PMT15-01535 i
i
City of Menifee Permit No.: PMT15-01535
29714 HAUN RD.
CCEL-A` MENIFEE, CA 92586 Type: Mobile Home
MENIFEE Date Issued: 06/05/2016
PERMIT
Site Address: 25913 WEST WINDS DR, MENIFEE, CA Parcel Number: 329-262-018
92585 Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of INSTALL PERMANENT FOUNDATION SYSTEM TON NEW MANUFACTURE HOME 1820 SO FT
Work:
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 ON Amount is
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 lhereunderwhen 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
1
City Of Menifee
I
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[,ny license is in full or e and e ep� Code:The Contractor's License Law does not apply to an owner of a property
License Clasp� 1P Loans No. 7 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'Stale 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, cannot legally sell a structure that 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
__ID-�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:httpJ/www.IeqInfo.ca gov/calaw.htmi.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier _=5 - ,l1 � �\� �� Property Owner or Authorized Agent Date
Expires — " `�� Policy# <l� /J'O Y6
❑ 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 stale 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 de if d property f r`jfie ins e ti n purposes.
shall not employ any persons in any manner so as to become subject to the 14
I�P //JQQQ/R�/"
workers'compensation laws of California, and agree that if I should become -4� �v\ ({{'(J 66
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent 6, l Date
Code,I shall forthwit comply with those provisions.
/p ,�f/ �` c' j '-- City Business License# LJY
Date{/ ,(/,/1 (�L /V Plicant; ^�.5 �l J
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, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE ,�—MIXTURE CONTAINING A HAZARDOUS MATERIAL
N
LABOR CODE, INTEREST,AND ATTORNEYS FEES ,,n O 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
i'FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ,' O DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
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 WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: �gE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A _
Any city or county that requires a permit to construct, alter, Improve, demolish, aD 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 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 AEPORYING.
compensation, will do ( ) all of or ( ) porting of the work, and the structure is PR Y ZQ N R Q f GENT
not intended or offered for sale.(Section 7044,Business and Professions Code; 1( u ( J { '
The Contractor's Stale License Law does not apply to an owner of a property X W`��-�._
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).
GVrvl• ;
BUILDING & SAFETY PERMIT/PL.PERMIT/PLAN CHECK APPLICATION
A&Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL 11rESIDENTIAL MULTI-FAMILY MOBILE HOME Ci POOL/SPA % SIGN
SUBTYPE: ::%ADDITION ,ALTERATION O DEMOLITION i:; ELECTRICAL 0 MECHANICAL
O NEW 'O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK L, 696?� j E� i— = (I ADO toIr {E 0A'1
7tla-W M"0 a D rM M I - I �
PROJECTADDRESS 2— T- �(U mve
ASSESSOR'S PARCEL NUMBER L62 (� �--� LOT TRACT
OWNER NAME C_C_*r-S
ADDRESS ftj!�)b krC
PHONE EMAIL
APPLICANT NAME bllu Cc— A,(-SJ__
ADDRESS ) �O(9%1a d (/'/ (F 04� (2-
PHONE ISIf—437 7-^S;43 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES C? NO
BUSINESS NAME
�}^i�-dtktOt nMi4 Cb(JST-ruL'C_D�xb/V ),LJC ,
ADDRESS J (AFNPS-j (-A ' 2>S
PHONE 9,SI� �S�'S'�`j ` EMAIL /� �
CONTRACTOR'S STATE LIC NUMBER � 651 S_ LICENSE CLASSIFICATION C/1
cT�
VALUATION $ SO FT ,7 L SO FT
APPLICANT'S SIGNATURE /WQDATE
rc-ITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEEEBBUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ��o11a' PAIDAMOUNT
AMOUNT Q 1 '->CASH ()CHECK9 ;✓CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT ;t CASH QCHECK9 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED C YES C NO DL NUMBER NOTARIZED LETTER C{ YES Q NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
g(NG
STATE OrCALIFORNIA NUMBER:
oA 4 ¢• BUSINESS TRANSPORTATION AND HOUSING AGENCY
M.a •"a 7 DEPARTMENT OF HOUSING AND.COMMUNITY DEVELOPMENT "
DIVISION OF CTUCODERANDSTANDARDS
MANUF
MANUFACTURED HOUSING PROGRAM
��O�frY 11EJ�'~Oq .
MANUFACTURER CERTIFICATE OF ORIGIN
CHECK IF THIS IS A DUPLICATE MCO-ENTER ORIGINAL MCO NO.
MANUffFACTURED HOME OR MULTIFAMILY MANUFACTURED HOUSING. NUMBER OF
❑ SFD(SINGLE FAMILY DWELLING) 0 MFMH(MULTIFAMILY.MANUFACTURED HOUSING) TRANSPORTABLE SECTIONS
COMMERCIAL MODULAR:
'OCCUPANCY GROUP
MANUFACTURER NAME; MANUFACTURER.LICENSE NUMBER:
T
QHAt FYI,�l l HOME S I 7r�1a3,:, INC,. I i 84018
MANUFACTURER ADDRESS: 'SUGGESTED RETAIL PRICEr-
Street City) State zip
MANUFACTURER TRADES NAME: - MDDEL NAME ANDfOR NUMBER: DATE OF MANUFACTURE:
NAME OF DEALER OR TRANSFEREE(OWNERSHIP TRANSFERRED TC): CALIFORNIA DEALER NUMBER OR DATE OF TRANSFER:
! - t'' TRANSFEREE.DESIGNATION:
fi�41�v!C-RI t...v. PA,_' lC, M. G` 1-lwrY LiJ 9 C7:B 1 11.51E 9i 1
DEALER:OR TRANSFEREE:ADDRESS:
s&15 BENT AVENUE u.i"I VAP2r,.+„ a Cfr.9tu"{i' 1t t State ZI
INVENTORY CREDITOR.NAME:
P t"1kiTLy E7 Il it t"1e"kld r, ..,, -K....:pai^i:C.
