PMT14-02843 a
F
I
City of Menifee Permit No.: PMT14-02843 k
y+����' ,. 29714 HAUN RD. Type: Mobile Home
4Y'CM A," MENIFEE, CA 92586 1
MENIFEE Date Issued:
04I30/2015
PERMIT
n
Site Address: 32860 TINO RD, MENIFEE, CA 92584 Parcel Number: 360-320-011 �
Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INSTALL 1280 SQ FT MOBILE HOME
Work: SERIAL#17600FHA10015A & 17600FHA10015B
HUD#NTA1657979 & NTA1657980
Owner Contractor
JOHN PETERSON LAND HOME CONSTRUCTION INC
26375 HAYDEN LN 35325 HIGHWAY 74
MENIFEE, CA 92584 HEMET, CA 92545
Applicant Phone: 9518302085
CRAIG DAVIS License Number: 892706
LAND HOME CONSTRUCTION INC
35325 HIGHWAY 74
HEMET, CA 92545
Fee Description CRY Amount f$1
SFR DIF 17 Public Facilities 1 1,207.00
esldentla�aensity less:than 8 0 dwelhn units e'�'r �``�x h �
111
g a kr m1 a 1 938.94
Single Family Residential on lots greater than % 2 500.00
Manufactured Install 1 240.72
S�R OiF'�Z�TX2f1�S
1Ma11ill ovg�ne
SFR DIF 17 Transportation Signals 1 420.00
s_..,�..sA.c,_� vw..- .,.,¢,,.....rw -z.a.tr. ..msm.,.„K �x.,t•" a.w. uu dC£21 Fii..w
SFR DIF 17 Regional Parks 1 563.00
SFR DIF 17 Regional Multipurpose Trails 1 316.00
SFR DIF 17 Library Books 1 341.00
Permit Fee 1 27.00
$10,050.72
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
5
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code Eind my license is in full force�and�e� Code:The Contractor's License Law does not apply to an owner of a property
License Class- - -? License No. ( who builds or improves thereon, and who contracts for the projects with a
Ex Tres Signature
Ff 1�C!^%Ad- licensed contractor(s)pursuant to the Contractors State License Law). '
WORKERS'COMPENSATION DECLA TI❑N
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
perms s issued. built as an owner-building if it has not been constructed in its entirety by licensed
Poli # contractors. I understand that a copy of the applicable law, Section 7044 of the
I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto'//www Ieginfo.i;a.gov/cpIaw.h1mI.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier `iiy&5 5 C 6 ( N S• C a G / Property Owner or Authorized Agent Date
Expires ���s Policy# Wi+/C 30 1 /00 SA
Name of Agent Afr7�< /ti L ��tphone# S b-Z p ❑ BY my Signature below, I certify to each of the following: I am the property
9 G I owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent Date
Code, I shall forthwith comply with those provisions.
A City Business License#
I Date; � J�� Applicant; - A
WARNING: FAILURE TO CURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, OYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed OYES WILLTHE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
or repair any structure, prior to its 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 License Law (Chapter9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f)EPORffING.
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Stale License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
pJSfNG 9N STATE OF CALIFORNIA NUMBER:
.'� rl BUSINESS,TRANSPORTATION AND HOUSING AGENCY
o,n a r .� y DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT 8807891
�tq �� w DIVISION OF CODES AND STANDARDS
'£ MANUFACTURED HOUSING PROGRAM
MANUFACTURER CERTIFICATE OF ORIGIN
CHECK IF THIS IS A DUPLICATE MCO-ENTER ORIGINAL MCO NO.
