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PMT18-01027 City of Menifee Permit No.: PMT18-01027 29714 HAUN RD. �XCCEGA MENIFEE,CA 92586 Type: Residential Re-Roof MENIFEE Date Issued: 03113/2018 PERMIT Site Address: 26151 FOUNTAIN BLEU DR,MENIFEE, Parcel Number: 337-103-006 CA 92586 Construction Cost: $9,900.00 Existing Use: Proposed Use: Description of TEAR EXISTING ROOF, REROOF PORTION OF HOME WITH OWENS CORNING COOL ROOF IN Work: OYSTER SHELL, BACK PORTION WITH ROLLED ROOFING CRRC#0890-0012 Owner Contractor WILLIAM WOOSLEY 40575 CAL OAKS RD#D2-170 MURRIETA, CA 92562 Applicant License Number: WILLIAM WOOSLEY 40575 CAL OAKS RD#D2-170 MURRI ETA, CA 92562 Phone:9099107884 Fee Description ON Amount 1$1 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 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_Perrmt_Template.rpl 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 7000)of Division 3 of the Business and XI am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full farce 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 contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for workers 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.le in o.ca. av cal�aw.)htmI Policyri V V� Date 3-13 -lob ❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AG T section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certifyto 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 with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy R Expires enter the above Identified pro pe y for inspection purposes.2 —( (This section need not to be completed is the permit is for one-hundred W{i-af;Vl Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED A 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 p workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 37DO 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 D 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 for guidelines CONSTRUCTION LENDING AGENCY ❑Yes ONo 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) ❑Yes ❑No 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 checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting. oyes ❑No Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,priarto 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(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 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( I portion of the work,and the structure is www.eoagov/lead/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-SOD-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a D 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: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code: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: �7 'S ��� PERMIT/PLAN CHECK NUMBER ( Q 1)1007 TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING RE-ROOF NUMBER OF SQUARES 27 i- DESCRIPTION OF WORK 57h{-r.,V LQ- PROJECTADDRESS Z6/S2I2r—OW1yT71-W �lL�� �!/LC1I� ZIP �ZSS ASSESSOR'S PARCEL NUr,M'BER 3; 7- 110�� LOT (0 (v TRACT ZS OWNER NAME 01 td iA� Wba v5 — k,-P-FtS�LCNJ 7*W OLe.Lt 77?a-4 ADDRESS p tOS S 7GA-W e+ ©kl�S /--d' DL 17O PHONE !d[" L G�q,,'�z�}lg¢ EMAIL Ef"�' CA-. �f�, APPLICANT NAME rS&M 67 ADDRESS PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? ES O NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATEjLIC NUMBER. LICENSE CLASSIFICATION VALUATION$ ,G ao SOFT L SQ FT //��// APPLICANT'S SIGNATURE ✓" DATE 3 8 ^ I S ,CLTYSTAFF USE ONLY" DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS UCENSE NUMBER BUILDING PLANNING ENGINEERING FIRE PERMITFEE ��.i�0 �� O SMIP GREEN ..� PLAN CHECK FEE INVOICE TOTAL J't�op ., OWNER BUILDERVERIFIED O YES O NO DRIVERS LICENSE H NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92596951-672-6777 www.cityojmenifee.us N o ° . Z n m m ct un y v f1 m .ZIy A C A O (� •A S rn ❑ mD W N Y C m 0 m O y O ti O W 6 d N ❑ ~ 3 m 0 c o Un 3 Om O N. a m n 1 r fA m �. T A Q O ^ O O N C m ^ "� y O a J 6 m ° < O vdi m n m A ao o ry ry m r: G o Z'c U n A N m O m y A [1 m O J N m A rn O D z z Q 3 ?, a ° .