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PMT15-01059 1 City of Menifee Permit No.: PMT15-01059 �-.y, 29714 HAUN RD. Type: Mobile Home ^� 9 GCCIE../t MENIFEE, CA 92586 MENIFEE Date Issued: 04/24/2016 I PE R M I T Site Address: 25170 MALONE AVE, MENIFEE, CA Parcel Number: 327-400-002 92585 Construction Cost: $79,000.00 Existing Use: Proposed Use: Description of REPLACEMENT OF MANUFACTURED HOME 68'X 26' Work: Owner Contractor VALENTINO MOCA 25170 MALONE AVE MENIFEE, CA 92585 Applicant License Number: ROBERT NICORICI 3849 HALLADAY AVE RIVERSIDE, CA 92503 Phone: 9517081150 Fee Description (sty Amount is Replacement Manufactured Building 1 240.72 $267.72 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 1 City Of Menifee LICENSED DECLARATION I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ 1, 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 and my license is in full force and effect. 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 Expires Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION am exempt from licensure under the Contractors'State License Law for the ❑ I 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 permit is issued. Policy# built as an owner-building if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the ❑ 1 have and will maintain workers' compensation insurance, as required by Business and Profession,�%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��}.1q/e/foJldGvIng Web site:http'//www Iepinfo na pov/c/al�aw html. permit is issued.My workers'compensation Insurance carrier and policy number are: // `� T' 2 7{' l� Carrier Propert ner or Author ed Agent Date Expires Policy# y my Signature below, I certify to each of the following: I am the property Name of Agent Phone# wner 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'nspection 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 Zr" 2f/'�� subject to the workers'compensation provisions of Section 3700 of the Labor Property Ow r or Authorized Agent Date Code, I shall forthwith comply with those provisions. City Business License# Date; Applicant; WARNING: FAILURE TO SECURE 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, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR ��. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES 'XNO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS 1 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address 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 ❑YES WILL THE 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, b<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 Stale 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 ❑YES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from licensors 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 le", UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORT ING. compensation, will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR THORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). � � a • • • a a . . a • Wenifee DATE 41n I IS PERMIT/PLAN CHECK NUMBER r M IS-CIO TYPE: COMMERCIAL c;RESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA _-SIGN ? SUBTYPE: : ADDITION ALTERATION ±.%DEMOLITION ' ELECTRICAL :.i MECHANICAL (ANEW - PLUMBING t?RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK R. EPL Ak C.t MfN-r B-f A-N 0C Mo 13 itf wl TH A MAI`Iu rA-C 0M1! PROJECTADDRESS 2.9 1-4- 0 M A, Lo NI E A 1/ EN 1 t'� E ASSESSOR'S PARCEL NUMBER 3V+-1}00— 00 z LOT S2 TRACT f q0 0 OWNER NAME VA LCN-rI NO Nl O C A ADDRESS 3? 