PMT15-01534 City of Menifee Permit No.: PMT15-01634
29714 HAUN RD. Type: Mobile Home
d'--'tCCEIIL MENIFEE, CA 92586
MENIFEE Date Issued: 06/05/2015
tl
I
PERMIT
Site Address: 25913 WEST WINDS DR, MENIFEE, CA Parcel Number: 329-262-018
92585 Construction Cost: $6,000.00
Existing Use: Proposed Use:
Description of INSTALLATION OF NEW SILVERCREST 27'X 60'MANUFACTURED HOME AND EXISTING AWNING
Work: SERIAL#176-000-H-A1000217A, 176-000-H-A1000217B
INSIGNIA#NTA1671285, NTA1671286
Owner Contractor
STACY D FELTS TERRA FIRMA CONSTRUCTION INC
25913 WEST WINDS DR 913 MAPES ROAD
MENIFEE, CA 92585 PERRIS, CA 92570
Applicant Phone: 9517575731
BRUCE EVANS License Number: 796315
TERRA FIRMA CONSTRUCTION INC
913 MAPES ROAD
PERRIS, CA 92570
Fee Description o yt Amount I$1
Permit Fee 1 27.00
$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,orwhere 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 ❑ 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 and y license is in full ore a ecc Code:The Contractor's License Law does not apply to an owner of a property
License Clash C9 Licens 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
❑ I 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. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
�ave 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:http,//www.leginfo.ca.gov/calaw.htmi.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier S�C 11 fir-
c)A�o'C i_ Property Owner or Authorized Agent Date
t 1—`� ti�I �— TT �["y'[//'
Expires I — Z� `�� Policy#_SOC/1�'C> 7 0
I ❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# 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-
El I certify that in the performance of the work for which this permit is issued,I ���d idyp����`iJJJf property f,,,,������rrrFFFppp•••a ins a ti n purposes.
shall not employ any persons in any manner so as to become subject to the /{' ,J /_(" J
il. workers' compensation laws of California, and agree that if I should become I- 4 D'
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent 6 � Date
Code,II shall forthwith complywith those provisions. -
6{-y l l/ J (/J))� 6`'s——f City Business License#
Date/%///%/",(�L��(11,� plicant;
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, ❑YES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE ---MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ffRO 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address . 5NO 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 reasons)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: E WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, 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(Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or 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 I EPORtING.
compensation,will do( )all of or( ) porting of the work, and the structure is PR R GENT
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).
�rls'l�Q
& SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: COMMERCIAL . RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA ? SIGN
SUBTYPE: 0 ADDITION C:7 ALTERATION 0 DEMOLITION '0 ELECTRICAL O MECHANICAL
_.(e�EW C% PLUMBING -) RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK /� -�f�(-L ('pN 0 6- N C�-W tid•V��,Q�I(,E�`T
PROJECTADDRESS 25913 /' t�j�/jT W (PJ_05 _ R) UV� (. 1/J7 4+ Gj•Z,>
ASSESSOR'S PARCEL NUMBER 3. a
1 \L1J �� +' ,1 LOT _� TRACT S�
OWNER NAME q RC
ADDRESS 13 J 6_;S_l VV k61 aD S�_ C.�'ACA I n 14- 2-Sy
PHONE — 2- 6� EM�A�IL
APPUCANT[�N'AME Cr
ADDRESS 14 ftf0{S- Mr�� .�g��,� 6A 2-s-•}?,
PHONE17 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? OYES • NO
BUSINESS NAME _F�ff(LA-
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION G
VALUATION $ RkSQ F _ L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE I
NLY
DEPARTMENT DISTRIBUTION CITV OF MENI E N5i5-LI[SgL)MBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP (((O�[[��,,`j`jUU
INVOICE PAID AMOUNT
AMOUNT ` - CASH 0CHECK# C%CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT ()CASH -%CHECK# CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED Ci YES Ci NO DL NUMBER NOTARIZED LETTER C% YES C% NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifCe.us Inspection Request Line 951-246-6213
_. MEN IMFEE,
Scott A.Mann June 5, 2015
Mayor
To Whom It May Concern:
John V.Denver
Mayor Pro Tern The following information is provided for the school district to determine mitigation fee
Wallace W.Edgerton amounts:
Councilmember
Applicant: Bruce Evans
Greg August Phone:
Councilmember Application Type: Building Permit for Installation of Permanent Foundation System to
Matthew Liesemeyer New Manufactured Home
Councilmember
Permit Number: PMT 15-01535
Location: 25913 West Winds Drive, Menifee CA 92585
Assessor's Parcel Number: 329-262-018
Legal Description: Recorded Book/Page: MB 74/62
Subdivision Name:TR 4540
Lot/Parcel:43
Block: Not Available
Tract Number:4540
Description: Square Footage:
Existing Single-Family Residence (Mobilehome)to Be Replaced 1,440 sq. ft.
