PMT18-02553 City of Menifee Permit No.: PMT18-02553
29714 HAUN RD.
�CCEL/? MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 05125/2018
PERMIT
Site Address: 25881 MIDDLEBURY WAY,MENIFEE, CA Parcel Number: 339-112-001
92586 Construction Cost: $9,000.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING SHINGLES AND REPLACE WITH NEW CRRC 0890-0020
Work:
Owner Contractor
NAOMI SPILMAN L F C CONSTRUCTION
25811 MIDDLEBURY WAY 23905 CLINTON KEITH
MENIFEE,CA 92586 #114- 182
Applicant Phone:9514905223
L F C CONSTRUCTION License Number: 964147
23905 CLINTON KEITH
#114- 182
WILDOMAR,CA 92595
Phone: 9514905223
Fee Description O_yt Amount($l
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_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 underprovisfons 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 of ff the following reason:
License Class 1 N7 L ens o. By my signature below 1 acknowledge that,except for my personal residence
Expires `3 1 Signatures /1/ in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell 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 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 wv.sv.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy N Date
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 o By my signature below 1 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: },� ���/ '-_ , /I application and the information I have provided is correct.I agree to comply
Carrier� IV Iry W�z llh� �Q V'N's' Y' with all applicable city and county ordinances and state laws relating to
Q 1 building construction.I authorize representatives of this city or county to
Policy Nlbo0D 18OW k Expires 0' q� l 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 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 N
worker's compensation laws of California,and agree that if I should become ?Tice>eRDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Cade.I shall orth 'h cam y with those provisions. �{ Will the applicant or future building occupant handle hazardous material or a
Applicant Date V I 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 o 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 Dyes V+Na
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 ❑ 0
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exerpnbRam the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicatede b` the California He Ith& afety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applica ezrQ tic.7031.5 hazardous teri reporting.
s
Business and Professions Code).Any ci��YY��!+�pu``��1. t requir�qi�kaa permit to Date
construct,alter,improve,demolish or re�'ai�rd,��£tructure,0, }. o its PROPERTY NER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit )cTa s gned state rz1�nt
that he or zhe is licensed pursuant[o the provisj�o pf t�a Contractors ice, EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Sections 000)of Div's`Tp� o he The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempcfrbA icensure receiving compensation for most work that disturbs paint in a pre•1978
and the basis for the alleged exemption.Any viols a p cctlon 7031.5 by residence or childcare facility to be RRP-certified firmsand complywith
an Applicant for a permit subjects the applicant'tgr`d enalty or not more required practices.This Includes rental property owners and property
than($500). 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.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 License law does not apply to an owner of a o 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 Contractor's State license Law does not apply to an owner of a If your project does not comply with EPA RRP rule please RII out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: ._L I PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: ii COMMERCIAL c. RESIDENTIAL MULTI-FAMILY C MOBILE HOME <: POOL/SPA < SIGN
SUBTYPE: "' ADDITION C ALTERATION C DEMOLITION C ELECTRICAL O MECHANICAL
O NEW O PPLUM`BIING `t✓RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK oU!/ Q.X�� YI l� gelptoLLa. V Lowi
PROJECTADDRESS �L 1 2�I ZIP `�-• plf
ASSESSOR'S PARCEL NUMBER
"� 1 '` I� •� ' LOT TRACT
OWNERNAME
ADDRESS
PHONE •� •b EMAIL
APPLICANT NAME
ADDRESS _6_j j,
PHONE aS 1, S�� � iQ��l. EMAIL
CONTRACTOR'S NAME Aakki VVIqL
' OWNER BUILDER? OYES 0
BUSINESS NAME p- C CQ �/" f.,,p,,, �q �j
ADDRESS 1. `Ong cAlk"v -- N't W � iI„1t11' V V. 1S `
PHONE 1C�-� U 11,ti 3 EMAIL
CONTRACTOR'S STATE LLI/I��C NUMBER 1 Vq l�•••�5 LICENSE CLASSIFICATION
VALUATION$ O o N taL t FT 1•% 0 O L SO FT Q
APPLICANT'S SIGNATURE DATE •�s• U
ciTys-rAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEP ED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL ,7)� , l� GREEN 1 C7 SMIP
OWNER BUILDER VERIFIED O YES 0 NO DRIVERS LICENSE p NOTARIZED LETTER 0 YES ') NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee,CA 92586 (951)672-6777
www.cityofmenifee.us
ENIFE
y. Y
o F + z n n w n v y v n c� � m
d � om Ez 0 m m a
m 0 m 0 m o -� A 3 < ro c?
