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PMT17-03369 City of Menifee Permit No.: PMT17-03369 29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Electrical MENIFEE Date Issued: 09/28/2017 PERMIT Site Address: 27686 LACOSSE ST, MENIFEE,CA Parcel Number: 360-592-003 92584 Construction Cost: $24,900.00 Existing Use: Proposed Use: Description of PV SOLAR 6.622 KW, 26 MODULES&26 MICRO INVERTERS Work: Owner Contractor KEITH ADAMSON NEW DAY SOLAR 27686 LACOSSE STREET 23811 WASHINGTON AVE STE C110 MENIFEE, CA 92584 #224 Applicant Phone: 8554446329 BRANDON CARLSON License Number:812958 NEW DAY SOLAR 23811 WASHINGTON AVE STE C110 #224 MURRIETA, CA 92562 Fee Description (3yt Amount I$) Solar, Residential or Small Commercial 1 252.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 65 64.55 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 4.00 General Plan Maintenance Fee-Electrical 1 12.60 $361.15 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_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 herebyaffirm under with a licensed contractors)pursuant to the Contractors State License Law), penalty of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from Iicensure under the Contractor's State License Law for Professions Code and my lic nse is full force and effe t. the following reason: License Classt t lV Lice w No. � By my signature below I acknowledge that,except for my personal residence Expires ! f� Signat in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DEC RATIO/I 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 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 www.leginfo.ca.aov/caWw.h[mI. this permit is issued. Policy R Date s�ve 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 for which a 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 an on the property owners behalf.I have read this number are: j� application and the information I have provided is correct.1 agree to comply Carrir - Cam/ * withal) conic able cityruction. and uthountyordis ordinances and state laws relating county to building construction.I authorize representatives of this city or county to Policyg xoires enter the above identified property for Inspection purposes. l (This section need not to be completed is the permit Is for one-hundred Date_ dollars($lO0)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 k worker's compensation laws of California,and agree that if 1 should become HAZARDOUS MATERIAL DECLARATION subject to thew rker' mpensa' ovisions of Section 3700 the La or Code,I sh o I wi comply w ose provisions. / / Will the applicant or future building occupant handle hazardous material or a Applic nt z Date � mixture containing a hazardous material equal to or greater that the amounts spa�� d on the Hazardous Materials Information Guide? WARNING. ALLURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 a yes ergo 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 SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAOMD)?See permitting checklist for guidelin�a' CONSTRUCTION LENDING AGENCY ❑yes d . I hereby affirm that under the penalty of perjury there Is a construction Will the propose Ilding or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is Issued outer bound of a school? (Section 3097 Civil Code) a Yes srAo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAOMD hereby affirm under penalty of perjury that i am exempt from the Permitting checklist.I understand my requirements under the State of Californi eaI In&Safety Cod [Lion 25505 and 25534 concerning Contractors License Law For the reason(s)indicated below by the has ous material repo rl checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 WPRR Business and Professions Code).Any city or county that requires a permit to Dat construct,alter,improve,demolish or repair any structure,prior to its NER UTHORIZED 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(RRP1 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(5500). managers who do the paint-disturbing work themselves or through[heir ❑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.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(5121). 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: a 1,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 RAP rule please fill out the RRP Acknowledgement BUILDING i SAFETY PERMIT/PLAN CHECK APPLICATION kMenifee DATE: qZ ! PERMIT/PLAN CHECKNUMBERPtATI�I-033LO� TYPE: O COMMERCIAL Vf RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN ---- — - -- — --SUBTYPE:--O-ADDITION—O-AUTERATION- O-DEMOLITION ol—LECTRICAL O-MECHANICAL ONEW OPLUMBING ORE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK lel 4Ab ` PROJECT ADDRESS 2 �_1,2R ZV?695S`I�, A'4' CA ZIP 7_5-1 ASSESSOR'S PARCEL NUMBER 0 5 )0 J LOT TRACT OWNERNAME JAI/IoLH/'�c� �� 1669q_ ADDRESS (�J/� /,a2CdSS��/ CA '7 PHONE `( "��Z EMAIL APPLICANT NAM�EQ f a) q6>`-� G� !� yJ ,��,y, p ADDRESS Z,J V! � �1//(�d/ (( -, Ave-- JUL g D �( /•'r/YrIc6- (A -l0 J PHONE �Y n CONTRACTOR'S NAME &0 ,1� /;1jr- OWNER BUILDER? O YES A"NO BUSINESS NAME ltlel4l (l �A q� ADDRESS ��D�OJZ2A� �/I'Nei� CrJ �G�Z PHONE g' `b /g r EMAIL �{ J�9 Q/�p✓ � /�`Z CONTRACTOR'S STATE /LICCNUMBER `O I LICENSE CLASSIFICATION VALUATION$ T 'i 0 0 ✓ L SO FT APPLICANT'S SIGNATURE%- " e DATE CLTY STAFF USE ONLY --� DEPARTMENT DISTRIBUTION ACCEPTED BY: �/CIT 01( F ENIFEE BUSINESS LICENSENUMBER BUILDING PLANNING ENGINEERING FIRE PERMIT FEE OI , ( SMIP GREEN PLAN CHECK FEE INVOICE TOTAL OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER YES O NO City of Pilenifee Building &Safety Department 29714 Houn Rd. Menifee, CA 92586951-'7%q? f Menifee www.cityo finenifee.us �uitdmg& Safety Dept. Receive