Proposed (New) Single-Family Residence (Mobilehome) 1,620 sq.ft.
COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION STAMP:
BUILDING AREA
VERIFIED
Date
PRIOR TO THE ISSUANCE OF THE PERMIT REFERENCED ABOVE, applicants are required to
submit written evidence from:
Perris Union High School District
Romoland School District
to City of Me ifee autMingissuance of building permits.
z�
By:
29714 Haun Road ya F wler, sociate Planner
Menifee,CA 92586
Phone 951.672.6777
Fax 951.6793843
www.cityofinenifee.us
ROMOLAND SCHOOL DISTRICT
25900 Leon Road, Homeland, CA 92548
(951) 926-9244 • FAX (951) 926-2170
Julie A. Vitale, Ph.D., Superintendent
SCHOOL FACILITIES FEE WAIVER
Date: June 5, 2015 DEPARTMENT OF BUILDING &SAFETY
To: Whom it May Concern
Applicant's Name: Bruce Evans
Owner: Bruce Evans
Building Dept.Permit#(s): PMT 15-01535
Assessor Parcel#(APN): 329-262-018
Project Address: TRACTILOT: 4540/43
Location :
25913 West Winds Drive
Menifee, CA 92585
To Whom It May Concern:
The Romoland School District does not intend to collect School Facilities fees (Developer Fees)on the
above-mentioned project because of the following reason(s):
Replacement of mobile home and additional 180 square feet
Therefore, building permits for this project may now be issued by your jurisdiction.
Sincerely,
Karen Owen
Romol id School District
Busine s Services Department
i
OVyBCNp,yam STATE OF CALIFORNIA
BUSINESS TRANSPORTATION AND HOUSINGAGENCY NUMRkR j
O '6 yie DEPARTMENT OF HOUSING AND.COMMUNITY
QEVELOPMENT
DIVISION OF CODES AND STANDARDS 8808931
�q
MANUFACTURED HOUSING PROGRAM
MANUFACTURER CERTIFICATE OF ORIGIN
Q CHECK.IF THIS IS A DUPLICATEMGO-ENTER ORIGINAL MOO NO. .
{TMA��NUHAt''CUR£D HOME OR MULTtFAfvtitLY MANUFACTURED HOP.§IN 7R CF
IJ O pl I31E FAMILY-DWELLING) ❑ MFMH(MULTIFAMILY.MANUFACTDRED HOUSkNC3) TRANSPORTA6LE SECTIONS = -
COMMERCIAL MODULAR.. .W
OCCUPANCY G90UP
MANUFACTURER NAME: - MANUFACTURER.LICENSE NUMBER:
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MANUFACTURERADOR£$$: -. SUGGESTED RETAIL PRICE;....
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sl7ea ICILY) (State) (zip)
MANUFACTURER TRADE:NAME: MODEL NAME ANO)OR NU VIBER� DATE OF MANUFACTURE;
6 R ADF R w3.'ra19 1a
NAMEOFOrALER:ORTR,ANSFERLE(OWNERSHIPTRANSFERREO Tq)i EALIFORNfA DEALER NUMBER OR DATE OF TRANSFER: -
TRAN$FEREE DE$IGNATION:
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DEALER OR TRANSFEREE AOORESSt. . ".
519x� BEiN!!T)VIE!`v`" SA+ 130 R A O a`A 92W LbState Z
INVENTbRY CREDITOR.NAME: _
_.INVENTORY CREDITOR ADDRESS!
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TRANSPORTER ADORESB:
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DESTINATION FOR UNIT 9ESCR16ED ASOVE: _
NAME` T,3;,j Sf.�4,,to^dE, Sk ' 3 i.,S 3 }�VE R �.r..e, '.$ C h r 535 fsral,0 zigt
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copy 2((YELLa I nVER TO THE
TRANSPORTER TO ACCOMPANY THE UNIT,TO ITS:DESTINATION:
COPY 9 ff3CLOENMDtl T9 DIF RETAINED BY NF MANUFACTURER.
