PMT17-02635 City of Menifee Permit No.: PMT17-02635
29714 HAUN RD.<ACCELA'> MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued:
OS/07/2017
PERMIT
Site Address: 30225 PEBBLE BEACH DR, MENIFEE, Parcel Number: 336-156-005
CA 92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of INSTALL ROOF MOUNTED SOLAR PV SYSTEM 10 MODULES, 10 MICROINVERTERS, 2.85KW
Work:
Owner Contractor
CATHERINE ZIEMIENSKI PEAK POWER SOLUTIONS INC
30225 PEBBLE BEACH DR 151 KALMUS DR STE L2
MENIFEE,CA 92586 COSTA MESA, CA 92626
Applicant Phone:7142583900
HENRY AFFRE License Number:973253
PEAK POWER SOLUTIONS INC
151 KALMUS DR STE L2
COSTA MESA, CA 92626
Fee Description QtV Amount(EI
Solar, Residential or Small Commercial 1 252.00
Building Permit Issuance 1 27.00
Additional Plan Review Electrical 110 110.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Electrical 1 12.60
$404.60
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 peril 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_Peonit_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
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for
Professions Code an y license Is in full force and effect.`' ' 2 the following reason:
License Class LI p se No. ,5 3 By my signature below 1 acknowledge that,except for my personal residence
Expires 3( Signatur in which I must have resided for at least one year priorto 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
❑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 w,ww.Ieeinf0.ca.eav/alaw.html.
this permit is issued. _
Policy# Date
have and will maintain worker's compensaton Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
se con 3700 of the Labor Code,for the performance of the workfor 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 on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier l E �Ot. I with all applicable city and county ordinances and state laws relating to
��6 ` nJ building construction.I authorize representatives of this city or county to
Policy#�204MZ26I ? Expires �—/ I 8 enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued, /`��t �}
1 shall not emotov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# y �s Z
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compen ation provisions of Section 3700 of the Labor
Code,I sRFA
ith cot p th(thhoose ppisions. Will the applicant or future building occupant handle hazardous material or a
Dafe � J mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
E T SECURE WORKER'S COMPENSATION COVE GE IS ❑Yes XNo
UNAWF , SHALL SUBIECT 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 crlf ci
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) o Yes XNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous materai reporting.
checkmark(s)i have placed next to the applicable item(s)(Section 7031.5 oyes No
Business and Professions Code).Any city or county that requires a permit to Date f ( 7
construct,alter,improve,demolish or repair any structure,priorto its PROPERTY O EX O ORIZE 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 iRRP)
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
0 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 ❑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:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors 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.
`��,Menifee
DATE 07/27/2017 PERMIT/PLAN CHECK NUMBER
TYPE: [—]COMMERCIAL (]RESIDENTIAL []MULTI-FAMILY ❑MOBILEHOME POOL/SPA []SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION QELECTRICAL []MECHANICAL
[—]NEW ❑PLUMBING [IRE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK 10 ROOF MOUNTED P.V.MODULES, 10 ATTATCHED MICROINVERTERS,2.85 KW
PROJECT ADDRESS 30225 PEBBLE BEACH DR.SUN CITY,CA 92586 p
ASSESSOR'S PARCEL NUMBER Q - IOID C0 LOT TRACT Ip 1
PROPERTY OWNER'S NAME CATHERINE ZIEMIENSKI
ADDRESS 30225 PEBBLE BEACH DR.SUN CITY,CA 92586
PHONE (951)244-2025 EMAIL
APPLICANT NAME HENRY AFFRE
ADDRESS 151 KALAMUS DR.COSTA MESA,CA 92626
PHONE (562)682-4511 EMAIL haffre562Qgmail.com
CONTRACTOR'S NAME PEAK POWER SOLUTIONS OWNERBUILDER? ❑YESONO
BUSINESS NAME 151 KALAMUS DR.COSTA MESA,CA 92780
ADDRESS
PHONE (800)265-6357 EMAIL
CONTRACTOR'S STATE LIC NUMBER 973253 LICENSE CLASSIFICATION B
VALUATION$ $ 10,000.00 FT 176 L SO FT
APPLICANT'S SIGNATUR DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN � SMIP
INVOICE ^A �QV PAIDAMOUNT
AMOUNT -'CASH OCHECKN OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT CASH %CHECK71 '.%CREDIT CARD vlsA/Mc
OWNER BUILDER VERIFIED 0 YES O NO DL NUMBER NOTARIZED LETTER O YES <' NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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Bureau Veritas City of Menifee
1665 Scenic Avenue, Suite 200 29714 Huan Road
Costa Mesa, CA 92626 Menifee, CA 92586
BV Project: 40017-039360.00 Menifee Project: PMT17-02635
Reviewer: TUNG LE, P.E/Khoa Duong, P.E Description: 2.85 KW Photovoltaic system on SFD
Direct:
General: 714 4314105
Project Address: 30225 Pebble Beach Dr.
Owner(s): James Provencher
Occupancy Group(s): R-3/ U
Construction Type: V-B
PC 1 REVIEW-APPROVED
August 4,2017
This plan has been reviewed and approved for conformance to the minimum requirements of the 2016
California Building Standards Code, as amended and adopted by the City of Menifee,California.
1665 Scenic Avenue ♦ Suite 200 ♦Costa Mesa,CA 92626
Phone: (714)431-4100 ♦ Fax: (714) 825-0685 ♦ www.us.bureauveritas.com
An Equal Opportunity Employer
Page 1 of 1
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CITY OF MENIFEE
TRANSMITTAL
Building Division
Date: 8/4/2017
Project Location: 30225 Pebble Beach Dr.
Plan Check No.: PMT17-02635
BV Project#: 40017-039360.00
Project Description: PV Solar— Catherine Ziemienski
Reviewer Date Hour Hourly
Rate Total
1st Plan Check Tung Le 8/04/2017 1.0 $110.00 $110.00
21d Plan Check
3rd Plan Check
4th Plan Check
Final Approval: Tung Le 8/04/2017 1.0 $110.00 $110.00
Bureau Veritas North America, Inc.
1665 Scenic Avenue,Suite 200
Costa Mesa,CA 92626
M: 714.431.4100 F: 714.825.0685