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PMT16-03308 City of Menifee Permit No.: PMT16-03308 29714 HAUN RD. Type: Residential Electrical <AcciELA—> MENIFEE, CA92586 MENIFEE Date Issued: 1013112016 P E R M I T Site Address: 32905 LAMTARRA LOOP, MENIFEE, CA Parcel Number: 372-331-009 92584 Construction Cost: $50.000.00 Existing Use: Proposed Use: Description of INSTALL ROOF MOUNTED SOLAR PV SYSTEM 34 PANELS, 34 OPTIMIZERS, 1 INVERTER 10.54KW, Work: REQUIRES PANEL UPGRADE TO 225AMPS Owner Contractor ROBERTFORD HELIOPOWER INC 32905 LAMTARRA LOOP 25747 JEFFERSON AVE MENIFEE,CA 92584 MURRIETA, CA 92562 Applicant Phone: 9516777755 JACOB ROUSSO License Number:915598 HELIOPOWER INC 25747 JEFFERSON AVE MURRIETA, CA 92562 Fee Description Qtv Amount($ Solar, Residential or Small Commercial 1 252.00 Building Permit Issuance 1 27.00 Additional Plan Review Electrical 158 157.50 GREEN FEE 1 2.00 SMIP RESIDENTIAL 1 7.00 General Plan Maintenance Fee-Electrical 1 12.60 $458.10 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 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 BIdgPermit Ternplate.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractods)pursuant to the Contractors State License Law). Chapter9(commenciing wilth section 7000)of Division 3 of the Business and ci I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Class— C L License No. I Irs-Z By my signature below I acknowledge that,except formy personal residence Expires Signature in which I must have resided for at least one year prior to completion of improvements covered by this perm ft.I ca nnot legally sell a structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by cr I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when cam pensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. www.Ieginfo.ca.gov/caIaw.htmI. Policy# Ewr��_C_�OC) %Los- Date ci I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which a By my signature below I certify to each of the following:I a in the property this permit is Issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property ownees beha If.I have read this number are: application and the information I have provided is correct.I agree to comply Carrier H DT- c-A-6A TAs,,r�,. with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# IF-uJ 6C -Expires �b (-LV7,D%-7 enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for criehundred Date �dollars�($ less PROPERTY OWNER OR AUTHORIZED AGENT certffy that,.,the performance of the work for which this permit is issued, I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's compensation provisions of Section 3700 of the Labo, Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a mixture containing a hazardous material equal to or greater that the Applicant JVL'-"J M"A' Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes o No UNLAWFUL,AND SHALL SUBJECr AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY u Yes ci No I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) 0 Yes 0 No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractor's License Law for the reason(s)indicated below by the California Hea Ith&Safety Code,Section 25505 a nd 25534 concerning hazardous material reporting. checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 ciYes n No Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT 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 Contmctoes State EPA RENOVATION,REPAIR AND PAINTING(RRPI License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their ci 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit; compensation,will do( )all of or( )portion of the work,and the structure is vivow.epa.govIlead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LFAD(5323). Code;The Contractor's State License Law does not apply to an owner of a ci An EPA Lead-Safe Certified Renovator Will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the improvements a re not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or Improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project bem use: o 1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement DATE(MWDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 1012112016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: the certificate holder is an DDITIONAL INSUR