PMT17-03982 City of Menifee Permit No.: PMT17-03982
29714 HAUN RD. Type: Residential Re-Roof
�6_CCEiO MENIFEE, CA 92586
MENIFEE Date Issued:
11/06/2017
PERMIT
Site Address: 29561 THORNHILL DR, MENIFEE,CA Parcel Number: 336-121-009
92586 Construction Cost: $2,100.00
Existing Use: - Proposed Use:
Description of REMOVE EXISTING ROOF, REPLACE W/OWENS CORNING COOL ROOF IN AMBER
Work: CRRC#0890-0009
Owner Contractor
VARINA DRAKE TRUST
29561 THORNHILL DR
MENIFEE,CA 92586
Applicant License Number.
VARINA DRAKE TRUST
29561 THORNHILL DR
MENIFEE,CA 92586
Fee Description Qtv Amount 1E1
Building Permit Issuance 1 27.00
Inspections not specified 98 98.00
GREEN FEE 1 - 1.00
General Plan Maintenance Fee-Building 1 4.90
$130.90
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_Perrnit_Templale.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 perjurythat I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)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 License No. By my signature below I acknowledge that,except for my personal residence
Expires 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 con nderstand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 o siness and rofessions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for thi pp' 'on is submi d or at the fallowing website:
by Section 3700 of the Labor Code,for the performance of work for which W. info.ca. o ca w.h[ml.
this permit is issued. /
Policy# Date
❑1 have and will maintain worker's compensation insurance,as required by 0 RTY NER OR AUTHORIZED AGENT (((JJJ
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 a rized to act on the property owners behalf.I have read this
number are: appli n an he information I have provided is correct I agree to comply
wit II ap ' . and county ordinances and state laws relating to
Carrier b Idi co truction I authorize representatives of this city or county to
Policy# Expires n[e th bove ide ified property for inspection purpos
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less R AU HER OTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the C=BESS 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 Date 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 ❑Yes ❑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 fdrguldelines — ----- ---
CONSTRUCTION LENDING AGENCY ❑Yes o No
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?
action 3097 Civil Code) ❑Yes ❑Na
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 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DYes ❑No
Business and Professions Cade).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its 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 fRRP)
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 farthe 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($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or I )portion of the work,and the structure is www.epa.aov/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Cade:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
- Menifee
DATE: PERMIT/PLAN CHECK NUMBER - D
OM
TYPE: O COMMERCIAL DOESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION OALTERATION O DEMOLITION O ELECTRICAL O ECHANICAL
O NEW O PLUMBING UME-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS �� AP 2 ce-6 7
ASSESSOR'S PARCEL NUMBER �j'�I p-`a� LOT TRACT
OWNERNAME �� "/ 0�-LL,S( e o C�
ADDRESS
PHONE EMAIL
APPLICANT NAME nn�
ADDRESS
PHONE �,�� Q fc2y / C�' EMAIL
CONTRACTOR'S NAME OWNER BUILDER? ES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ ' / 00 SOFT L SO FT —7
APPLICANT'S SIGNATURE DATE
_CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE SMIP GREEN
PLAN CHECK FEE INVOICETOTAL
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us
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gui4
Received
THE VsARINsA E. DRAKE 2006 TRUST
Dated, May 15, 2ow
Trustor. Varina E. Drake
Trustee: Varina E. Drake
Rrst Suocessos Trustee: Cynthia Bennett
Second Successor Trustee: By appointment of Probate Court
Executed, at Wd&mar, California on May I S, 2ow
Prepared, by:
Robert D. Barth, JD, LI.M.
Law Offices of Robert D. Barth
32395 Clinton. Keith Road, Suite 2o6
Wildomar, CA 92595
provided herein, to all persons who occupy the position of Trustee, whether one
or more persons occupy the position at one time, and include any successor
Trustee or appointed Trustee.
2.13 Trust Estate: The term "Trust Estate" shall refer to the total
principal and any accumulated income in any Trust.
2.14 Trustor: The term "Trustor" shall refer to VARINA E. DRAKE.
3.0 TRUSTEE
3.1 Original Trustee: The Trustor is hereby designated as the original
Trustee.
3.2 Appointed Trustee: During the lifetime of the Trustor, the Trustor
may appoint a co-Trustee. However, on the death of the Trustor, the co-Trustee,
if any, shall be deemed to have resigned and the provisions of Paragraph 3.3(A)
shall apply.
3.3 Successor Trustee:
(A) Should the Trustor and the Trustee appointed pursuant to
Subsection 3.2, if any, cease to act as Trustee because of death, incompetence,
incapacity or resignation, then CYNTmA BENNETT (SSN: 557-02-4185) of the city
of Murrieta, California, shall be named as successor Trustee.
(B) Should CYNTHu BENNETT cease to act as Trustee, because of
death, incompetence, incapacity, resignation or other cause, then the trust shall
terminate and distributions should be made in a reasonable manner
3.4 Unanimous Consent: Notwithstanding anything to the contrary
contained herein, action by the Trustees and/or successor co-Trustees shall only
be deemed valid pending the unanimous consent of the then acting Trustees.
3.5 Appointed/Successor Trustee Powers: Any persons serving as
successor Trustee(s), appointed or otherwise, shall have the same powers, rights,
authority, duties and obligations as the original persons designated as Trustees,
except as specifically provided otherwise herein.
3.6 Special Trustee:
(A) While a Beneficiary other than the Trustor serves as sole
Trustee, the Special Trustee shall make all decisions regarding discretionary
payments to such Beneficiary Trustee, except that the Trustee's discretion is
limited by an ascertainable standard related to the Beneficiary's support, health
V.DtzvcE/LT -4-