PMT18-04929 City of Menifee Permit No. PMT1 B-04929
29714 HAUN RD. Type: Residential Electrical
/ MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 1011812018
PERMIT
Site Address: 30485 LAKE WATCH CT, MENIFEE, CA Parcel Number: 364-132-017
92594 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of MAIN BREAKER DE-RATE TO 100A FROM 125A
Work:
Owner Contractor
LINETTE JOHNSON TESLA ENERGY OPERATIONS, INC.
30485 LAKE WATCH CT 6800 DUMBARTON CIR
MENIFEE,CA 92594. ATTENTION LICENSING
Applicant Phone: 8448375201
ARWEN WASHBOURNE License Number:888104
TESLA ENERGY OPERATIONS, INC.
6800 DUMBARTON CIR
FREMONT,CA 94555
Fee Description city, Amount 1E1
Services, Switchboards, Control Centers& Panels 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 carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise staled,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_Bidg_Permit_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 ContmctorsState License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and O l am exempt from licensure under the Contractor's State License Law for
Professions Code and m license Is in full force and effect. r� the following reason:
License Class —,C_-1��JLC J_ccensreNo. �U�-I By my signature below acknowledge that-except-forinypersonaf residence-
Expires ---c Signature fi ns 1\ "t/�, in which l must have resided for at least one year priorto completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legallysell a structure that I
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 Cade,is available updn request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the fallowing website:
by Section 3700 of the Labor Code,for the performance of work for which thisap application
submitted
this permit is issued.
Policy If Date-
[
trot 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 D By my signature below I certify to each of the following:)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 I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier ��11 ) tt building construction.I authorize representatives of this city or county to
Policy#\N3 L A V3201 H 'expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
Cdollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
ll erUfy that in the performance of the work for which this permit is Issued, /� �L
shallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# n�5A(4::
worker's compensation laws of California,and agree that If I should become I�a`I f�HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor 1K1
Code,I s II forthvAth complywith those provisions. Will the applicant or future building occupant handle hazardous material or
J Date , 1 ?� mixture containing hazardous material equal to or greater that the
Appiican amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes 6M
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 modifiation 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 Oyes dz o
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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) oyes `tr0
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
Contactors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 2SS34 concerning
hazardous material reporting.
chsiness and
I have placed next to the applicable that)(Section 70315 OYekr
Business and Professions Code).Any ciryor county that requires a permit to c� � A Dale
construct,alter,improve,demolish or repair any structure,prior to its pR0 R OW R O T IZED 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(RRPI
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 Ecensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7032.5 by residence or childcare facility to he 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 orthrough 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.eov/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 Ucense 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. D 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
Code: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