PMT17-01768 City of Menifee Permit No.: PMT17-01768
29714 HAUN RD.
4-ICCEL/k? MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued:
06/20/2017
PERMIT
Site Address: 29936 CORTE CRUZADA, MENIFEE,CA Parcel Number: 340-083-008
92584 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of INSTALL NEW METER SOCKET, ONE(1)220 RECEPTACLE, 125A SUBPANEL,ONE(1) UTILITY BOX
Work: FOR EV CHARGING STATION
Owner Contractor
CHARLES CARTER CURRENT POWER ELECTRIC INC
29936 CORTE CRUZADA 36884 RED OAK STREET
MENIFEE, CA 92584 WINCHESTER,CA 92596
Applicant Phone:9514402441
KAYLA VONMOOS License Number.993291
CURRENT POWER ELECTRIC INC
36884 RED OAK STREET
WINCHESTER, CA 92596
Fee Description O_yt Amount lE)
Services, Switchboards,Control Centers&Panels 1 116.00
Receptacle,Switch, Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 5.80
$265.80
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_61dg_Pe=1t_Temp1ate,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 contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effect.2 n the following reason:
License Class License No. � 7 (I I By my signature below I acknowledge that,except for my personal residence
Expires S I Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot 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
o 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 workers 7044 of the Business and Professions Code,is available upon request when
compensation,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 www.Ieeinfo.ca.gov/caIaw.htmI.permit is issued.
Policy g Date
❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the fallowing:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
numberCare:1 application and the information I have provided is correct.I agree to comply
Carrier )1Q\C C*[Y�py\Sajien �f�sU�unce E'^it� with all applicable city and county ordinances and state laws relating to
r I building construction.l authorize representatives of this city or county to
Policy p 9 15 G S 7 7—Z 0I Expires 12/Q J1� enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑1 certify that in 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 N
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Cade,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant ` —' Date Q mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o No
UNLAWFUL,AND SHALL SUBJECT 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 OYes nNo
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) D Yes O 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
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item hazardous material reporting.
$)(Section 7031.5 oyes o 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 Iicensure 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
❑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 www.eoa.eov/lead or contact the National Lead Information Center,at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o 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 are 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 because:
o I,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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Y 'iy
i Menifee
DATE Le II, Ly 111PERMIT/PLAN CHECK NUMBER Q„
TYPE: ❑COMMERCIAL ziRESIDENTIAL MULTI-FAMILY n MOBILE HOME n POOL/SPA SIGN
SUBTYPE: [-]ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL []MECHANICAL
NEW EIPLUMBING RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK A��6 ',�QCC(\A MO&C C V\q Q ,
Pta e
PROJECTADDRESS I (p ac e y-ck& q City of Menifee
8ufldi afety Dept.
ASSESSOR'S PARCEL NUMBER S\\__YOCS3O03 LOT TRACT a 2y )
PROPERTY OWNER'S NAME 6)G Q(A �/�t g�
ADDRESS ) CO (' Q 0. 1 ` 1 QR�1 Q C !lE'.1Ci ived
PHONE C1S I- (095 -,94 00 EMAIL
APPLICANTNAME Q 1 Q UQ A M 00 S
ADDRESS Co Q„Q Q izc 0 Qc(Aa Q
PHONE q 1-1515 a 400 EMAIL rn
CONTRACTOR'S NAME Q Q OWNER BUILDER? MYESMNO
BUSINESSNAME UC Q WQ(' I ('1 ''``
ADDRESS QC Q Q Q # U (R)S O
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER C1 Q 13a�j l` LICENSE CLASSIFICATION
VALUATION$ � 5)n SOFT a/ GI LSQFT 1010�
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP �C
INVOICE11Q PAID AMOUNT
AMOUNTSol OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.citycfinenifee.us Inspection Request Line 951-246-6213
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Single Meter Sockets -Without Bypass
125 & 200 Amp
Application
• .,,u,.,.. y,� • Single meter position
• Receive ANSI C12.10 watthour meters
•• • Surface or flush mount(see chart)
Construction
• Ring type
• NEMATypa 3R
• ANSI 61 gray E-coat finish
• Aluminum snap ring included
Standards Accessories A,
• UL 414 Listed • 5th Jaw Kit-50365 W
1111(closed) U204(apen) a ANSI C12.7 a 200ATriplex Ground-ETB200
• AW Hub
Pano r�r
NumUpcber Catalog Amp Service cannectims � �
Number Number Regnp Jews Type Access Line
Load -Neutral
+.r` 782057420d0.': aeH' ' .:115. 4' 10/3W OH/UG CT
78205142040 Oil F '. 14
125 A 0
10/3W OH/UG #14-1/0 #14-1/D 14-2/0
.78265142045. .:Oi1Ms73 :125 4 10/3W .OH/UG 114'-1/0 ', #14.IM #14-2J0
78205142050 D11 SF 125 4 10/3W OHAJG 114.1/0 #14-110 #14.2/0
782051d403p 927 ' ,; (:100 : ] 30/4W : _ OHNG #14.1/0 #14-1/0 " 114.2/D-
78205156000 204 200 4 10/3W OH A-250MCM #6-250MCM #6-350MCM
7820516502D' IN Ft - '.. 100 ' _ . .4: -10AW OH d6-250MCM.
