PMT18-02116 City of Menifee Permit No.: PMT18-02116
29714 HAUN RD. Type: Residential Electrical
�ACCEL/�\ MENIFEE,CA 92586
'° ''A Wt—" MENIFEE Date Issued: 05/04/2018
PERMIT
Site Address: 30053 LEEWARD CT, MENIFEE, CA Parcel Number:
92584 Construction Cost: $5,594.00
Existing Use: Proposed Use:
Description of INSTALL ROOF MOUNTED SOLAR SYSTEM, 12 PANELS, 1 INVERTER,3.78 KW
Work:
Owner Contractor
PULTE GROUP TESLA ENERGY OPERATIONS, INC.
27101 PUERTA REAL,#300 3055 CLEARVIEW WAY
MISSION VIEJO, CA 92691 ATTN ZOE STEELE
Applicant Phone:6509635100
ARWEN LOTT License Number: 888104
TESLA ENERGY OPERATIONS, INC.
3055 CLEARVIEW WAY
SAN MATEO, CA 94402
Fee Description gty Amount(51
Solar, Residential or Small Commercial 1 252.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Electrical 1 12.60
$293.60
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 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_Templale.rpl 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 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. r� /� the following reason:
License Class F.o"""iC-1V11Tr UL-1'&/�cense No. e8V-"Io By.my signature-below"I acknowledge that-except-for my personal-residence- --
Expires)Zi 7 J) 111! Signature t' rr-� in which l 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
O 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.leginfo.ca.gov/calaw.html.
Policy# Date
"'oI have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 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 behalL I have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier ' t building construction.I authorize representatives of this city or county to
Policy#\t\xos a 71)IL-] —c4ires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
CCdo__llars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
kertlfy that in the performance of the work for which this permit is Issued, ^&5A'^.1
shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# n w�('
workers compensation laws of California,and agree that if I should become IZy I.�HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 370D of the Labor r
Code,IsF1��llffoorth._withcco ply with those provisions. ,� Will the applicant or future building occupant handle hazardous material or
Applicants f V `� \ 11 Dated 1 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETO SECURE WORKER'S COMPENSATION COVERAGE IS ❑yes r]m7b
UNLAWFUL,AND SHALLSUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the Intended use of the building by the applicant orfuture 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 forguidelines
CONSTRUCTION LENDING AGENCY czYes r0
1 hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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 LQ No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist I understand my requirements underthe 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 al Safety Section 25505 and 25534 concerning
hazardous material reporting. I
checkmark(s)I have placed next to the applicable items)(Section 7031.5 oYe 6vNo Z
Business and Professions Code).Any city or county that requires a permit to c
construct,alter,improve,demolish or repair any structure,prior to Its ^ A Date 1
PRO ER OW RO T ORIZEDAGENT
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 fRRPI
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 orthrough their -
o 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.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 Contractor's State License Law does not apply to an owner of a oAn 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. o No EPA Lead-Safe Certified Firm is required for this project because:
o 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.
B & SAFETYPERMIT/.LA APPLICATION
Menifee
DATE 0 5/0 212 01 8 PERMIT/PLAN CHECK NUMBERftqj: lX
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑✓ NEW [—]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Roof mount pv system(3.78)kw, (12)panels, (1)Delta inverter City of Menifee
Building Dept.
PROJECT ADDRESS 30053 Leeward Court MAY 0 2 2018
ASSESSOR'S PARCEL NUMBER LOT TIC
PROPERTY OWNER'S NAME Reflections 37161 Lot 12 R
ADDRESS 30053 Leeward Court, Menifee, CA 92584
PHONE (951)660-1.561. EMAIL
APPLICANT NAME Bdttni Tena
ADDRESS 43320 Business Park Drive Suite B-104
PHONE (951)365-8204 EMAIL temeculapermits@tesla.com
CONTRACTOR'S NAME Tests Energy OWNERBUILDER? ❑YES❑NO
BUSINESS NAME
ADDRESS 43320 Business Park Drive Suite B-104
PHONE (951)365-8204 EMAIL btena@tesla.com
CONTRACTOR'S STATE LIC NUMBER 888104 LICENSE CLASSIFICATION C-10,C-46,B
VALUATION $ $5,594.00 SO FT L SO FT
Brittni Tena Digitally signatlby8nllniTana 05l02/2018
APPLICANT'S SIGNATURE Date;2018.02.1212:03:04-oe'00' DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN 1 SMIP
INVOICE PAID AMOUNT
AMOUNTOR5 0• 3•� 0CASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES C NO
City of Menifee Building& Safety Department 29114 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213