PMT17-02636 City of Menifee Permit No.: PMT17-02636
29714 HAUN RD. Type: Residential Electrical
�/-�CCELh? MENIFEE, CA 92586
MENIFEE Date Issued:
0712812017
PERMIT
Site Address: 25595 DORADO DR, MENIFEE, CA 92586 Parcel Number: 339-153-023
Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 200A
Work:
Owner Contractor
RICHARD OSBURN D T E
25595 DORADO DRIVE 5753 EL PALOMINO DRIVE
MENIFEE, CA 92586 RIVERSIDE, CA 92509
Applicant Phone:9514440379
License Number:978905
Fee Description Qtt( Amount 151
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.
CONDITIONS
Condition Comment
1 C-10 LIC
AA_Bldg_Permil_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 perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 70D0)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. q the following reason:
License Oass L — to License No. '7 7 /(, By my signature below I acknowledge that,except for my personal residence
Expires &7O rg Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that 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 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 fallowing website:
by Section 3700 of the Labor Cade,for the performance of work for which ,www.leeinfo.ca.epv/calaw.html.
this permit is issued.
Policy# Date
1 have and will maintain worker's compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
4section 3700 of the Labor Code,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 on the property owners behalf.I have read this
number are:a�JJ_ I_ application and the information I have provided is correct.I agree to comply
Carrier 51Zs'JG with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires / enterthe above identified propertyfor 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,
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 workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith c .vY those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date /OVER!ACEIS
� 7 mixture containing a hazardous material equal to or greater that the
amounts splicified on the Hazardous Materials Information Guide?
I WARNING:FAILURE TO SECURE WORKER'S COMPENSATION ❑Yes 0mo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECHON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)7_See permitting checklist _
for guidelines
CONSTRUCTION LENDING AGENCY o Yes Ao
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) a Yes Ao
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material rep in
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 pYes ❑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 OWI ER 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 licensure
receiving compensation for most work that disturbs paint in ape-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($50D). 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( )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 Renovatorwill 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 City of
contractors to construct the project(Section 7044,Business and Professi lid ng & Safety Dept'
Code:The Contractors State License Law does not apply to an owner of a If oj� ect does not comply with EPA RRP rule please fill out the RRP
JUL 2AJn` Ugement.
solat
MAX
TerLnology.Inc.
July 27,2017
Permitting Authority
Building and Safety Department
RE: Authorization for agent to secure permits from 7-27-2017 to 7-27-2018
To Whom It May Concern:
Please allow Jorge Comejo of D T E to act as an agent on behalf of D T E to apply for, sign I g
for, and purchase, Electrical and Building Permits and associated requirements for O
Photovoltaic/Solar System, which will be installed by D T E. 5
U
LL 1
Should you have any questions regarding this information,please contact me at(716)863-01630 =
Sincerely, WA
DTE n
Name DANIEL MARK TILLMAN
Title SOLE OWNER
Contractor's License: 978905 C-10
=-bn
E lA iORREp' 049266 zz California �'DTE o County5753 EL PALOMINO DRIVE Nov' 17,2017
RIVERSIDE, CA 92509
Business Phone Number:(951) 444-0379
City of Menifee
Sullding & Safety Dept,
3080 12nn St.,Riverside,CA 92507 JUL 2 8 20V
TEL:(951)300-0788/FAX:(951)213-3099
W W W.SOLARMAXTECH.COM
Received