78205156030 204 F M973 200 4 10 W #0-260MCM #5-350MCM
/3 OH #6-250MCM #6-250MCM #6 350MCM
782(1515§040r. .A ., SOB .:: 200� � 4. :. •.. 10/3W #6r250MCM:';;, 46-250MCM.., #6,350MCM
18205156035 204MSfi8A 200 4 10/3W OH #6-250MCM #6-250MCM #6-350MCM
7B205106490. :-g44MS73- 200 .4 . 10/aw - OH :.d'6=260MCM #6-258M0M ' d6.360MCM 782D5156005 U209 200 4 1013W UG #6-250MCM #6.250MCM 16.350MCM
`7620515.045 1)*IF - 200 4 .. 10/3W . UG 46-25WCM A.250MCM #61360MCM
78205156060 U284 IF MS73 200 4 10/3W UG #6-250MCM #6-250MCM #6-350MCM
.76205156070: ' U2.W.MS73 200 4: 10AW us /6=250MCM" 1116.250MCM -"A-36gMCM
78205156140 U207 200 7 3014W OH/UG 46-250MCM #6-250MCM #6-250MCM
782056170.". 'U2071' :. ,. 200.. . 7. 30/4W UG #6-250MCM #6-250MCM #6-250MCM
78205156180 U207 MS73 200 7 30/4W OHNG dG-250MCM #6.250MCM #6-2SOMCM
Pan/UPc Catalog - overall Dimensions ---
Number Number Haight Ada Depth Provision Knockout
Layout
7 8 2051 420(g: oil - . 12. - •.F.7 4110' AW Hub' Fig..,
78205142040 Oil F 12' 8" 45/e 2"max KO Fig.1
:70205142045. elf MS73 a2": 8' 45/a" AWHub Fig.t
78205142050 Oil SF 12' 8" 41/e" 2"max KO Fig.1
78205144030 ii& 11" B'• 'Off AWHub Fig.1•
70205156000 204 15" 8" 41/e AWHub Fig.2
76205156020, .204 F: - 15^. 6^_. . . . g••_, 2"max KO' R6,2 -
78T05156030 2g4 F MS73 15" 8" 6" 2"max KO Fig.2
782g5156040.. 44 MS68..... : .
15" V 'qb/a" AW/2"Huh Rg,Z•
78205156035 204MS68A 15" 8" 45/a" AW/2"Hub Fig.2
I8205106990 204 MS73 15 8" 44/a" None Fig.2
7810515G005 U204 15" 12' 41/9" None Fig.3
78205156045; U204 F .151. 12" : 6", 1212"max KO Fig.3
78205156060 U204 F MS73 15" 12" 6" None Fig.3
782o5156070 -0264MSTF - 15' • ..12" 4'/e" None Fig.3
78205156140 U207 l8" 12' 5" AW Hub Fig.
702.0515617l) U207 IF ._. '18' . . 12" S. r AIC Nate:
2h"max KO Fig.4 For short circuit current
78205156180 U207 MS73 18" 12" 5" AW Hub Fig.4 ratings see page 131.
B-Une Data subject to flange without notice-Consult local utiiiry for area acceptance.All dimensions are in inches.