4q a kttA- t6 Ay A k/er jZ T L) "S I A 1F CA q9 :3 PHONE q 1 *1-0$ 11 Sd 1, EMAIL -f Ir L I C f A . IN GM A'I L .CONt APPLICANT NAME Sa"1�`r �JI{.1(L+ ADDRESS J D41rl A't(, Ik V p `. �I ��SI /�Cr C�' q Z -0,1 PHONE qS.� �0b II �0 EMAIL ���.1Cl /l-. (N & CiNA'ILCUJEt CONTRACTOR'S NAME OWNER BUILDER? X YES C-NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ R [ O 0 O SO FT L SO FT q .APPLICANT'S SIGNATURE DATE 2�I' CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP INVOICE PAID AMOUNT AMOUNT 26-1.1 -CASH CHECK# Cl CREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT CASH CCHECKN CREDIT CARD VISA/MC OWNER BUILDER VERIFIED ,-,'YES NO DL NUMBER NOTARIZED LETTER -`.% YES `.- NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee; CA 92586 951-672-6777 NwLV.cityofinenifee.u.s inspection Request Line.951-246-6213 i City of Menifee Building & Safety Dept. APR 2 4 2015 CITY OF MENIFEE Receiv �oSIL1; .DING AND SAFETY DEPARMENT PLAN APFKOVAt REVIEWED Q'Aq_ Oglayle DATE 'Approval of these pians shai!not hp 1 onstrued to he a permit for,or an �N approval of,any violation of any provi ions of the federal,state or city regulations and ordinances. This set f approved plans must he kept on the r. johsite until completion. 34y f SFr 2}t d I 40' 2° V Q i LrI fi i Power of Attorney Let this serve as an authorization letter for Robert Nicorici to pull permits At City of Menifee for 25170 Malone Ave,Menifee. Sincerely, Valentino Moca State of California, County of Riverside, On 4/22/15 before me,Anna I. Rodriguez, Notary Public, personally appeared Valentino Moca, who proved to me on the basis of satisfactory evidence to be the persons whose name I re ubscribed to the within instrument and acknowledged to me that ee he/they executed the same i /her their authorized capacit ' s),and that by is h r/their signatur�on the instrument the perso or the entity upon behalf of which the person(7acted, executed the instrument. I certify under P NALTY OF PERJURY under the haws of the State of California that the foregoing paragraph is true and correct. WITNESS my 1011and official seal. Lk� '7� Signature ANNA I. RODRIGUEZ COMM.# 2004702 r�nn N NOTARY PUBLIC-CALIFORNIA ORANGE COUNTY MY COMM.EXP.JAN.20,2017 f I �suNa I + S?ATZ OF BALIfQRMA pEk" WD-BueINIESiI- RF-R'oUt9J L;..- )� - - � .'M➢kN{7R4'GTl7R'�'P�_'f�'11"76{IiCi PVYQG`R7lIC�""•: •� :,._ a, n... - , MANUFACTURER CERTIFICATE Of. gRlGtN, CHECK IF THIS IS A DUPLICATE MCO•ENTER ORIGINAL MCC NO,- {:. MAN4JFAOTUM2_�„ &Q Ha na ra JI11FAMI ILI--Y--y�MAnt mrA^ BED HO SI NUMBER©F SFD(SiNO,LE FAMILY DWELLING) L--I MFMH(MUL7tEAMILY MANUFACTURED HOUSING) TRANSPORTABLE SECTIONS OCCUPANCY GROUP UP ) Fleetwood Homes, Inc, L R. ItAF 1r5If 'NIANUFAQ7UR£R ADDRESS: -c Am 7 Jerups Ave. Riverside CA '92504 SUGGESTED RETAIL PRICE; MaNUFacruRBR TRADE NAME: c MO4EL NAME ANDIQR NUMBER; DATE OF MANUFACTURE! Crownpokte kreme 220PX28568 Y' Q2l0412D15 NAME OF pEA ER OR TRANSF E(QWNERBHIF THAN ERREp TO): CALlFQRNIA pFJ{L is NUMBER OR D TE OF TRAM PER^ ims SAUS,INC, Y 4E$43MA7iON r DEp : .....N1 T; O t�F13 2 itg91ii:L AV414ME 95-*206 `CO$TA"'$A CA csao I 1 FLt*220(+ 1$-6124A PFS d1451t10 2 ei- • TRANSPO NAME Melrltee CAb9S „ Ak671kAY1pN KARlaNi�d�CICUbF•R:AtlDYk.1 (Dm') lSteW q}:. - `.. . ... $80 IceNHy under PaRallSMpar)ury under the lawe aF the SWIG of Callfomie thatpra ahcva facts-are true and c'ANgot E aeuptlon 0?Pxw-14 1Riverside Riverside CA (Date) my) (County) ;Slate) eiGNATURB OF gUTNORtr,£DAs®IJT: •* �" '"e " ru w..S r . . ,. • +,•,' "" 0IO�(NAI�t{K) .FDFpWkRD,T9.'