MANUFACTURED HOME OR MULTIFAMILY MANUFACTURED HOUSING NUMBER OF
LI SFD(SINGLE FAMILY DWELLING) ❑ MFMH(MULTIFAMILY MANUFACTURED HOUSING) TRANSPORTABLE SECTIONS
COMMERCIAL MODULAR:
OCCUPANCY GROUP
MANUFACTURER NAME: MANUFACTURER LICENSE NUMBER:
CHAMPION HOME BUILDERS[;dC 1218438
MANUFACTURER ADDRESS. SUGGESTED RETAIL PRICE:
2»vl Ill SIAITH AVENUE CORONA, CA 92n&' NIA
Street) (City) State (zip)
MANUFACTURER TRADE NAME: MODEL NAME ANDADR NUMBER: DATE OF MANUFACTURE:
F,Il FS SUMMIT PLUS
NAME OF DEALER OR TRANSFEREE(OWNERSHIP TRANSFERRED TO); CALIFORNIA DEALER NUMBER OR DATE OF TRANSFER:
TRANSFEREE DESIGNATION:
MA W11 1 JAMC!, 1 c TI t AI i—C q ^: S 7I F,
DEALER OR TRANSFEREE ADDRESS:
S 74 HEMET, CA (City) State (zip)
INVENTORY CREDITOR NAME:
INVENTORY CREDITOR ADDRESS:
stBeef75 RAINWATER DRIVE SUITE 430- ALP1 a TTA CA 30009 State (zip)
SECTION LENGTH WIDTH JWEIGHTMANUFACTURER SERIAL NUMBER HCD INSIGNIA OR HUD LABEL NUMBERtE INCHES INCHES .1 176-00E-H-A100115A NTA IC5797�1 576 1cCI 2 1T6-ODF-H-AtGO9158
NTA 1ti57980 57f� i6o
TRANSPORTER NAME:
RBKTRANSPORT TRANSPORTER ADDRESS - 1FE1
27 V; TCrrELL RD , SA.NTA 'vlARIA A 9345 ; ,) BUILDING A D S
(Street) E B t� (CI') (state) (L
DEST�j fppLFWgu"D€CgI1T f11 RL?AG, Tv1EN' E, -A. 92584
r't't PLAN APPR VAL
NAME Street (City) State Pi
I certify under penalty of perjury under the laws of the State of California that the above facts are true and correct
vM7115 v0R:"�NA RIVERSIDE CALfl ORLPA.
Emcmea on at _ REVIEWED i«wt=D
(Date) (City) (County) (State) ki
SIGNATURE OF AUTHORIZED AGENT I. L 1_ -L_
DISTRIBUTION: ORIGINAL(PIINI r FORWARD TO THE INVENTORY CREDITOR,UNLESS THERE IS NONE,THEN FORWARD TO THE PURCHASER(DEALER Mp triova o@these plansahall
COPY 1(WHITE) FORWARD TO THE DEPARTMENT AT P.O.BOX IB28,SACRAMENTO,CA 95812 1828.WITHIN FIVE(5)DAYS OF RELEASE
COPY 2(YELLOW) DELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS DESTINATION. approval Of,any violation Ofa
COPY 3(GOLDENROD) TO BE RETAINED BY THE MANUFACTURER.
HCD 483-0-Side 1-(Rev.01/12)
regulations and ordinances, 1
jahsite until completion.
I
" Mall *iams
since 1969 m a n f r c lured kom es' (no.
March 4, 2015
To Whom It May Concern:
"Ma" Williams Manufactured Homes authorizes the placement of a 2015, Silvercrest
Home, Serial # 176-OOF-H-A-100115A & 176-OOF-H-A-10011513. HUD#NTA 1657979
&NTA 1657980, home to be placed on a permanent foundation at the address below:
32860 Tino Road
Menifee, Ca 92584
This home is for customer John Peterson and Sharon Otis and is to be financed.
If you have any other questions please feel free to call me at(951) 926-1581.
Regards,
Claudia Saunders
"Ma" Williams Manufactured Homes Inc.
AFETY '
35325 Highway 74 Rosarito Beach not be ton:
Hemet, California 92545 Mexico
Tel 951,926.1581 Intersection of Toll Road and Free Road �Yptovisiot
Fax 951.926.9622 Tel 011.52.661.613.1091 his set of al
DOC # 2014-0259064
RECORDING REQUESTED BY
07/11/2014 01:37P Fee:21.00
Page 1 of 3
DOCStar Services,LLC Recorded in Official Records
AND WHEN RECORDED r rHS DEED AND,UNLESS OTHERWISE COUnty of Riverside
St eELOW,rMa TAX STATEMEWr Ta. Larry W. Ward
Assessor, County Clerk & IIRecorder
Name John Peterson I IIIIII IIIIIII IlI IIIII IIIIIII II���II�II lII III7�III I II
&treat Sharon
Otis
Address 30534 Wyndham
city& Menifee,CA 925e4 S R U PAGE SIZE CA MISC LONG RFO COPY
State
➢p
M A L 465 426 CO NCOR SMF NCHG rEXAM
Title Order No. 7642 WC Fscmw No.N/A I(/
T� CTY UNI "L/
Grant Deed o
THE UNDERSIGNED GRANTOR(S)DECLARE(S)
DOCUMENTARY TRANSFER TAX IS S 0.00.No Sale,R&T 11911
unincorporated area City of M 0—R Y C G
Parcel No. 360-320-011 TRA 026-093 M
❑computed on full value of intemst a property conveyed,or
[-]computed on full value less value of liens or encumbrances remaining at time of sale,and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
John M. Peterson, a Widower
hereby GRANT(S)to
John M. Peterson, a Widower and Sharon Otis, an Unmarried Woman, BOTH as Joint Tenants
the following described real property in the C.I�y( vw-Nfee
County of Riverside J ,state of California
See attached Exhibit"A"for Legal Description
Dated Melfft�T D
STATE OF CALIFORNIA r
COUNTY OF /ZI VbYLS 10/� n M. Peterson
On . \ J 1 (b q �1 ( 07 before me.
