PMT18-03616 City of Menifee Permit No.: PMT18-03616
��r�, 29714 HAUN RD. Type: Residential Electrical
i MENIFEE,CA 92586
MENIFEE MENIFEE Date Issued: 07/20/2018
PERMIT
Site Address: 29730 HOLSTEINER WAY, MENIFEE, CA Parcel Number:
92584 Construction Cost: $6,527.00
Existing Use: Proposed Use:
Description of ROOF MOUNTED SOLAR SYSTEM, 14 PANELS, 1 INVERTER,4.41 KW
Work: CANVAS TR 32277-3
LOT 29
Owner Contractor
PARDEE HOMES TESLA ENERGY OPERATIONS, INC.
1250 CORONA POINTE COURT, STE 210 6800 DUMBARTON CIRCLE
CORONA,CA 92879 ATTENTION LICENSING
Applicant phone:6506815100
ARWEN LOTT License Number:888104
TESLA ENERGY OPERATIONS, INC.
6800 DUMBARTON CIRCLE
FREMONT, CA 94555
Fee Description ,OQrt Amount 1E1
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 builli ing 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_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 700D)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. the following reason:
License Class r CtC7! LQt; License No. - By my signature below l acknowledge that,except for my personal residence
Expires Signature in which l must have resided for at least one year prior to 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 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.IeRInfo.cz.Rov/caI2w.htML permit is issued.
Policy# Date
cr have 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 ciBy my signature below l 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 act on the property owner's behalf.I have read this
number are: application and the information 1 have provided Is correct.I agree to comply
Carrier '7 IL r;S L, ri%Lu fir, with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#PLUS ICE-'S Expires /G 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 I certify 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 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 to or greater that the
Applicant ; 0.`nu'-t- Dale I � 11 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS isYes of 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 DO LLARS($100,o00),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 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidellnes
CONSTRUCTION LENDING AGENCY aYes cfNo
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) o Yes ErNo
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
Contractor's License Law for the reason(s)Indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DYes
N o
Business and Professions Code).Any city or county that requires a permit to a 4i� Date /7
construct,alter,Improve,demolish or repair any structure,prior to Its pR6F'EI�TY 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter9(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 receivingcompensation for most work that disturbs
and the basis for the alleged exemption.Any violation of Section 7031.5 by p paint ina ply with
an Applicant fora permit subjects the applicant to a civil penalty of not more required pra cites. his Includes
to be renRRItal
propertyfied firms ando roper[with
than($500). required practices.This Includes rental property owners and property
managers who do the paint-disturbing work themselves or through 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.eav/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
dP:The Contractor's 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.
& SAFETY PERMIT/PLAN CHECK APPLICATION
t:
."Meni ee
DATE 07/17/2018 PERMIT/PLAN CHECK NUMBER ONMQr 03wo
TYPE: O COMMERCIAL d)RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION 6 ELECTRICAL O MECHANI19Wy of Menife
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES Building
DESCRIPTION OF WORK Install( 14 )rooftop solar panels, ( 4.41 ) kW
1 wall-mounted inverter
PROJECTADDRESS 29730 Holsteiner Way, Menifee, CA 92584 d
ASSESSOR'S PARCEL NUMBER LOT _� TRACT
OWNER NAME Arsenio Delos Reyes
ADDRESS 29730 Holsteiner Way Menifee, CA 92584
PHONE 909239BB44 EMAIL arseniodelosreyes@sbcglobal.net
APPLICANT NAME Arwen Washbourne
ADDRESS 43320 Business Park Dr. Suite B-104, Temecula, CA 92590
PHONE (951) 331-0373 EMAIL TemeculaPermits@tesla.com
CONTRACTOR'S NAME OWNER BUILDER? O YES C 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$ $ 6,527.00 SQ FT L SO FT
APPLICANT'SSIGNATURE Anvers washboame DATE 07/17/2018
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN 1 SMIP 1
INVOICE � pp�� PAID AMOUNT
AMOUNT •�I!{/ OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES 0 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