PMT17-02062 City of Menifee Permit No.: PMT17-02062
29714 HAUN RD. Type: Residential Electrical
<ACCEIIL� MENIFEE, CA 92586
MENIFEE Date Issued:
08/22/2017
PERMIT
Site Address: 23441 OHIO PL, MENIFEE, CA 92587 Parcel Number: 350-152-007
Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of INSTALL MAIN PAIN UPGRADE TO A 225 AMP
Work:
Owner Contractor
ANDREW CORTES MOHR POWER SOLAR INC
23441 OHIO PLACE 1452 POMONA ROAD
MENIFEE,CA 92587 CORONA,CA 92882
Applicant Phone:9517362000
MIKE MOHR License Number:661434
MOHR POWER SOLAR INC
1452 POMONA ROAD
CORONA, CA 92882
Fee Description Qly Amount 1$1
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_Bldg_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter-9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Cade d m license is in full force and eff ct. I the following reason:
License Clas �AU License N - 1 By my signature below I acknowledge that,except for my personal residence
Expires 1116 Signat re 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 DECLA TION 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 ropy 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 ,le info.ca: ov c aw.htm
this permit Is iy/sssed. (,�'(`� L—`�
Policy# �"II O� IV 1 n ✓ Date v�
PROPIERTY OWNER OR AUTHO ZED AGENT
❑I have and will maintain worker's compensation insurance,as required by
section 3700 of the labor Cade,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation Insurance carrier and policy owner or authorized to act an the property owner's behalf.I have read this
number ar ) application and the information 1 have provided is correct.I agree to comply
:
Carrier I y `�Mrd I I 'V tv tIr V l wJ with all applicable city and county.ordinances and state laws relating to
// building construction.I authorize representatives of this city or county to
Policy#� M es 1 ent rtke above identified property fog inspection purpos sr./1'r/f/
(This section need not to be completed is the permit is for one-hundred , Date v v
dollars($300)or less PRdRpVrY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not emolov 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 shlmrthwith for ply .th those provisions. 2 I Will the applicant or future building occupant handle hazardous material or a
Applicant Date 7/ mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING: LURE TO SECURE WORKER'S COMPENSATION COVERAGE IS. ❑Yes ❑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 o Yes ❑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 ❑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 Health&Safety Code,Section 25505 and 25534 concerning
ha dous material reporting
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oy �Z I�
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repair any structure,priorto Its pR P TY OWNER ORA HORI2 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contactors
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
❑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( I portion of the work,and the structure is www.epa.gov/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 Ucense Law does not apply to an owner of a ❑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. ❑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.
APPLICATION:ILDING & SAFETY PERMIT/PLAN CHECK
Jb •
r
Menifee
DATE PERMIT/PLAN CHECK NUMBERQZO�7-
TYPE: [-]COMMERCIAL RESIDENTIAL [-]MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION []ALTERATION []DEMOLITION BJELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING [I RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Mfl�k1 ?FhJI=1 +O rAp pRiJL
PROJECTADDRESS 'Z 344 1 hvlj 0 P(A('` cL 04 QZ
ASSESSOR'S PARCEL NUMBER JrJ 0 I 5 219D LOT TRACT
PROPERTY OWNER'S NAME 1qT-(VaEA/.( (�!�-I'rr 5 �i
ADDRESS � P.1(�Q-F �� C('��tS -234'4 oy, P4 ., O 1\ DI\I L.)II`O�-- C
n
PHONE '/ S/ l50, C/- 115 EMAIL 4VL' Jze'glC�'�
APPLICANT NAME 'I �r11 ��hh
ADDRESS I�S rZ R�i�/1L-K a Kl1D . �.( eel, Ire- (,la- 9zii, '-
PHONE �!•7��, C� EMAIL jVC'IZ21' CaMchIU21 uG/✓. A
CONTRACTOR'S NAME 1'M'KE OWNERBUILDER? OYES ONO
BUSINESS NAME Mot+1Z. P0 We-i2- S A'L -j,4 C .
ADDRESS 1452. 'jDOMIaI44 }2F) Cloi9oAIFa 04 qZ Z
PHONE n5); 73(r. ZCCO EMAIL Mc2Re C ),,AvN1Z;P0W,s2.,, G: w,
CONTRACTOR'S STATE LIC NUMBER tvI 434 LICENSE CLASSIFICATION
VALUATION$ I SDO SO FT / ( 4 L SO FT
APPLICANT'S SIGNATURE DATE I�
1
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE PAID AMOUNT AMOUNT ' 0CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-6 72-6 77 7
www.cityofinenifee.us Inspection Request Line 951-246-6213
i
Mohr Power Solar, Inc.
1452 Pomona Road, Corona CA, 92882
Let us plug you into the Sun "
htti)://www.mohrl2ower.com
Toll FREE: (800) 637-6527 /Tel: (951) 736-2000
Fax: (951) 736-0074 Lic: 661434 CA C-46
LETTER OF AUTHORIZATION
I hereby authorize the following to act as my agent(s) in obtaining permits in California:
Shane Mohr
Sarah Brittany Mohr
Tawnya Mohr
Bill Hannon
Frank Hernandez
Nancy Cohee
Charlie Carpenter
Larry Carpenter
Morri Mohr 9,
Frank Contreras Cl
Javier Luna (�
This authorization is to remain in effect until December 31, 2017, unless cancelled in
writing by t;777
ed: f
� l( Michael F. Mohr
r
Contrac or's Signature Printed Name
A notary public or other officer completing this
State of California certificate verifies only the identity of the
individual who signed the document to which this
certificate is attached,and not the truthfulness.
COUNTY of RIVERSIDE eccuracy.or validity of that document.
On ��je . ,>)7 2016 before me, %r Z-A'�dJiir!
(Here insert name and title of the 6fficer)
\Personally appeared
who proved to me on the basis of satisfactory evidence to be the person whose name is
4ubscribed to the within instrument and acknowledged to me that he executed the same in
\s authorized capacity,and that by his signature on the instrument the person, or the
'ity upon behalf of which the person acted, executed the instrument.
ify under PENALTY OF PERJURY under the laws of the State of California that
-egoing paragraph is true and correct. CULE7TE 1.cGRDON
COMM. #2118693 z.,
SS my hand and official seal = Nolary Public-Calihtmid u
� j Riverside County
y�Lb�� l� l'� ry1Y Comic F�Pires Art .4.2E19
Votary Public �C� (Notary Seal)