IRHT7ZLClA f-'hnza lez
(here insert came and fills of the officer) N
,00rary pudic,personally a,__d John M.Peterson
...................................««...............
.......««».«......
who proved to me on the.�sis of satisfactory evidence to be the DEPAR
(�whose neme(,gT'is/Qre bed to ec within insWment
a rwMedged m me he/ eflhey executed o' same in
e reir au !del capDG and that by hi erltheir
aich the
pe the ins mane xe person( , tr the entity behalf
of which the persan(y�acted,executed the Instrument.
CQfAMW" 1' MIN
I certify under PENALTY OF PERJURY under the laws of the state of f
Califomla that the foregoing paragraph is true and correct. RYP�- M1t
I A—
WITNESS my h "al seal COtrlm, 2 11e
Signature A I C. (TM.,. IIcoloowteissee trued to be
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE;IFNO PARTY SHOWN,NLkM AS DIRECTED ABOVE 5 Of the fedl'Same as above
Name Street Address
City&&rate proved plm'
Exhibit "A"
THAT PORTION OF PARCEL 2 OF PARCEL MAP 6165, RECORDED IN BOOK
14, PAGE 97 OF RIVERSIDE COUNTY RECORDS, DESCRIBED AS FOLLOWS:
COMMENCING AT THE NORTHWEST CORNER OF PARCEL 2 OF SAID PARCEL
MAP 6165; THENCE NORTH 890 52' 07" EAST, 220.00 FEET ALONG THE
NORTHERLY LINE OF SAID PARCEL 2; THENCE SOUTH 00 10' 07" {VEST,
396.84 FEET TO THE TRUE POINT OF BEGINNING; THENCE SOUTH 690
49' 36" WEST, 220. 00 FEET TO A POINT ON THE WESTERLY LINE OF
SAID PARCEL 2; THENCE SOUTH 00 10' 07" WEST, 261. 35 FEET ALONG
SAID WESTERLY LINE TO THE SOUTHWEST CORNER OF SAID PARCEL 2;
THENCE NORTH 890 49' 36' EAST, 333 .71 FEET; THENCE NORTH Go 06'
42' EAST, 261 .35 FEET TO A POINT THAT IS NORTH 890 49' 36" EAT,
113.45 FEET FROM THE TRUE POINT OF BEGINNING; THENCE SOUTH 890
49' 36' WEST, 113.45 FEET TO THE TRUE POINT OF BEGINNING.
SAID LAND IS ALSO SITUATED IN THE UNINCORPORATED AREA OF
RIVERSIDE COUNTY.
TMENT
I
j permit for,i
rai,state or t
3 must be kel
°* LARRY W.WARD Recorder
P.O.Box 751
COUNTY OF RIVERSIDE Riverside,CA 92502-0751
ASSESSOR-COUNTY CLERK-RECORDER (951)486-7000
w .`iversideacr.com
`Rm act'
NOTARY CLARITY
Under the provisions of Government Code 27361.7, 1 certify under the penalty of perjury
that the notary seal on the document to which this statement is attached reads as
follows:
Name of Notary: W8 t(.)t} C�r p /V 7 A LC Z
Commission #:
Place of Execution:
Date Commission Expires: A� � U lu
Date:
Signature:
Print Name: �9/Z jlf} Qlq 1 (�/aLc i�
� E
u an
ity
t on the
ACR 186P-AS4RE0(Rev.0712005)