PMT15-03721 City of Menifee Permit No.: PMT15-03721
29714 HAUN RD.
-CA MENIFEE,CA 92586 Type: Residential Electrical
`" 5'"- MENIFEE Date Issued:
12101I2015
PERMIT
Site Address: 28881 AMERSFOOT WAY, MENIFEE, CA Parcel Number: 337-131-013
92586 Construction Cost: $2,000.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 200A
Work:
Owner Contractor
JOHN ROBINSON VIVINT SOLAR DEVELOPER LLC
28881 AMERSFOOT WAY 3301 N THANKSGIVING WAY
MENIFEE,CA 92586 STE 500
Applicant Phone:8558772974
ROBYN YOUNG License Number.973756
VIVINT SOLAR DEVELOPER LLC
27449 COLT COURT
TEMECULA, CA 92590
Phone: 9513266783
Fee Description Qtv Amount 1E1
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 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_Bidg_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 Code ap rg license is in fu f l effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class 1, l9 License No. 6 who builds or improves thereon, and who contracts for the projects with a
Expires b� 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
❑ 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- _A residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one w prior to ,
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit. I ca• _sil a structure u,o, . .lave
permit is V issueV f Soq /_0,500 built as an owner-building if it has^-.ueen ^nnsncted in its entirety by licenseu
Policy# �v lU contractors. I understand" �x a ropy;r the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation insurance, as required by Business and r' .'. siom'.jv,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this subnured mr v-fhe luliowing Web site:htto-/AN w+leginfo.m.00v/calaw.htmi.
permit is issued.Myyyw,,orkers'oompensation insurance caner and policy number are:
Carrier_GVO�SI(IIr _ Property Owner or Authorized Agent Date
Expires 1 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 owners 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 represents ives of this city or county to enter the above-
❑ 1 certify that in the performance of the work for which this permit is issued,I ide U 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 Rirovisipps of Section 3700 of the La Property Owner or thorized Age � 1Date
Code,I shall forthwith comply with thus p vis ons.
City Business License# O
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 HANDLEA 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 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
t_,(, FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address
!/�{Tr_") 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�'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(Chapter9(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($500).) CODE,SECTION 25505 25533,AND 25534 CONCERNING
El 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I'tEPOR1ING.
compensation,will do( )all of or( )porting of the work,and the structure is PRO R �NERORA U RIZEDAGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement Is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK AP PLICATION
Y2
,"Menifee
DATE 'a PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOUSPA O SIGN
SUBTYPE: OADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES S A AR
DESCRIPTION OF WORK electrical upgrade 200 amp
Ity of Menifoe
Building & Safety Dept.
PROJECTADDRESS 28881 amersfoot way
ASSESSOR'S PARCEL NUMBER ��jk- D\3 LOT TRACT{
OWNER NAME john robinson Received
ADDRESS
PHONE 951-679-4891 EMAIL jwaughrobinson@verizon.net
APPLICANT NAME Robyn Young
ADDRESS 27449 Colt Court Temecula CA
PHONE 951-326-6783 EMAIL robyn.young@vivintsolar.com
CONTRACTOR'S NAME OWNER BUILDER? YES }<NO
BUSINESS NAME Vivint Solar LLC
ADDRESS 27449 Colt Court temecula ca 92590
PHONE 951-326-6783 EMAIL
CONTRACTOR'S STATE LIC NUMBER 973756 LICENSE CLASSIFICATION C46/c10
VALUATION$ 2,000.00 SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN ( SMIP 7C
INVOICE ��++ PAIDAMOUNT
AMOUNT 1 ' O0 OCASH QCHECKN OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES C NO DLNUMBER NOTARIZED LETTER O 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