PMT15-02922 City of Menifee Permit No.: PMT16-02922
29714 HAUN RD.
" GC OX? MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 09/21/2015
PERMIT
Site Address: 29818 PARK CITY AVE, MENIFEE, CA Parcel Number: 339-231-027
92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of MAIN SERVICE PANEL UPGRADE TO 200AMP FOR SOLAR PERMIT PMT15-02921
Work:
i
Owner Contractor
ROBERT LA GRANDE VISION INSTALLATION
29818 PARK CITY AVE 5255 N EDGEWOOD DR
MENIFEE, CA 92584 PROVO, UT 84604
Applicant Phone: 8887817074 -
KELLY BAKER License Number: 853582
VISION INSTALLATION -
5255 N EDGEWOOD DR
PROVO, CA 84604
Fee Description Qty Amount 1$1
-
�a.,
Building Permit Issuance _ _ 1 27.00
AGREE
General Plan Maintenance Fee-Electrical 1 5.80
$149.80
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 Menlfee. 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 am exempt from licensure under the Contractors'State License Law for the
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
Chapter 9 (commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence in
Professions Code and my license is in full-force and e which I must have resided for at least one year prior to completion of
License Class �' (.� License No. .�J improvements covered by this permit, I cannot legally sell a structure that I have
Expires f-.�1-I'1 Signatur 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 `
WORKERS'COMPENSATION DECLARATiON Business and Professions Code,is available upon request when this application is
submitted or at the following Web site.
,hereby affirm under penalty of perjury one of the following declarations: htto://www.leglnfo ca oovlcalaw html.
ave and will maintain a certificate of consent of self-insure for workers'
compensation, issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# +1 "'" �-}' � ❑ By my Signature below, I certify to each of the following: I am the property
I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit Is issued.My workers'compensation insurance carrier and policy number are: 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-
Carrier,! jpLf'�`�. �) _ identi ie property forte spectio purposes. ?
Policy# 8,2o10- I'S Expires ) Date
Prope y Owri Authorized JO [�Agent ('�y(This section need not be completed if the permit is for
one-hundred dollars($100)or less) CityBusiness License# ® `lio
�Lcertify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts pecified on the Hazardous Materials Information Guide?
Code, shall orthwith o ply with those provisio�n}s. ❑YES NO
Appll art ata; r ) S Will the Intended use of the building by the applicant or future building
ES
require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelin s
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND El YES ( NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS VVVV
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary cf a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES H/1TTO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist. I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous material reporting.
OWNER BUILDER DECLARATIONS ❑lyE 4NO`y— /
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
I Date 1 ,
License Law for the reasons)indicated below by the checkmark(s)I have placed OP RTY OW ER OR AUTHORIZED AGENT
next to the applicable items) (Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION. REPAIR AND PAINTING(RRP)
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 The EPA Renovation, Repair and Painting(RRP)Rule requires contractors -
provisions of the Contractor's State License Law (Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code) or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than ($500).) employees. For more information about EPA's Renovation Program visit:
www.epa,govilead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation, will do ( ) all of or( ) porting of the work, and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project because: -
contractors to construct the project (Section 7044, Business and Professions -
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a -
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
a
i
DATE PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ®RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION []ALTERATION []DEMOLITION ®ELECTRICAL ❑MECHANICAL
❑NEW [:]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Installation of Photovoltaic Solar Panels on roof of home. 6.24 KW total and
upgrade of main service panel to a 200A panel with a 100A Main Breaker. Zy odu�c$
PROJECTADDRESS 29818 Park City Ave.
Sun Ci °'A 92584
ASSESSOR'S PARCEL NUMBER �?; tr&`J'�®� p LOT - TRACT
PROPERTY OWNER'S NAME ,O�7.ey'�
ADDRESS 29818 Park City Ave. Sun City, CA 92584
PHONE t, q5i J /�,25—,�s2Q / { EMAIL
APPLICANT NAME //%� �" -7
ADDRESS k16 P— GYRO 1 G 7r7 A c/q/7� �
PHONE EMAIL
CONTRACTOR'S NAME �,/lLL OWNER BUILDER? ❑YESENO
BUSINESS NAME Vision Solar
ADDRESS 5255 N. Edgewood Dr. #125 Provo UT 84604
PHONE (888)781-7074 EMAIL
CONTRACTOR'S STATE LIC NUMBER 853582 LICENSE CLASSIFICATION C-10
VALUATION$ bl� S� �p L SO FT
APPLICANT'S SIGNATUR TE
DEPARTMENT DISTRIBUTION e CITY OF MENIFEE BUSINESS LICENSE NUMBER u
BUILDING PLANNING ENrIAIIERING FIRE GREEN SMIP V'
AMOUINVOIc'NT l4q. KID PAID AMOUNT'
<)CASH '.)CHECK OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH ':'CHECK# cJ CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED ()YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES (:. NO
City of Menifee Building&Solety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213