oy' J O c o� H 3 m O » o' N o. fail n 0 Cif) m
0 ? S J Nw T an d 9 f.. m w L a Z Om
m 3^• C o n O r v m N 6 m j < O m X 0
m S 0 3 00
5 w 0 n 0 9 n v 6 G r Z
p O' w o ui m o m < m M fra'f m m r m a - O
J 30 FF p m M 'm — m Z m m m w
10
r. .� , m a m m m G m m f�Il Q
!mC -w o, z O j m a '� M Z1 n,< V v w Z " A
3 p o ry n
o m v » c r�.� S 0 N n z �� 3 .Oi O m r
m m o o N w m O oo m
.G 0 ti n J m n ro. m ^ m m w p 3 Z D'i D sue_
o N m 0 " a < Z
o, n d r m o m 3 v� �m—n -mp m a s J O T Q
N M d 0 A m N S m F J' F n ^ F T J N CO)i 9 m .O D M 3 m vi m C n ;
a m ~' vNi G m » m m -or, '^ >• m < c a s O
v� d 0 N A .nd. = � m in m a w N 0 d 3 =t
M V O. y m 3 O O N a p O i N _ c 3 O
mi m F d 3 F i� a "' v „ C O T_
lOn O m m n p n d 3 y. in m •G f� y/
m O O
n o 0 m m °o' m o m m ' 3 m F
p 0 p. a d m s N
» .t O p .r^
O 0 3 N 0 O' O m Fa p F N ID
J f 0 o m I
0 a m O
a », m T n a. 3 0iF
A d • -m..
m 0 S m w �. N C Ip N d d d
a d � m
m o N a o o J 00 0
a s 0o N ^ 0 3 A
c m o
m ��, m m N w m
d < O
m 0 o v d 0, S 'o
3 o d o
o m 0 3 '{ m w d M °O
d m L 'm di O r
m 3 m
F 3 91 m 'm m n
a c m 3 3 •o c m -
3 m d a
» m m
O m w M m a m
a J o
J o J p 0 9 O S 0
J m p a N d Q 0
N
n
p m n
m
c M
� a
o m m 0 r
d m n >• � p z
v m d ,� m J, Rl m
m x o m' o 0 3 m N m
pm m t�ii uJi m 3 "' pj
J 3 A
0 30. a � °' A 'om <
d d m a y 00
mm 5. m 0
v_. x 3 a -�- O 'm F-� O
s m
Z O
0 �m a l d
0 d
O N Q II o E
O (U m on .Ld. = m -o
=
�
n m E Y
E a o d
a N m y U v
ul a Z v 3
0 N m m W N
u O d
w W c u d w H
J '+- o at ¢ m w
n « + vl U o
m
J 10
j II
N O d V V C Y C
O C
J c � a d
a o 0 0 0 «
Y! E a m m o o a N
m = J w o
J w c 1O Q J d
0 o c an d v t m
y 0 O C C Y d
s m z '�, 3 n
J o d
.. �o',
o m v O a v E 0 C = Lp
d y u
d N a m m « U p a jy
v 3 a z o v 3 = m c Y u J
« v
v 0 d v
c m
� o v
u m >'. v ^' w « m u m w m in u a o
¢ Z o m O �' a u U a o. c
Z d _ O u
Ei u O a n v m m v
C u C m W J C. u a LL J d C O
O OCD O C 6 C W ¢ y U 0�0
O d W y K LL m L' ei
d S U a C m O' m f0 W O m C •i
UI C J Y K m C Cl. i1
.r
O d d v d O IC w W C yOj d V y d m E a 0 m — Z '� v o N ai y c
u�i •C a 0 = u ; Q w « n aE = m
�. O 00 u d 0 VI N O N c
p JO j -p = U O d C. O m O V V m
C N C 0 a 0 y
� v ala m m W
0 _a
C N Q d
u Yl Wm _ m J C O
Y+ a °' •� d d U H O y O LL Y C N y 0 a J YJ
V m d O C C O O d G d m O O m N w d d Y
.` « e m m l d u O .� 'm W P U u w U m a m C O
Z w a m •Ti w .vc u c E .P •c 0 .�
oui u o h o ad. c N > 'o a vv0i a we pm F- ❑ v
O N c m o d « "0 d c a E a '^ a G u m 0 0 a W e c
c c m m 0 o E m a a Y o m ca a J d m m 0 '•- °1 m
o m m d c = = c o E m a u
Lo N a ._ c v 0 „m, v. `w ry c a v E F' O �o
z t J ' � m u d m m '� +' w •y-, y c v « Z o c
a. E E " > m e �� O c W
O O 0 a V V. O C C d d x C_ O d O K "I ~ w
y w K Z 1' d N O a• d m m a LL E m �p W �' d W •O' m
e W d -�W O O C Y, u 0 u p m E E W O
Q Q w w m H o 0 0 w t d `ai m o c m `m c Q E p wp e`mo
Z =° °o ? m a u E a d ¢ F v a o « d
y, 0 a i, u m a m 1° "' m W N 3 a a v m y p S
O (D F' D S N c m a v 0 m 7 y J H
U O d
u. H O
d Z 1 d 6 N d Q N 1- N ay+ K K YI O > Z m J S
OW z z a �• a m c m d o m m = E E E 0u u O « , `o
15 t Y J J J F y
Q i -o 3 0 o " "' o o E E E y `o Q °- o
U y t m m i o 01 0 n m
;' o o E •E •E W y a c
d
LL •u H a e`. z a a J 5 a a 3 a y m h N
F- yw � �v i r a
z « uu m m
� a o z 0m ,0
^ ��� v