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PMT18-03168 City of Menifee Permit No.: PMT18-03168 29714 HAUN RD. ZAr MENIFEE,CA 92586 Type: Residential Electrical MENIFEE MENIFEE Date Issued: 06/25/2018 PERMIT Site Address: 30778 DESERT EAGLE WAY, MENIFEE, Parcel Number: 360-433-010 CA 92584 Construction Cost: $500.00 Existing Use: Proposed Use: Description of MAIN BREAKER DOWNSIZED TO 175AMP FROM 200AMP Work: Owner Contractor TOM JACKSON TESLA ENERGY OPERATIONS, INC. 30778 DESERT EAGLE WAY 6800 DUMBARTON CIRCLE MENIFEE,CA 92584 ATTENTION LICENSING Applicant Phone:6509635100 BRITTNI TENA License Number:888104 3055 CLEARVIEW WAY SAN MATEO, CA 94402 Fee Description QQtt( Amount 1$1 Receptacle, Switch, Outlet&Fixture 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 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_Templatesiat 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 contractors)pursuant to the Contractors State License Law). Chapter9(commencing with section 700D)of Division 3 of the Business and o I am exempt from Iicensure under the Contractors State License Law for Professions Code and my license is in full force and effect. the following reason: License Class i� _ License`N`ow� $Y�fA4 By my signature below l acknowledge that,except formy personal residence Expires I% �'i !% Signature :f in which l must have resided far at east one year priorto completion of improvements covered by this permit.I cannot legallysell 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 cament of self-insure for workers 7D44 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 ys,,�g.,leein(o.c-.eov/calam•.html. this permit is issued. Policy# Date ofhave 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 behalf.I have read this number are: application and the information I have provided Is correct I agree to comply Carrier ' �,r;G Ic A fDy,_,f Aix with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy#PIGS IG`14S 3C Expires /(ZD*!i .Y enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGENT o l cenrly that In the performance of the work for which this permit is issued, I shall not emolov 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 workers compensation provisions of Section 370D of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a : ,^ mixture containing a hazardous material equal tour greater that the Applicant "`/ Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes o 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 forguidelines CONSTRUCTION LENDING AGENCY ❑Yes uSNo 1 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 permits issued outer boundary of a school? - (Section 3097 Civil Code) O Yes EfNo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25595 and 25534 concerning checkmark(s)I have placed next to the applicable items)(Section 7031.5 hazardous material reporting. Business and Professions Code.An city or county thatre requires permit to DYes " Y ty structure, , P ') cans[roct,alter,improve,demolish or repair any structure,prior to Its -" ' r'f Date PROPERTY OWNER 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(RRP) 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 mast 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 D 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.zov/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 ciAn 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: D I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Fpdp:«he Contactors 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 0� MAE BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE .0 6/2 512 0 1 8 PERMIT/PLAN CHECK NUMBER b TYPE: OCOMMERCIAL %O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN SUBTYPE: O ADDITION 0 ALTERATION O DEMOLITION 0 ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Main breaker downsized to 175A PROJECTADDRESS 30778 Desert Eagle Way, Menifee, CA 92584 ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME Tom Jackson ADDRESS 30778 Desert Eagle Way Menifee, CA 92584 PHONE 7602143996 EMAIL insptrgagit@gmail.com APPLICANT NAME Arwen Lott ADDRESS 43320 Business Park Dr. Suite B-104,Temecula, CA 92590 PHONE 951.260.4306 EMAIL TemeculaPermits@tesla.com CONTRACTOR'S NAME OWNER BUILDER? O YES O NO BUSINESS NAME Tesla Energy Operations, Inc. ADDRESS 3055 Clearview Way San Mateo, CA 94402 PHONE 650-638-1028 EMAIL CONTRACTOR'S STATE LIC NUMBER 888104 LICENSE CLASSIFICATION B. C10, C46 VALUATION$ pp SQ FT L SQ FT APPLICANT'S SIGNATURE DATE 06/25/2018 aTYSTAFFUSEONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING fNGINQRING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT O CASH 0 CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED 0 YES O NO DL NUMBER NOTARIZED LETTER 0 YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213