PMT17-02956 City of Menifee Permit No.: PMT17-02966
29714 HAUN RD.
rACCEI-A? MENIFEE,CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 0 813 112 01 7
PERMIT
Site Address: 28748 TUPELO RD, MENIFEE, CA 92584 Parcel Number: 372-072-010
Construction Cost: $0.00
Existing Use: Proposed Use:
Description of INSTALL 12 ROOF MOUNTED PV MODULES, 12 MICROINVERTERS,210 SO FT
Work:
Owner Contractor
PATRICIA FOWLER PEAK POWER SOLUTIONS INC
28748 TUPELO RD 151 KALMUS DR STE L2
MENIFEE, CA 92584 COSTA MESA, CA 92626
Applicant Phone: 7142583900
PEAK POWER SOLUTIONS INC License Number:973253
151 KALMUS DR STE L2
COSTA MESA, CA 92626
Phone:7142583900
Fee Description QtV Amount($I
Solar, Residential or Small Commercial 1 252.00
Building Permit Issuance 1 27.00
Additional Plan Review Electrical 110 110.00
GREEN FEE 1 0.00
SMIP RESIDENTIAL 1 0.00
General Plan Maintenance Fee-Electrical 1 12.60
$401.60
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 carded 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_Bidg_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 contractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure underthe Contractor's State License Law for
Professions Code an y license is in full force and e� ?ffyect. ✓ the following reason:
License Class U pRse No. -1 + ��Z By my signature below I acknowledge that,except formy personal residence
Expires -3 I Gl Signatur 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
❑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
this permit is issued. www.leeinfo.ca. au calaw.html.
Policy If Date
9Vhave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
se ion 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 workers 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 J G ( with all applicable city and county ordinances and state laws relating to
S�r} (� '
,` (' building construction.I authorize representatives of this city or county to
Policy#y 2 c4MLI '3�:-'I ') Expires �— �r , S 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 cerpfy 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#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compenption provisions of Section 3700 of the Labor
Code,IsBallor with co TOY, th hose provisions. Will the applicant or future building occupant handle hazardous material or
II 4 d6 7 mixture containing a hazardous material equal to or greater that the
Applican Date T j 7�/ amounts specified on the Hazardous Materials Information Guide?
WARNING:FA I�jRE TO SECURE WORKER'S COMPENSATION COVE"GE IS a 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 ❑Yes rv'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 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 material 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 permRto
construct,alter,improve,demolish or repair any structure,prior to Its
PROPERTY O GENT
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(FIRM
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
❑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.epa:eoy/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:
❑I,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.
pU vEP
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Bureau Veritas City of Menifee
1665 Scenic Avenue, Suite 200 29714 Haun Rd.
Costa Mesa, CA 92626 Menifee, CA. 92586
BV Project: 40017-039468.00 Project: PMT17-02956
Reviewer: Khoa Duong, P.E Description: Roof Mounted PV System
Direct: 714-431-4123
General: 714-431-4100
Khoa.duong@us.bureauveritas.com Project Address: 28748 Tupelo Rd
Owner(s): Patricia Fowler
Occupancy Group(s): R-3/U
Construction Type: V-B
PC 2-APPROVED
August 28,2017
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: 8/28/2017
Project Location: 28748 Tupelo Rd
Plan Check No.: PMT17-02956
BV Project#: 40017-039468.00
Project Description: PV Solar— Patricia Fowler
Reviewer Date Hour Hourly
Rate Total
1st Plan Check Khoa Duong 8/28/2017 1.0 $110.00 $110.00
2n1 Plan Check
3rd Plan Check
41h Plan Check
Final Approval: Khoa Duong 8/28/2017 1.0 $110.00 $110.00
Bureau Varitas North America, Inc.
1665 Scenic Avenue,Suite 200
Costa Mesa, CA 92626
M: 714.431.4100 F: 714.825.0685
Menifee
DATE 08/16/2017 PERMIT/PLAN CHECK NUMBER MT —D2,L'1 Y/
TYPE: [-]COMMERCIAL ❑✓ RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME POOL/SPA []SIGN
SUBTYPE: ❑ADDITION []ALTERATION []DEMOLITION ❑✓ ELECTRICAL ❑MECHANICAL
❑NEW []PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 12 ROOF MOUNTED P.V.MODULES, 12 MICROINVERTERS,210 SOFT
PROJECT ADDRESS 287MTUPELO RD.MEN�I-F7EE, CA 9257844
Lj
ASSESSOR'S PARCEL NUMBER 312'C I--O� y LOT �T21 TRACT ��
PROPERTY OWNER'S NAME PATRICIA FOWLER
ADDRESS 28748 TUPELO RD.MENIFEE,CA 92584
PHONE (951)679-3090 EMAIL
APPLICANT NAME HENRY AFFRE
ADDRESS 151 KALAMUS DR.SUITE L-2,COSTA MESA,CA 92626
PHONE (562)682-4511 EMAIL haffre562Qgmail.com
CONTRACTOR'S NAME PEAK POWER SOLUTIONS OWNER BUILD 7 ❑YESRINO
BUSINESS NAME g0ildin;
ADDRESS 151 KALAMUS DR.SUITE L-2,COSTA MESA,CA 92626 pUG "l 20
PHONE (800)265-6357 EMAIL r.
CONTRACTOR'S STATE LIC NUMBER 973253 LICENSE CLASSIFICATION
VALUATION$ $ 12,000.0 210 L SQ FT
APPLICANT'S SIGNATURE DATE 08/16/2017
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT <%CASH OCHECKp 'CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH `?CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED ",YES + NO DL NUMBER NOTARIZED LETTER C YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee; CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 95.1-246-6213