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PMT15-01168 I City of Menifee Permit No.: PMT15-01168 29714 HAUN RD. CCIEIIL MENIFEE, CA 92586 Type: Residential Electrical om snns.e MENIFEE Date Issued: 05/15/2016 PERMIT P a Site Address: 31503 SHADOW RIDGE DR, MENIFEE, Parcel Number: 372-250-015 CA 92584 Construction Cost: $29,295.00 Existing Use: Proposed Use: Description of INSTALL GROUND MOUNTED SOLAR SYSTEM, 36 PANELS, 1 INVERTER, 9.360 kW Work: Owner Contractor DALE FUNDAK HORIZON SOLAR POWER INC 31503 SHADOW RIDGE DRIVE 7100 WEST FLORIDA AVENUE MENIFEE, CA 92584 HEMET, CA 92545 Applicant Phone: 9519261176 HOLLY THOMPSON License Number: 992053 HORIZON SOLAR POWER INC 7100 WEST FLORIDA AVENUE HEMET, CA 92545 Fee Description Qtv Amount l$1 Building Permit Issuance 1 27.00 GREEN FEE 1 2.00 $442.60 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_Permil_Template.rpt Page 1 of 1 City Of Menifee a 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 C od my I'cense is in full fo e - us � Code:The Contractor's License Law does not apply to an owner of a property License C�^1I� ss I� oo cerise ehNo. who builds or improves thereon, and who contracts for the projects with a { Expires �1 K Signature V licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECL ❑ 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 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 s+ o:-.dre that I have permit is issued. Policy# built as an owner-building if it has not been constnict-�';o its en,—, .., contractors. I understand that a coov r"t!. dpoFcablr 4aw, Section 7G4.. ,t coo I have and will maintain workers' compensation insurance, as required by Business and Professions Code is ar' , _„pun 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:httoi//www.leqinfo.ca.gov/calaw.htmi. ermit is issu. .My workers'compensation insurance carrier and policy number are: Carrier&�TAk C Property Owner or Authorize gent Date - Expires Policy# �_O b-7-"1 ' ❑ 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 provload is correct. I a e to comply one-hundred dollars($100)or less) with all applicable ci and ount ordinances and slate laws re ti g to building constructio.. auth n ep ese tatives of this city or county to ant r the above- ❑ I certify that in the performance of the work for which this permit is issued,1 1 entifi roperty f r the 1 pect n ppur as. shall not employ any persons in any manner so as to become subject the workers' compensation laws of California, and agreyt h uld b come S subject to the workers'compensation provisions o/Saction 70 o th Labor ro rt d Agent Date Code, I shall forthwith comply with th sN isi p y g -g fusine e# d � L Date; S Applican WARNING: FAILURE TO SECUR ORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNIL 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 EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY r 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION �/p FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address -1 DISTRICT (SCAQMD) SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS 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 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, 1XO 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 ry S INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from licensure and the basis for the alleged exemption. Any J` CHECKLIST. I UNDERSTAND ,,,MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to El NO UNDER THE STATE OF CALIFORI 11A HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 5533 NO 25534 CONCERNIN ❑ I, as owner of the property, or my employees with wages as their sole y\AZARDOU MATERIAL ORl'I G. compensation, will do ( )all of or( ) porting of the work, and the structure is PRQPERT O NER O A T 0 1 ED 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 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- Bullder will have the burden of proving that it was not built or Improved for the purpose of sale).