PMT18-03036 City of Menifee Permit No.: PMT18-03036
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE MENIFEE Date Issued: 0 911 2/2 01 8
PERMIT
Site Address: 30655 BUCKBOARD LN, MENIFEE,CA Parcel Number: 358-450-020
92584 Construction Cost: $20,000.00
Existing Use: Proposed Use:
Description of INSTALL ROOF MOUNTED SOLAR SYSTEM, 20 PANELS,20 MICROINVERTERS,5.9 KW,
Work: REVISIONS APPROVED 08/29/16
Owner Contractor
RALPH ALLEN BAM CONSTRUCTION INC
30655 BUCKBOARD LN 760 E FRANCIS STREET STE R
MENIFEE, CA 92584 ONTARIO. CA 91761
Applicant Phone: 9099309003
JUSTIN GUTIERREZ License Number:952311
BAM CONSTRUCTION INC DBA EVERYTHING EFFICIENT
760 E FRANCIS STREET STE R
ONTARIO, CA 91761
Fee Description gtv Amount(SI
Solar, Residential or Small Commercial 1 252.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 129 129.07
Additional Plan Review Building 129 129.07
Additional Plan Review Building 65 64.55
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 3.00
Document Reproduction Reimbursement 1 0.50
Document Reproduction Reimbursement 1 0.50
General Plan Maintenance Fee-Electrical 1 12.60
$619.29
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_Sldg_permk_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 70001 of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. / the following reason:
License Class UcepAig No. z I By my signature below I acknowledge that,except for my personal residence
Expires qlS C Zc' Signature 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 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 following website:
by Section 3700 of the Labor Code,for the performance of work for which www. ofo.ca. ov/calaw.html.
this permit is issued.
Poll I # - '�"-c�/� 7 Date
d I have and will maintain workers compensation insurance,as required by ` PROPOWNER OR fCUTHORRED AGENT
section 3700 of the Labor Code,for the performance of the work for which y my signature below I certify to each of the fallowing: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 re: l/ 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 /�"`� /Cy<�✓ ,.�P
l �� �Q"'`�" r P �builtling construction.I authorize representatives of this city or county to
Policy# -7 Z�OoC Soy Expires Z / ( / �e above ident:4%d Pery for inspection Purposes.
(This section need not to be completed is the permit is for one-hundred =s /77 - Date
dollars($100)or less PROPERT1r`OWN l OR AUTHORIZED AGENT
❑I certlfythat in the performance of the work for which this permit is issued, L �j
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 4 >
v
workers 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 h hcomply it� s provisions. { Will the applicant or future building occupant handle hazardous materialora
Ao Ii f Date f j- <� mixture containing a hazardous material equalto or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNIN :FAILURE TO SE URE W R'S COMPENSATION COVERAGE IS ❑Yes No
UNLAWFUL,AND SHALL SUBJE N EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building bythe applicant or future building
AND CIVIL FINES UP TO ONE H NDRED 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
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMO)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes D'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 ❑wo'
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythat I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor ha l
s License Law for the reasons)indicated below by the California Health&Safety CodelSe ion 25505 and 25534 concerning
reporti -
checkmark(s)Ihave placed next to the applicable item(s)(Section 7031.5 oyes zardous tena /J�g.
Business and Professions Code).Any city or county that requires a permittoate
construct,alter,improve,demolish or repair any structure,prior to its pR9PERTY OWNE R UTH D 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 fRRPf
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 icensure 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.eoa.gov/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:
in 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
�� w 1 \I-eQ _ r�-� / , Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER b� O
PLANNING CASE NUMBER
TYPE: O COMMERCIAL dRESIDENTIAL O MULTI-FAMILY OMOBILEHOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION LfELECTRICAL O.MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
r
PROJECTADDRESS O (��S % r.(v (o n� c-/ C ZIP
ASSESSOR'S PARCEL NUMBER / LOT / TRACT
OWNER NAME /PCC f N �F _� 2
ADDRESS
PHONE f — Y co
J d EMAIL
APPLICANT NAME N G /
ADDRESS /!O C T�riGc-o. c, S !/�-�/74
PHONE EMAIL
CONTRACTOR'S NAME 1c/Pis-z� ` OWNER'B LDER? OYES NO
BUSINESS NAME /
ADDRESS
PHONE �D /'"�1 Q'—f�OQ EMAIL
CONTRACTOR' TAT LIC NUMGJBER LICENSE CLASSIFICATION
VALUATION SO FT 1=5L SQ FT
APPLICANT'S SIGNATURE DATE
/Z 1:
OTYSTAFF USE O r' 10
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITYOFMENIFEE BUSINESS LICENSENUMBER
BUILDING PLANNING ENGINEERING FIRE O
INVOICE TOTAL I GREEN SMIP
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us
ENIF