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PMT15-03650 City of Menifee Permit No.: PMT15-03650 29714 HAUN RD. Type: Residential Electrical S-�CC=L/-> MENIFEE, CA 92586 MENIFEE Date Issued: 1 2101/2 01 5 PERMIT Site Address: 2823 BLOSSOMWOOD CT, MENIFEE, Parcel Number: 372-031-001 CA 92584 Construction Cost: $1,500.00 Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 200A Work: Owner Contractor JAMES PROVENCHER VIVINT SOLAR DEVELOPER LLC 28223 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:9513266783 Fee Description ,gty Amount 151 Services,Switchboards, Control Centers&Panels 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 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 carded on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as otherwise slated,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_Pennit 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 at rqy license Is in ful for 4 nd effect. Code:The Contractor's License Law does not apply to an owner of a property License Class (- l9 License No. 7 who builds or improves thereon, and who contracts for the projects with a Expires b� Signature licensed contractors)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ lam exempt from licensure under the Contractors'Stale 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 tha4 except for my- ..di residence in compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one ve^- prior to ., Section 3700 of the Labor Code,for the performance of work for which this impro v„vements covered by this permit,I cP- ,eqa!". ---it a structure d . .rave permit is issue �& oq �01 3 o p built as an owner-building if it has Policy# eeen consuucted in its entirety by licensee. contractors. I understawl" ,e a rrpy ;the applicable law.Section 7044 of the ❑ 1 have and will maintain workers' compensation insurance, as required by Business and r _,.,is available upon request when this application is section 3700 of the Labor Code, for the performance of the work for which this suunared n,_4^rc iuliowing Web site:hftp,/Avww.leginfo.m.gov/ralaw.htmi permit is issued.My workers'compensation insurance carder and policy number are: Carrier Eyial n Property Owner or Authorized Agent Date ` Expires 1� I�5 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 represent ves 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 ide ti property for the ins on purposes. shall not emolov 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 RrOvisi s of Section 3700 of the La property Owner or thorized Agent Date Cade,I shall forthwith comply with thos pr vis ons. n �r ��f C) City Business License# Date; Applicant; WARNING: FAILURE TO SEC RE 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, ❑YES 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 N 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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address �,_„(� FROM THE SOUTH COAST AIR QUALITY MANAGEMENT `!/4J^"_"J 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, y 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 []YES 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 N UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I';EPORIING. compensation,will do( )all of or( ) porting of the work, and the structure is PRO R �NERORA U RIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). NMI Menifee DATE 1\ PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES SCN AR DESCRIPTION OF WORK solar install 5.72 kw dc, 22 modules 1 inverter, electric panel upgrade 200amp PROJECTADDRESS 28223 Blossomwood Menifee CA 92584 ASSESSOR'S PARCEL NUMBER �;'JQ-O,?j\ -00 1 LOT TRACT OWNER NAME James Provencher ADDRESS 28223 Blossomwood Menifee CA 92584 PHONE 951-309-3283 EMAIL APPLICANT NAME Robyn Young ADDRESS 27449 Colt Court Temecula CA PHONE 951-326-6783 EMAIL robyn.young@vivintsolar.com CONTRACTOR'S NAME OWNER BUILDER? O YES1mNO BUSINESS NAME Vivint Solar LLC ADDRESS 27449 Colt Court temecula ca 92590 PHONE 951-326-6783 EMAIL CONTRACTOR'S STATE LIC NUMBER 973756 LICENSE CLASSIFICATION C46 VALUATION$ 25,000.00 SQ FT L SQ FT APPLICANT'S SIGNATURE DATE 0 DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN r SMIP INVOICE T PAID AMOUNT ` G1 � AMOUNT V 1 _1 OCASH O CHECK# OCREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER C YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213