#N£INNENTtlWY,6RED70R UNl #.tBRE iB p�NTiy TJ{gN,pgpyypRE TD, Bp 1 ) PORWA 7O7N£DEPARTMENT A7 P D BOX SACRAM£NTC,CA 96Btfi4888,WtTHiN PIWE(5} pA'yyEpptREE{LE,ggp R TRAN9FRfdEB}"COPY8 OW) DSI.IV£R TOTH£TPANSPORT£RTOACCOMPA THE UNIT TORS DESTINATION, COPY$.OfILDENROO) YO RE RETAM£D£Y THE MANUFACTURER. I - HCp A83.0-.SIdp1-(Rev.Di/12) i i �fr�inity Escrow, Inc. 12345 Mountain Ave., Suite T, Chino CA 91710 Tat: (909) 591-1668 -Fax: (909)591-1610 BUYER/BORROWER STATEMENT Final f- Escrow Number: 21153-1S Title Order Number: Escrow Officer: Kellie S.Potter Date: 03/30/2415 -1132:48AM' Closing Date: 03/34J2015 Buyer/Borrower: 25170 Malone Avenue,Trust UTD 110414 Seiler: JMS Sales,Inc. Property-, 25170 Majono Avenue,Romolaud CA 92585 TOTAL CONSIDERATION 75 994.10 initial Deposit rec'd from Citizens Business Bank-Incoming Wire-ResoluteA NV Corp/Nest FBO 10,009,00 22427 Akers Lane Trust UTD 110414 Additional Deposit reed from Citizens Business Dank Incoming Wire-Resolute NV Corp/Nest '- 65,994.10 Lendi FBO 22487 Akers Lane Trust TOTALS 75 994 10( 75,994.I D 1 I RECORDING REQUESTED BY: DOC#2015.0080512 Fidelity National Title Company 9r^ 02/27/2015 05:00 PM Fees: $25.00 Page 1 of 1 Doc T Tax Paid j Recorded in Official Records WHEN RECORDED MAIL DOCUMENT AND County of Riverside TAX STATEMENT TO: Peter Adana Assessor,County Clerk&Recorder Valentino Mora,Trustee ff 5120 E. La Palma Avenue#105 pd Anaheim Hills,CA 92807 "This document was electronically submitted to the County of Riverside for recording" Receipted by"MGARCIA APN: 327-400-002.6 TITLE ORDER NO.:00026334-991-IE1-BS2 ESCROW NO.:175511-L mb—/C/-'-�- GRANT DEED The undersigned Grantor(s)declare(s)that the DOCUMENTARY TRANSFER TAX IS:$ 68.20 County XX computed on the full value of the interest of property conveyed,or —computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale. —OR transfer is EXEMPT from tax for the following reason: V cvt� o f �ow/'R na FOR A VALUABLE CONSIDERATION,receipt of which is hereby acknowledged,RALPH G. MORNINGSTAR S HEREBY GRANT(S)to Valentino Mora Trustee of the 25170 Malone Avenue Trust UTD February 2015 ' All that real property situated in the City of Romoland,County of Riverside,State of California,described as: PARCEL 2 OF PARCEL MAP 8900 AS PER MAP ON FILE IN BOOK 34, PAGE 64 OF PARCEL MAPS, RECORDS OF RIVERSIDE COUNTY,CALIFORNIAAPN: 327-400.002-6 Commonly Known As:26170 MALONE AVENUE, Menifee, CA 92585 Dated:February 24,2015 A notary public officer or other officer completing this certificate verifies only the Identify 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 VV VC �, ^ COUNTY OFF V Y'S1 _ ) � � �G.� On &Anrs 10A 4 �J , )D l6J ,before me, �— RALPH M INGSTAR Notary Public personally appeared.QG!iPh G , LADY-nlY i!1 l who proved to�rye on the basis of satisfactory evidence to be the personol DANA C.F088 whose n e are subscribed to the wit in instrument and acknowledged to ` Commission#2058433 me that a Ahey executed the same in(blgYheritheir authorized capacityjie , Q:(_�o z and that b hi her/their si natu -�- Notary Public-California z g rrson op the Instrument the nsrumen, or the Riverside County entity upon behalf of which the person(v�acted,executed the Instrument. •"' M Comm.Expires Jan 31,2018 r I certify, under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph Is true and correct. WITNESS my hand and official seal. Signature GA. Ct s (SEAL) 'l MAIL TAX STATEMENTS AS DIRECTED ABOVE