasrCumruc-cnua (n verifies only the identity of the individual who signed theosF"`EoOuxrr �' M1»COMM Ex,.ME 9. 2018 document to which this certificate is attached,and not the truthfulness,accuracy,oryalidity of that document.