°�+ 0a o '�• vmac mZ o mT �. ra a m v .d.. iri �, o ^' ~ O a r m u >• v m J _� ,�.,11 J D m 5 m J s m m o o w a 0 l N O w m -i m '� 2 o o a m 3,. 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N c m 3 m a Q a .a. n = o� 'O m m vA7 3 a oJ m m s w ^ 3 �^ w A m 'o °o_ w o c m c a > m m = A p = D m m coon o m .. y m d 3 r °; m w D A z A A 3 c N A aD ZD a mc A¢ m m = N o 3 Tmon a wN Otti 7D > $ m N o o a n p0 O m 3 d o• -°., n v N n n v m wo ° m N a 3 0 o _ o N ' ° m n n _ c », Z� B °' , J s o a < _• J s o 1D ^ m m n °O m _n O o. o- a O a c y '^ f m m m Il o N n O n O ? = 3 ±} m x O N, f u n a a _ n n n < ° G n m Gl u 0 ' 7 > 1_ M m 3 J- .a. o v '� m A S n m o u 2 a m a o c m » ^ N < m O d m N d a J J w = °1 'o M. y a 5 a n m n m o c ,7 a w 3 a o o ..1 j n $ o n o w A Tm 0 n > n � c o o o m c v o o o m n, o o •2 m f' ^ W A N u m y ,`G n u T N O 9 R O m J m (° .p m u n u S A �• � a O p F'w+ O .9 K m T J 0 O O � C_ T � n A N G w a J = > m 00 c o n 20 n o .°. ° d a o ,2 A m S O N H x n fn'1 d N m d G '° » N 9 S .ai OJO ° N J w T 00 £ (Y m ^a n E 0 �J' e 3 m a o w o W d M m ^ a m' o` °o m a 0 m T c A b N ae '0 3 m m o a .2 u m b o ° n w ° N ° � a T m m b 'o o ^ m e a s c m. c -• w n V S c m J o o N J !p d m n n o m '^ Poi m 3 0 o fl N a n n T _ c a 3 w g o m D m b m m m m m F+ n 3 °,� T s m m u o n n 3 s 3 '° �^ m t m m 3 - ° c m 2 G n m n1 [wD O J w c N O 3 m a n ° Z v u0 N N d OFFICIAL CERTIFICATION OF TRUST PURSUANT TO PROBATE.CODE 18100.5 NOTICE TO PERSON OR ORGANIZATION TO WHOM THIS CERTIFICATION IS PRESENTED THIS FORM IS AN OFFICIAL FORM AUTHORIZED AND PROTECTED BY STATE LAW. FAILURE TO ACCEPT THIS FORM CAN RESULT IN PENALTIES AND DAMAGES. Probate Code Sec.18100.5 provides: YOU MAY RELY ON THIS FORM WITHOUT FURTHER PROOF OF AUTHoArrY. Any person making a demand for"documents In addition to a certification of trust to prove facts set forth In the certification of trust...shall be liable for damages Including attorney's fees.Incurred as a result of the refusal to accept the certification of trust In lieu of the requested documents..".(emphasis added) Probate Code Sec.18100 provides that: You"are not bound to inquire whether the trustee has power to act or is properly exercising a power and may assume without Inquiry the existence of a trust power and Its proper exercise"pursuant to this certificate and that you are"fully protected In dealing with or assisting the trustee lust as If the trustee has and Is properly exercising the power the trustee purports to exercise"pursuant to this certificate. INSTRUCTIONS TO PERSON OR ORGANIZATION TO WHOM THIS CERTIFICATION IS PRESENTED 1.Check to make sure this form has been signed and notarized. 2.Make a copy of this form for your records. 3.Complete your organization's/nstitution's forms from the Information listed below. 4.Follow the directions of the trustee regarding any matters regarding the trust and any accounts,assets or properly In the name of the trust. THE UNDERSIGNED HEREBY CERTIFY AS FOLLOWS:. Trust Information This trust was established and is currently in existence as follows: City Of Mantle@ Name of Trust(title or trust document): The Fountain Bleu Trust Idullding Dept. Date of Current'Controlling Trust Document 1 A N if d A ate of execution): - N !r Type or Truce: - Revocable Trust r• Name of Trustor(s)(Settlor(a),Grantor(s), William A. Woolsey and Victoria L. Woolsey Donor a Creators,Makers Currently Acting Trustee(s): William A. Woolsey and Victoria L. Woolsey Name of Parties signing trust: Above Trustors/Trustees Successor Trustee(s): First: Cade Woolsey Second: Amy E.Ando Third: Steve W.Bari Fourth: Quin E. Woolsey Name In which title to assets transferred to trust Name of Trust as indicated above should be taken: Mailing address of trust: Trustor/Trustee's address Legal Description Lot 66 of Tract No. 2544 as shown by map on file in Book 45 page(s) 56 through 59,inclusive,of maps,records of Riverside County, California. Full Force and Effect laid trust Is in full force and effect and has not been revoked, modified or amended in any manner which would cause the