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PMT18-04208 City of Menifee Permit No.: PMT18-04208 29714 HAUN RD. Type: Residential Electrical MENIFEE,CA 92586 MENIFEE MENIFEE Date Issued: 08/30/2018 PERMIT Site Address: 29910 LOY DR, MENIFEE,CA 92585 Parcel Number: 333-600-026 Construction Cost: $2,500.00 Existing Use: Proposed Use: Description of INSTALL NEW ELECTRIC VEHICLE CHARGING STATION Work: TESLA WALL CONNECTOR Owner Contractor LESTER VIDAL TESLA ENERGY OPERATIONS, INC. 29910 LOY DRIVE 6800 DUMBARTON CIRCLE MENIFEE, CA 92585 ATTENTION LICENSING Applicant Phone:6506815100 TESLA ENERGY OPERATIONS, INC. License Number:888104 6800 DUMBARTON CIRCLE FREMONT,CA 94555 Phone: 6506815100 Fee Description QtV Amount I$) Services,Switchboards,Control Centers&Panels 1 116.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 129 129.07 GREEN FEE 1 1.00 General Plan Maintenance Fee.-Electrical 1 5.80 $278.87 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 PermR_Template.rpl Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects With a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that i am under provisions of Chapter!)(commencing with section 7000)of Division 3 of the Business and D 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 C — License No. By my signature below I acknowledge that,exceptformy personal residence Expires l% �i '1 X 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 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.leeinfo.ca.eov/calaw.htmL Policy# Date tz1 have and will maintain workers compensalon insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which o 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 an the property owners behalf.I have read this numberare: application and the information I have provided is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy#i;U).S IC'1 -SS<. -Expires! enter the above identified property for inspection purposes. (This section need not to be completed Is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AG ENT ❑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# 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 forthwith(comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant, �',t A.'.L"�T Date 1^ mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes aFNo UNLAWFUL,AND SHALL SUBIECTAN 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)7 See permitting checklist IN SECTION 3706 OF THE LIBOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY OYes efNo 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 permitting checklist.I understand my requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25S34 concerning Contractors License Law for the reasons)indicted below by the hazardous aterial reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Oyes X. Business and Professions Code).Any city or county that requires a permit to a f.A-a Date v7 !� construct,alter,improve,demolish or repair any structure,prior to[Is PRtPERTY 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 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 rt 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.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-80DA24-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. 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 die:The ContraMr's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill outthe RRP Acknowledgement. 19 BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE Y�I�Wi1fYr4;--�-..�.,..:�,.. _._ _ 7f�1►�rrTR�°it �r DATE: 08.24.2018 PERMIT/PLAN CHECK NUMBER TmU f Eat GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES TYPE: 0 COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN SUBTYPE: @ADDITION ()ALTERATION O DEMOLITION Q ELECTRICAL O MECHANICAL ONEW OPLUMBING ORE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK Install new electric vehicle charging station OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS()YES ONO PROJECT ADDRESS 29910 Loy Drive 21P92585 ASSESSOR'S PARCEL NUMBER 02" •(6 CI D �L� LOT TRACT OWNER NAME Lester Vidal Co ADDRESS 29910 Loy Drive, Menifee, CA 29585 C a N ZS PHONE (702) 588-4237 EMAIL ian.viernes@yahoo.com `o N APPLICANT NAME Arwen Washbourne U m Q ADDRESS 43320 Business Park Dr. Ste B-104, Temecula, CA 92590 PHONE EMAILtemeculapermits@tesla.com CONTRACTOR'S NAME OWNERBUILDER? ©YESONO BUSINESS NAME Tesla Energy ADDRESS 3500 Deer Creek Rd, Palo Alto CA 94304 PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER 888104 LICENSE CLASSIFICATION B C10 C46 VALUATION$ 2500 SQ FT L SQ FT o �.0 APPLICANT'S SIGNATURE Date:2018.08.2409:60:43-07.00' DATE 08.24.2018 CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGIN RING FIRE INVOICE TOTAL GREEN SMIP OWNER BUILDER VERIFIED O YES G NO DRIVERS LICENSE k NOTARIZED LETTER 0 YES O NO City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 www.cityofmenifee.us pqa�NIF TES LA WALL CONNECTOR s s(.53'(U O1m16m)0')m\6 ) ..(J( 0 m•m). T.5'(19Qnm) l WOC � CmWm u.e _ vl ")`FE:E a :GtiAFETY DEPARTMENT Voltage and Wiring „ .a �� 08�Tor 4 A�� �I� Ll. 1-2, and earth Current Maximum output: 87 A. 6 A, 56A, 48A, 40A, 36A, 32A, 28A, 24A, 20A 76A. 12A h construed to be a ermit for,or an Frequency ,V,N!IN0i 4pcedsieookhe federal.state orcity i ra7anc , snwl:be kept on the Cable Length 8.5' <2. m) and 24' (7.4 m) .r Wall Connector Dimensions — --- Width: 6.3" (160 mm) City of Menifee Depth: 5.5" (140 mm) Building Dept. Top Entry Bracket Dimensions Height: 10.8" (275 mm) AUG 2 q 2018 Width: 5.1 " (130 mm) Depth: 2.0" (50 mm) Received Weight (including bracket) 20 lb (9 kg) Operating Temperature -220F to 1220F (-30°C to 50°C) Storage Temperature -40OF to 185OF (-40°C to 85°C) Enclosure Rating Type 3R Agency Approvals cULus listed for United States and Canada under file number E354307, FCC Part 15. Ventilation Not Required