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