PMT18-02949 City of Menifee Permit No.: PMT18-02949
Ar!, r 29714 HAUN RD. Type: Residential Alteration
j'A' MENIFEE,CA 92586
MENIFEE MENIFEE Date Issued: 0 611 412 01 8
PERMIT
Site Address: 28914 SPINDRIFT CT, MENIFEE, CA Parcel Number: 364-182-007
92584 Construction Cost: $0.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of SPECIAL INSPECTION FOR CODE CASE CE18-0728
Work:
Owner Contractor
QUN LIN
28914 SPINDRIFT COURT
MENIFEE, CA 92584
Applicant License Number:
MENIFEE, CA
Fee Description ON Amount f$1
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$156.07
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_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 Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors 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
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
o 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 70"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.himl.
Policy Date
o I have and will maintain workers compensation insurance,as required by /LPROPERTY OWNER ORAUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which 7 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 on the property owners behalf.I have read this
number are: ap lication and the information I have provided is correct.I agree to comply
Carrier wit all applicable city and county ordinances and state laws relating to
bui Ing construction.I authorize representatives of this city or county to
Policy Expires en r 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
OP RTY OWNE)R OR AUTHORIZED AGENT
D 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 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 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 oYes ❑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($300,000),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 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?
(Section 3097 Civil Code) ❑Yes o No
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
Californiaealth&Safety Code,Section 25505 and 25534 concerning
Contractor h
s License Law for the reason(s)indicated below by the
hazardous material reporting.
checkmark(s)1 have placed next to the applicable Rem(s)(Section 7031.5 oyes o No
Business and Professions Code).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(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 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($500). managers who do the paint-disturbing work themselves or through their
o I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. in No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a if your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE. PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOLO''''''II,O�i
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL 0 MECHXlri7#PAp9 Dept•
0 NEW 0 PLUMBING 0 RE-ROOF NUMBER OF SQUARES ^�a
DESCRIPTION OF WORK ` V ' p
Received
��jj
PROJECT ADDRESS Z (� I� ,�01 rl`�-�- �L ZIP
ASSESSOR'S PARCEL NUMBER �, yL.(^�$p�-[�� LOT TRACT
OWNERNAME U
ADDRESS /G\ a
i
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? K YES 0 NO
BUSINESS NAME
ADDRESSptc /Zv
PHONE -C7� , EMAIL
CONTRACTOR'S STATE LIC NU ER LICENSE CLASSIFICATION
I#
VALUATION$ SQ FT L SO FT
APPLICANT'S SIGNATURE ! DATEjuhc o
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: y 'n CIT/OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ►1"Ity✓l
INVOICE TOTAL I I ,O I GREEN SMIP
OWNER BUILDER VERIFIED OYES 0 No DRIVERS LICENSE## NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6*7��
www.cityofmenifee.us
Hi,
Alan Nierenberh, the contractor, has my permission to represent me in obtaining the permit for the contracting
work that needs to be done for the following property: 28914 Spindrift Ct menifee ca 92584. If you have any
questions or concerns,please contact me,Qun Lin, the landlord at 510-316-6619.
Sincerely,
City Menefee
Building Dept.
Qun Lin JUN 14 2018
St?e A+�-ta,�\aa Np�ary Rrry, Received
r
CAUFORMIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE §1189
.cOdrt'„"'•••nEt-.-r_�.�•.�n�rv�r...r..•c..r_—��•.c•.S:c:�'a:C'.cs`.c(„cGCGcfc{da�`a�Gf7sCt
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 attached,and not the truthfulness,accuracy,or validity of that document.
State of California )
County of
On (r Iy - -!K before me, aiiM Mad► %A Notairy vb1i
Date Here Insert Name and Title of the Officer
personally appeared -- OQn __LiY1 ---
Name(s)of Signer(s)
who proved to me on the basis of satisfactory evidence to be the personWwhose nameW isi x
subscribed to the within instrument and acknowledged to me that he/sft$/ttiW executed the same in
his/b*/1their authorized capacity((W,and that by his/W/"ir signature(o on the instrument the persorlW.
or the entity upon behalf of which the persons acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
OU rP411C-r3fi WITNESS my hand and official seal.
@My
No1&rq 7ubllc•CoIHarNaLosan®elos Cvmly
Commisslon 71241963
Comm.Enplres fay 11,2022
f— Signature
Signature of Notary Public
Place Notary Seal Above
OP77ONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Dezoription of Attached Document
Title or Type of Document: �EY_Y111 �rniltufiDn -_ _
Document Date: Number of Pages: —_--
Signer(s) Other Than Named Above:
Capacky(les) Claimed by Signer(s)
Signer's Name: Signer's Name: -
Corporate Officer — Title(s): � Corporate Officer — Tdle(s):
Partner — Limited - eneral iJ Partner — Limit eneral
Individual ttomey in Fact C Individual 11 Attorney in Fact
Trustee Guardian or Conservator Trus a Guardian or Conservator
Other, ,7 er:
Sign Is Representing: SI er Is Representing: _
)2015 National Notary Association • www.NationaiNotary.org • 1-800-US NOTARY (1-800-876-6827) Item#5907