D,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SLIBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Owen-Dunn Insurance Services CONTACT 1455 Response Road, Suite 260 ffLONIEL Ext' 19161993-2700 1 FjU, l. (9161993-2683 Sacramento, CA 95815 "'MAN. ADDRESS, INSURER(S]AFFORDING COVERAGE NAIC# wvAq.owendunn.corn 0522677 INSURERA: HDI Global Insurance Company 41343 INSURED INSURERS: Topa Insurance Company 18031 HelioPower, Inc. INSURER C: International Insurance Company of Hannover SE 25747 Jefferson Avenue Murrieta CA 92562 rNSURER D�� IN: SU:: r REI m. COVERAGES CERTIFICATE NUMBER: 32492769 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAW:BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. KO—DL SUBR POLICY EFF KO—ElaMp LIMITS INSR TYPE OF INSURANCE INSD .M POLICYNUMBER IMMIDDn`yYYl (MMADDlYYYY1 LTR COMMERCIAL GENERAL LIABILITY EGGCC0001 10516 2121/2016 2/2112017 EACH OCCURRENCE 1.000,000 N 100,000 CLAIMS-MADEM OCCUR PREMISES 5acerrmence No Deductible MED EXP(MY one person) $ Excluded 00 PERSONAL&ACV INJURY $ 21:2200—.0-11 2 M GENERAL AGGREGATE S 00 00 GEN-LAGGREGAM LIMITAPPLIES PER, PRO- F-1 PRODUCTS- OMP/OPAGG $ 2,000,000 POLICY E]JECT LOC $ OTHER- COMBINED SINGLE LIMIT H RRENCE S "000'000 N .:connote Y. FX" C OCCU REMISES ED ,I PERSONAL&ADV"JURY GENERAL AGGREGATE PRODUCTS.C'MPIOP AIG A AUTOMOBILELIABUTY EAGCC0001 10516 2/2112016 27211201.7 (Ea ardderol $ 1,000,000 BODILY INJURY(Per Person) $ ANY AUTO — OVINED SCHEDULED BODILY INJURY(Pa,..ou.nD 5 AUTOS ONLY AUTOS PRO ERTY DAMAGE HIRED NON-OWNED 1P., roldentl AUTOS ONLY AUTOS ONLY $ UMBRfLU%LIAS .1 OCCUR XL6606765-01 2J21/2016 _�2�1/2017 EACH OCCURRENCE $ 2,000,00 7 EXCESS LIAB CLAIMS-MADE AGGREGATE 2,000,000 13 WN __F0_ N S RETE T'O --7-PER OTH TAT7 DED RETENTION S -TO—/2312016 T0_123 _/7, UTEJ�l ER /2017 E GCCO00110516 TATUTE A WORKERS COMPENSATION W 0 TY AND EMPLOYERS'UABILIL YIN EA-EnCHACCIDENT S 1,000.00 I ANInzROPRIETOMPARTNER�ECUTIVE F__1 MIA T OFFICE�EMBEREXMTUDED? E.L.DISEASE-EA EMPLOYEE S 1'000�00 HI (MandaVwy In N 7 If a dognobte under E.L DISEASE-POLICY LIMIT S 1.000,000 A I �OF 0 RATIO"below U In C 1 -02 OM lRen OF OPERATIONS below 2/21120-16 112017 Lfmit 100,000 It C Leas ted Lquipment CPRI6E08B9UZ DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES(ACORD 101.AddlOonal Remarloc Schedule.maybe attached If mom space Is mqulmd) RE:License No.915598 CERTIFICATE HOLDER CANCELLATIO" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Contractors State License Board THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Workers Compensation Unit ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 26000 Sacramento CA 95826 ALITMORMOREPRESENTATIVE Arica Dunlap @ 1988-2015 kCORD CORPORA I JUN. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 32492769 1 HELIINC-01 1 16-17 Hearse with Equ'lacent I Sylvia Garza 1 10/2112016 2:50:54 PH (PDT) I Pago I of I EsGil Corporation In Tartnersfiip witfi governmentfor Buiffing Safety DATE: 10117/2016 U APPLICANT U-,4'dRIS. JURISDICTION: City of Menifee 0 PLAN REVIEWER U FILE PLAN CHECK NO.: PMT16-03308 SET: I PROJECT ADDRESS: 32905 Lamtarra Loop PROJECT NAME: Ford l0KW rooftop Photovoltaic System The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. El The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check list has been sent to: F-1 Esgil Corporation staff did not advise the applicant that the plan check has been completed. Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: (b Fax #: Mail Telephone Fax I erson E-mail: F-1 REMARKS: By: Morteza Beheshti Enclosures: EsGil Corporation [I GA El EJ El PC 10/10/2016 9320 Chesapeake Drive,Suite 208 * San Diego,California92123 + (858)560-1468 * Fax(858)560-1576 City of Menifee PMT16-03308 10/17/2016 [DO NOT/I THIS IS NOTAN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: City of Menifee PLAN CHECK NO.: PMT16-03308 PREPARED BY: Morteza Beheshti DATE: 10/17/2016 BUILDING ADDRESS: 32905 Lamtarra Loop BUILDING OCCUPANCY: TYPE OF CONSTRUCTION: BUILDlNC3 AIR —Re M 0 PORTION q Ft.) M Mod. I Air Conditioning Fire Sprinklers TOTAL VALUE Junsdicti Cod mnf I a nua I Input Bldg, permit Fee by ordinance Plan Check Fee by ordinance Type of Review: E] Complete Review Structural Only [:]Repetiuve Fee Other @ Hourly LLF— EsGil Fee Based on hourly rate Comments: 1 1/2 hours plan review. Sheet 1 of 1 macvalue.doc+