PMT17-01773 City of Menifee Permit No.: PMT17-01773
29714 HAUN RD. Type: Residential Electrical
<A-CCELrt' MENIFEE, CA92586
MENIFEE Date Issued: 0610912017
PERMIT
Site Address: 24689 COMANCHE CREEK DR, Parcel Number:
MENIFEE,CA 92584 Construction Cost: $8,910.00
Existing Use: Proposed Use:
Description of SOLAR TR 36485 WILLOWiREE
Work: 11 PANELS,2.97KW
LOT 2
Owner Contractor
RSI COMMUNITIES R S I COMMUNITIES LLC
620 NEWPORT BEACH CENTER DR 620 NEWPORT CENTER DRIVE#12
12TH FLOOR NEWPORT BEACH, CA 92660
Applicant Phone:9492703602
LARRY COFFEY License Number: 1015892
R S I COMMUNITIES LLC
620 NEWPORT CENTER DRIVE#12
NEWPORT BEACH, CA 92660
Fee Description city Amount(SI
Solar, Residential or Small Commercial 1 252.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Electrical 1 12.60
$294.60
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_Bldg_Permit_Template.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 perjurythat I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o 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 J� License No. �� 5 g Z By my signature below I acknowledge that,except for my personal residence
Expires 7/5///`a 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 DECLARATI i have built as an owner-builder if it has not been constructed in its entirety by
❑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
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 sy�y�y.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# A 600 /7 Z y S Date
o 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 forwhich ❑By my signature below I certify to each of the following:)am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
numberare: r application and the information I have provided is correct.I agree to comply
&Ve�f I Nq 4-1&r4 I I n SP reA,12 �UM�'+f with all applicable city and county ordinances and state laws relating to
Carder _ Y building construction.l authorize representatives of this city or county to
Policy# 71 %%00 2YS Expires 'A/Z01Q 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
a I 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#
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 Labor
Code,I shall forthwith ompl 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:FAI RE TO S j2E WORKER'S COMPENSATION COVERAGE IS o Yes DINO
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(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes A1,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) ❑Yes J2CLdo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guideand 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 far the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
hazardous material r porti
chsiness and
I have placed next to the applicable that
(Section permit X� ❑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 Oytl ER O 71( IZEDAGENT
issuance,also requires the applicant for the permit to file a signed statement J
that he or she is licensed pursuant to the provisions of the Contractor's State EPA REND ATION. EPA 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 licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 70313 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
o I,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 Contractor's 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. a No EPA Lead-Safe Certified Firm is required for this project because:
❑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.
DATE 05/26/2017 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 Solar(PV) 11 Panel 2.97kw
PROJECT ADDRESS 24689 Comanche Creek Or
ASSESSOR'S PARCEL NUMBER LOT 2 TRACT 36485
PROPERTY OWNER'S NAME RSI Communities
ADDRESS 620 Newport Beach Center Dr.12 Floor Newport Beach,Ca.92660
PHONE (951)7944705 EMAIL
APPLICANT NAME Larry CoftY
ADDRESS 620 Newport Beach Center Dr.12 Floor Newport Beach,Ca.92660
PHONE (949)230-1497 EMAIL lcoffey@rsisolar.com
CONTRACTOR'S NAME Pat Donahue OWNERBUILDER? ❑YES❑NO
BUSINESS NAME RSI Communities
ADDRESS 620 Newport Beach Center Dr.12 Floor Newport Beach,Ca.92660
PHONE (949)270-3603 EMAIL pdonahue
CONTRACTOR'S STATE LIC NUMBER 1015892 LICENSE CLASSIFICATION
VALUATION$ $8,910.00 SO L SQ FT
APPLICANT'S SIGNATURE DATE 05/26/2017
DEPARTMENT DISTRIBUTION 00 Q CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING Ey FIRE GREEN I SMIP
INVOICE A
AMOUNT PAID AMOUNT
OCASH OCHECK# OCREDITCARD VLSA/MC
PLAN CHECK FEES PAIDAMOUNT ODASH OCHECK# OCREDITCARD VISA/Mc
OWNER BUILDER VERIFIED 0YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
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