by rjTsN 5 Meter Mounting Equipment
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Catalog Number, SC214
Item Descriptlrn: 400A 1 PH 2p BUS GUTTER
MILBANK' UPC Code' 784572111318
rNEROYA'r WORK
Brand Name: Milbank
Type: Wire 1'ereninat=cn
Special Features: tingle Ph ass Three Wirw; i
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Connectlon:
Single Position r.AWG to F1'A kcmil
Line Sida Lugs,2 Positions 6 AWG to L'7Fi"i°
250 kcatil Load Sid,.Lugs I "..y-"—
Constractian: Type 3R,GPO Galvani].ed Steel
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ENERGV I Renewable Energy VEHICLE
TECHNOLOGIES PROGRAM
Electric Vehicle Supply Equipment (EVSE) Test Report: Voltec 120V
EVSE Features
Low and High Current Settings Integrated Flashlight EVSE Tested
Auto-restart Voltec 120V
EVSE Specifications Level
1
Modelel No.2024191
Grid connection Plug and cord NEMA 5-151
Connectortype J1772
Test lab certifications ETL Listed
Approximate size(H x W x D inches) 16 x 9 x 4
Charge level AC Level 1
Input voltage 120 VAC
-,
Maximum input current 12 Amp `4
Circuit breaker rating 20Amp K .
.
Test Conditions'
Test date 9/4/2012
Nominal supply voltage(Vrms) 117A5
Supply frequency(Hz) 59.99
Initial ambient temperature CF) 58
Test Vehicle'.3
Make and model 2012 Chevrolet Volt
Battery type
Li-ion
Steady state charge power(AC kW) 1.36
Maximum charge power(AC kW) 1.45
EVSE Test Results1,2.4
EVSE consumption prior to charge(AC W) 3.6
EVSE consumption during
steady state charge(AC W) 4798 _
EVSE consumption post charge(AC W) 3.6
Efficiency during steady state charge 96.62%
rs Charge Start
r Charge End
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NOTE: Charge start and charge and power demand curves are dependent upon the vehicle T me(e)
Features and Specifications Reference: http9/nctco&org/imns/air/programs/evnt/ContractorinsPectOrOutmachTexmMay2011.pdf
1.Hioki 3390 Power Meter used for all current and voltage measurements
2.Measurements were taken at EVSE grid connection and 51772 connection
3.Steady state charge power is the most common power level dictated by the vehicle during the charge
4.Steady state charge refers to the portion of the charge when power was greater than or equal to steady state charge power
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INUEn-11-23986
• DO NOT USE WITH AN EXTENSION CORD. .
• USING WITH A WORN OR DAMAGED AC OUTLET
=� MAY CAUE BURNS OR START AFIRE,
• IF THE A ALL PLUG FEELS HOT WHILE CHARGING,
UNPLUG THE UNIT AND REPLACE THE AC OUTLET.
• DO NOT USE THIS PRODUCT IF THERE IS DAMAGE
TO THE UNIT, FLEXIBLE POWER CORD OR EV CABLE.
• NO USER SERVICEABLE PARTS"INSIDE.
• UNIT WILL ATTEMPT TO RESET IN FAULT
CONDITIONS.
• FOR USE WITH ELECTRIC VEHICLES.
• VENTILATION NOT REQUIRED.
• NE PAS UTILISER AVEC UN CABLE DE RALLONGE.
• L'UTILISATION AVEC UNE PRISE C.A. USEE OU
ENDOMMAGEE PEUT PROVOQUER DES BRULURES
OU UN INCENDIE.
• SI LA PRISE MURALE C.A. EST CHAUDE AU
TOUCHER PENDANT LA CHARGE, DEBRANCHER
L'UNITE ET REMPLACER LA PRISE C.A.
• NE PAS UTILISER EN PRESENCE DE DOMMAGES
A UUNITE, AU CORDON D'ALIMENTATION
FLEXIBLE OU AU CABLE EV.
• NE COMPORTE AUCUNE PIECE REPARABLE PAR
L'UTILISATEUR.
• EN CAS DE DEFAUT, L'UNITE TENTERA DE CE
REINITIALISER.
• POUR UTILISATION AVEC DES VEHICULES
ELECTRIQUES.
• VENTILATION NON REOUISE. 0
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