representations contained in this :ertification to be incorrect. Current Trustee(s) -he names of all the currently acting Trustees)of the trust are as indicated above. Said trustee(s)have full authority,power and ability to conduct all business on iehalf of the trust and otherwise act on behalf of the trust and buy,sell,transfer,and manage all money,accounts, assets, and property of the trust and sign all louments and papers for and on behalf of the trust including but not limited to signing all checks,signature cards,withdrawal documents and other banking and hancial documents for and on behalf of the trust. The number of current trustee signatures necessary to conduct the business of the trust Is as indicated above. 'rustess may hold title In one trustees name alone for convenience sake. Powers of Trustee(s) 'rustor has given the Trustees of said Trust the powers listed below in addition to those on any attached pages: To open,establish,and maintain interest and non-Interest bearing accounts,deposit and safe deposit boxes of all kinds and in amounts greater than covered by FDIC Insurance. Make,sign,authorize,and deliver checks,drafts,orders,withdrawals and transfers of all kinds. • Borrow,assign,pledge,guarantee,grant security,for any person,debt,or obligation and enter Into all other credit transactions. To appoint attorneys-in-fact and agents to take any and all actions on behalf of the trust. Authorize and enter into overdraft lines of credit,credfUdebit card,ATM,cash management,and all other account and financial services. Purchase acquire,sell,transfer,trade and otherwise deal in stocks bonds Indentures,options.warrants/rights and all other investments&securities. 11 powers referred to herein are those currently in effect and there has been no subsequent change or modification therefrom that would cause the Ipresentatlons contained in this certification to be incorrect. Successor Trustee(s)Act he successor trustees may act upon presentation of any of the following: 1)Letter of resignation of the previous trustees,2)Certified copy of the death certificate the previous trustee(s), 3)New Certification of Trust showing them as trustees. Trustee(s)Signing le undersl ned are the current Truslee s of the above named trust. SEE EXECUTION AND ACKNOWLEDGMENT ON NEXT PAGE MmyWillluncMmPrvry.d Idt ONnd 4�avNv.IdnM[nw MtiPImIY.C�,I:p-]>)d EXECUTION AND ACKNOWLEDGMENT CERTIFICATION OF TRUST THE UNDERSIGNED DECLARE AND CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF CALIFORNIA AND ANY OTHER STATE THAT ALL OF THE INFORMATION,STATEMENTS AND REPRESENTATIONS CONTAINED IN THIS DOCUMENT ARE TRUE AND CORRECT AND IF CALLED TO TESTIFY THERETO COULD AND WOULD SO COMPETENTLY TESTIFY THERETO AND THAT THIS DOCUMENT WAS EXECUTED AT THE PLACE AND DATE INDICATED IN THE NOTARY ACKNOWLEDGMENT. T,,u,c SigryilvrL:,� - "- T. ip�a{ur CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC A notary public or other officer completing this certificate verifies only the Identity of the Individual who signed the document to which this certificate is (elect a i ornia, attached and not the truthfulness,accura or valldll of that document, Countyof: ,RS.Versl�/�j(tl fA 61r �OI Lr )SS ,,.,�1 On 2 £s 'U before me Bcsµad-a.pu CQ'- a Notary Public In and for said Slate,personalty appeared: William A. Woolsey and Victoria L,Woolse who proved to me on the basis of satisfactory evidence lobe the peson(s)whose names Ware subscribed to the within instrument and acknovded ed to me that helsheAhey executed the same In his/herAheir authorized capacity(tes),and that by hislherAhelr signatures)on the Instrument the person(s),or the entity upon behalf of which the person(a)acted,executed th In rument. - I certify under PENALTY OF PERJ er the laws of the Stale of California that BENILDA DU19 the foregoln .pang Is true antl WITNESS m ` nd and if(dai se �rr�ryry Cornwailon to Y /' 2000/00 e: . Signature: r/ ItlolOry Publlt•CBAPgrN® � RtyereIda County NOTARY PUBLIC Comm.E fret Me(5,2017 hcywallunCMn:Prvcy dea 6S.WIMt I�r(mpn)„1 Mingi�w.il.nlpG pMi]C),