PMT15-01220 City of Menifee Permit No.: PMT15-01220
29714 HAUN RD, Type: Residential Electrical
9iCCIEL MENIFEE, CA 92586
MENIFEE Date Issued: 05/20/2015
PERMIT
Site Address: 29929 LAMPREY ST, MENIFEE, CA Parcel Number: 338-351-024
92586 Construction Cost: $5,746.00
Existing Use: Proposed Use:
Description of INSTALL ROOF MOUNTED SOLAR PV 10 PANELS 1 INVERTER 2.6KW
Work:
Owner Contractor
PRINCITA DEGUZMAN SOLARCITY CORPORATION
29929 LAMPREY ST 3055 CLEARVIEW WAY
MENIFEE, CA 92586 ATTN ZOE STEELE
Applicant Phone: 6509635630
BEVERLY MILLER License Number: 888104
SOLARCITY CORPORATION
3055 CLEARVIEW WAY
SAN MATEO, CA 94402
Fee Description Oft Amount
a; e l e I o e.cS 252;
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
$438.50
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 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
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City Of Menifee
i
LICENSED DECLARATION i
1 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 Co and my license is in full
�ect. Code:The Contractor's License Law does not apply to an owner of a property
License Cla s ( r4eicense No. who builds or improves thereon, and who contracts for the'projects with a
Expires 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
Cl following reason:I hereby affirm under penalty of perjury one of the following declarations: i
I have and will maintain a certificate of consent of self-insure for workers' g
yy9 g except m signature below acknowledge that, for
compensation,issued by the Director of Industrial Relations as provided for by P m y personal residence in
which
Section 3700 of the Labor Code, for the performance of work for which this 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
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
❑ 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:htto'(Iwww leoinfo ca.gov/calaw.html.
permit is issu d y workers'compensation insurance carrier and policy number are:
Carrier ��11 t,,,��Lc.J/✓) Property Owner or Authorize Agent Date
Expires `"1 Policy#
❑ By my Signature below, I certify to each or 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 representatives of 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 prop e 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 property Owner or Authorized Agent Date
Code, I shall forthwith comply with those provisiorps.
Date; Applicant; City Business License# 6 �1p4
WARNING: FAILURE T 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, 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
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address NO 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 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 fie 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 DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from ]!censure 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 do( ) all of or( ) porting 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 Slate 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/PLANAPPLICATION
r,
Menifee
DATE 05/08/2015 PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑ POOL/SPA ❑SIGN
SUBTYPE: []ADDITION ❑ALTERATION ❑DEMOLITION QELECTRICAL ❑ MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK residential roof mount 10 panels 1 inverter 2.6 kw
PROJECTADDRESS 29929 Lamprey St. 'IaJ oV
ASSESSOR'S PARCEL NUMBER 3-Z.AAVI ' ' CM LOT 40 TRACT
OWNER NAME Princinta Deguzman
ADDRESS same
PHONE (619)227-2241 EMAIL
APPLICANT NAME Beverly Miller
ADDRESS 41568 Eastman Dr. Murrieta,CA 92562
PHONE (951)291-8703 EMAIL bmiller2@solarcity.com
CONTRACTOR'S NAME OWNERBUILDER? ❑YES❑NO
BUSINESS NAME Solarcity
ADDRESS 3055 Clearview Way San Mateo, CA 94402
PHONE (650)638-1028 EMAIL
CONTRACTOR'S STATE LIC NUMBER 888104 LICENSE CLASSIFICATION B, CM C46
VALUATION $ $5.746.00 SO FT 181 L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION O'er l SMIP loO CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE oW PAID AMOUNT
AMOUNT ` CASH `-%CHECK# --.%CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH 0CHECK# 'DCREDITCARD VISA/MC
OWNER BUILDER VERIFIED " YES NO DL NUMBER NOTARIZED LETTER ' YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213