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RECORDING REQUESTED BY DOC 98 2005-072a 190
09/01/2005 08:00F Fee:9.00
ERIN LEE FELTS Page 1 of 1
Recorded in Official Records
AND WHEN RECORDED MAIL TO: County of Riverside
If I I I` I Larry W,II{Ward I i1! '
Add ress: 25913YWeDst wiindsS❑r. lillllll�III�IIuIII�IIIII�IIIII�I III�Illnty dllllil
City&Slate: Romoland, CA
LZip: 92585 J M s u PgOE„_ _ - - _ 912E 00. I pCOR 1 CGR bMF MI6G
A R. ..L._ --. COPY LONG REFHND H. EMpL�
ASSESSORS PARCEL NO. 329262018-9
GRANT DEED
The undersigned Grantor(s)declare(s)under pane pa ury that the following Is true and correct:
Documentary transfer tax is$ ' 0. 00
.
0 Computed on full value of property conveyed,or Vra
® Computed on full value less value of liens and encumbrances remaining at time of sale.
® Unincorporated area: [3 City of and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
ERIN LEE FELTS, A WIDOW
hereby GRANT(S)to
STACY D. FELTS, amarried woman as her sole 'and separate property
the following described real property In the County of Riverside ,State of California:
Lot 43 of Tract 4540, Whispering Winds Estates, as shown by map on
file in Book 74, Pages 62 and 63 of Maps, Riverside County Recorder.
Property more commonly known as: 25913 West Winds
Winds Dr. , Romoland, CA
Dated �_ J -G7 S !.7�i.�,. can )1!' P�ia,..__�
Erin Lee Felts
State of California ---
Countyof Riverside
On AUGUS-T 1, 2ao5
before me, David C. Jarman
personally appeared Erin Lee Felts
pesbeRal y known to me(or proved to me on the basis of satisfactory evidence)to be the person(p)whose name+kD*
subscribed to the withln Instrument and acknowledged to me that s tl)4y executed the same In Iy1il&fli#r authorized
capacity(it*,and that by Oed*r signatureQg�on the Instrument the person(q4 or the entity upon behalf of which
the person acted,executed the instrument.
Vy1jF1�lES5 my hand and official seal. DAVID to JARMAN
Il r Notary Public-California y
slcNAruRs Rlverdde County
Title Order No. ---- 'E9I5rkTW,-Ld5?07M1o%78ffe%o. ----
MAIL TAX STATEMENTS TO:
same as above
NAIVE ADDRESS CIiY,BTATE,ZIP
rho Jcnio GRANT DEED
Ma&,oven'¢Fa.1 Farms TM
Order: Non-Order Search Doc: RV:2005 00723190 Page 1 of 1 Created By: galarze.b Printed: 5/1/2015 12:14:38 PM PST
o�,ataut�actuM Hoes
1415 E.6"St
Beaumont, Ca 92223
(951)8452671
5/28/201S
County of Riverside
Building& Safety Department
Re Permanent Foundation Release for Stacy D Felts
25913 West Winds Dr
Romoland, Ca 92585
Champion Home Builders SERIAL# 176-000-H-Al 000217A1B
To whom it may concern
We hereby allow Stacy D Felts and Terra Firma Construction to place this manufactured
home on a permanent foundation with a 433a fonn.
Th k you s
is el T lar
Manager
Pacific Manufactured Homes
CALIFORNIA IA ALL-PURPOSE j
CERTIFICATE OF ACKNOWLEDGMENT I
State or California
courltv
(etre me,
d {i dY4 treat name 4nd odc 4f da:ofreai l
who pravt.,d to me on the basis of satisfactory clr'idence to be the person(s)who5ii nian e(s) is/arc subscribed to
the within illstrurnent and acknowledged to liic that he/she/they executed the saniQ in hiallierltheir authorized
capaalty¢iest, and that by his"heirltheir signtaturc(s)on the instrument the person(s).or [lie entire up:io behalf of
which the person(s) autmi, exeQuted the instrument.
Lc;crtCiy under PEN At,ry Of" PERJURY under the laws ofthe State,or Ca I Hornia that the liaegt7ing paragraph
is true and aovreet.
iL.VILLA
l� COmmission No 200M5
V TNC:S may franc] and af'ticial S za(, ,`w ,= NOTARY Pue410, IFCVnN1)
� SAN i7ENNMRpIN0001lNTY #. ''.
( Ny Comm,.@WHtltl JflNiMnY8,2017 3i
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