PMT15-01049 City of Menifee Permit No.: PMT15-01049
29714 HAUN RD.
CCCGL.t�3. MENIFEE, CA 92586 Type: Residential Electrical
6ax""""'Awk'.a MENIFEE Date Issued: 0 6/0 612 01 5
PERMIT
Site Address: 28184 BLOSSOMWOOD CT, MENIFEE, Parcel Number: 372-024-007
CA 92584 Construction Cost: $17,8%00
Existing Use: Proposed Use:
Description of INSTALL ROOF MOUNTED SOLAR SYSTEM, 14 PANELS, 1 INVERTER, 3.53 kW
Work:
Owner Contractor
AGUSTIN GARCIA VIVINT SOLAR DEVELOPER LLC
28184 BLOSSOMWOOD COURT 3301 N THANKSGIVING WAY
MENIFEE, CA 92584 STE 500
Applicant Phone: 8558772974
ROBYN YOUNG License Number: 973756
VIVINT SOLAR DEVELOPER LLC
27449 COLT COURT
TEMECULA, CA 92590
Phone: 9517193795
Fee Description Qtv Amount l$1
'Splay Reslde teal gr��ma�l OomrttGrcial , sr } � r *,� v `'�� ?. " 262'00
Building Permit Issuance _ 1 27.00
GREEN FEE 1... 1.00
$440.50
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 Cade 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 Cod a my license is in full,fore�a SeP,ct. Code:The Contractor's License Law does not apply to an owner of a property
License la s 1, License No. U I, I t(/ who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractors)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 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 I have
permit is@sue{i.G S� L0 Q I 1 r,I O
Policy# �I 7 ,) V 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
❑ 1 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:hftp-//Www.lgginfo.ga.gov/calaw.htmi.
permit is iss—t�/Uted..nM�y/woorkers'compensation insurance canier and policy number are:
Carrier f ' J �o n Property Owner or Authorized Agent Date
Expires Policy#
❑ 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
(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 representafii s of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I id ntifi d1, party for the in eon purposes. l C
shall not employ any persons in any manner so as to become subject to the J
workers'compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions of Section 3700 9khe Labor Property Owner o uthorized Agent Date y
Code,I shall forthwith omply with those pr of ' s. #3-1�^�,
City Business License# CJO
Date; Applicant;
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 A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
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
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address \❑ DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS J� 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 AYES 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, 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 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 I. UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARD US MATERIAL f�EPOR�ING.
compensation,will do ( )all of or( )porting of the work, and the structure is PROPER NE RAUTHORIZED GENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
Met'
DATE PERMIT/PLAN CHECK NUMBER —
TYPE: C COMMERCIAL RESIDENTIAL 0 MULTI-FAMILY ': MOBILE HOME POOL/SPA C.' SIGN
SUBTYPE: ADDITION C ALTERATION - DEMOLITION c�ELECTRICAL MECHANICAL
NEW ') PLUMBING RE-ROOF-NUMBER OF SQUARES SOLAR
DESCRIPTION OF WORK solar roof mount 3.53 kW DC 14 module panels
PROJECTADDRESS 28184 Blossomwood Ct [..�
ASSESSOR'S PARCEL NUMBER LOT TRACT
suilcfinS D enifeD
OWNER NAME Agustin Garcia & Safety
ADDRESS 28184 Blossomwood menifee CA 92584 APR
PHONE 951-672-7881 EMAIL rudieg@gmail.com ,.p
APPLICANT NAME Vivint Solar Developer LLC ce veed
ADDRESS 27449 Colt Court , Temecula, CA 92590
PHONE 951-719-3795 EMAIL robyn.young@vivintsolar.com
CONTRACTOR'S NAME Robyn Young OWNER BUILDER? <:- YES %XNO
BUSINESS NAME Vivint Solar Developer LLC
ADDRESS 27449 Colt Court, Temecula, CA 92590
PHONE 951-719-3795 EMAIL robyn.young@vivintsolar.com
CONTRACTOR'S STATE LIC NUMBER 973756 LICENSE CLASSIFICATION C46
VALUATION$ 17,850.00 SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE `1 PAID AMOUNT
AMOUNT 3 '.% CASH '.'CHECK q CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT CASH (:;`CHECKN ?CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED "'YES C'+ NO DLNUMBER NOTARIZED LETTER YES <; NO
faL .s u �l fee JSUItrw p ✓ iUf"Py c fj ( 4Pt 97. liau R e F fLAt x 92}e S 6,72 67;7
1
EsGil Corporation
In(Partnership with Government for ouifding Safety
DATE: 05/1/2015 ❑ APPLICANT
❑ JURIS.
JURISDICTION: City of Menifee ❑ PLAN REVIEWER
❑ FILE
PLAN CHECK NO.: PMT15-01049 SET: I
PROJECT ADDRESS: 28184 Blossomwood Ct
PROJECT NAME: Garcia 3,800 watt rooftop PV 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 Enclosures:
EsGil Corporation
❑ GA ❑ EJ ❑ PC 4/24
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858)560-1468 ♦ Fax(858)560-1576
i
i
City of Menifee PMT15-01049
05/1/2015
[DO NOT PAY— THIS IS NOT AN INVOICE] j
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Menifee PLAN CHECK NO.: PMT15-01049
PREPARED BY: Morteza Beheshti DATE: 05/1/2015
BUILDING ADDRESS: 28184 Blossomwood Ct
BUILDING OCCUPANCY: TYPE OF CONSTRUCTION:
BUILDING AREA Valuation Reg. VALUE ($)
PORTION ( Sq. Ft.) Multiplier ModIF
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code mnf IManual Input
Bldg. Permit Fee by Ordinance Tr
Plan Check Fee by Ordinance
Type of Review: ❑ Complete Review ❑ Structural Only
❑(_Re petiiive Fee Other
r Repeats L Hourly 1.5 Hrs. @*
EsGII Fee $105.00 $157.50
" Based on hourly rate
Comments: 1 1/2 hours plan review.
Sheet 1 of 1
macvalue.doc+