INVENTORY CREDITORADORESSi
1Th f i>ti?n ,GnfATI lj i ) £ tiI G:, �.:"-5i ll'' . 1,30r.rALPH I�4' '�(,11� CJ�: ill ('�:1
(Styes Ci -State Zi
$ NI NIIFAC r4�REF .SEft4AL N[UMBEF� F{CEEz°f #51 t CP4=C7R NU{7 EA�ECrNUt18ER , LEN+ rH wl N w tGnT
n B -' `* INOkIE3 ,. INC'ES fPC�R08 a'S
'rG�•L)f"+v r'; rl.A li.. a ,YA. 7_C,
TRANSPORTER NAME:
TRANSPORTER ADDRESS:
`027 W Sr, v 11 0ND,.8 rA 4J; ^ CA ?4,53
Stree)
(State) (Ylp)
DESTINATION FOR UNIT DESCRIBED ABOVE:
;7 vVCS St�ar� AID,s (,ME: CA.125c95 zstatet fzlo'r
I certffy under penalty Of perjury Under the laws al the Stara of California that tho above facts are Into and correct,
obu`.c''19;^III
Executed or at.
(Data) ;Cih') (Comity) (State).
SIGNATURE OF AUTHORIZED AGENT
DISTRIBUTION: ORIG'INA NK) ARO TO THE INVENTOR'YCREDITIOR,UNLESS THERE 15 NONE,THEN FORWARD TO THE PURCHASER IDEALER OR TRANSFEREE).
COP WHITE) WARD TO THE DEPARTMENT AT R O,BOX 1828,9ACRAMENTO,CA 95612-1528,,WITHIN FIVE(.5)DAYS OF RELEASE.
COPY 2(YELLOW) ELIVEft TOiHETRANSPORTEft T6 ACCOMPANY THE UNIT 70 ITS DESTINATION,
COFY 3(GOLDENROD) TO BE RETAINED BY THE MANUFACTURER:
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RECORDING REQUESTED BY DOC a 20®S-0T23190
ERIN LEE FELTS 013/01/2005 0e:00A Fee:7.00
Page 1 of 1
Recorded In Official Records
AND WHEN RECORDED MAIL TO: County or Riverside
F Name: I II Larry W,II Ward 1I1 ff JJ
Y D.
FELTS u
Address: 25913West Winds Dr. IIIIIII�IIIII II I�Illlll�l�l II�IIII h�1III III IIII
City&State: Romo land, CA
L Zip: 92585 J M S I__0 PAGE SiLs GA PCGP OR wr
_— L.. .. ... _ .— _ _
A R —_ _—
GOPV LGNO pEPI1N0 NGHG EMM1
ASSESSORS PARCEL NO. 329262018-9 I..
GRANT DEED
The undersigned Grantor(a)declare(n)under penalty of pe ury that the following is true and correct:
Documentary transfer tax Is$ ' 0.00
.
❑ Computed on full value of property conveyed,or VG
❑Computed on full value less value of liens and encumbrances remaining at time of sale.
® Unincorporated area: ❑ City of and
FOR A VALUABLE CONSIDERATION, recelpt 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 Dr. , Romoland, CA
Dated $- ) -v 5 `" 'e, %
Erin Lee Felts
State of California
County of Riverside
on AUC-US-r i, 2a05
before me, David C. Jarman
Personally appeared Erin Lee Felts
gemeaelly-knewRga-nRe(or proved to me on the basis of satisfactory evidence)to be the person(*whose nameAD448
subscribed to the within instrument and acknowledged to me that t t*executed the same in i he tt*r authorized
capacity(i*,and that by F ie "r signature*on the Instrument the person(,or the entity upon behalf of which
the peisonoi�actad,executed the instrument.
V}NFA(ESS my hand and official seal. DAVID Commission
JARMAN
w Notary Public -California
SIGNATURE Rlverdde County -
Title Order No. ---- r , n,o A o e e o. ----
MAIL TAX STATEMENTS TO:
same as above
NPhIE AGGRESS Cfn',9TATE,ZIP
NON.lcmo GRANT DEED
MerAn Ceen'sEswnHel Fams TM
Order: Non-Order Search Doc: RV:2005 00723190 Page 1 of 1 Created By: galarze.b Printed: 6/1/2015 12:14:38 PM PST
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t
MANUFACTURED HOMES
1415 E.601i St
Beaumont, Ca 92223
(951)845267.1
5/28/20 t 5
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-A1000217A/B
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.
ZKkTha,,you �,.---`el T ylor
Manager
Pacific Manufactured Homes
rll
it CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
COUrlay of j
On be rore me,
V TI:err rIleat!Will I ILI I O'dat 1105recr)
I personally appeared
who proved to me on the basis of satisfactory evidence to be the person(i) whose name(s) is/, Q Subscribed to
the within instrUITICInt and acknowledged to me that heishe/they CXeCt.Ited the same in his/her/their aLah(DriZodi
eapacity(ics), and that by his/har/theirsignatum(s) on the instrument the pevson(s), or the entity Upon behalf of
I which the person(s) a0ted, CrMlted the inStrUnlent.
I certil'y under PENAL I'Y OF PETUUu under the jaws orthe State,ol'CaliCornia that the ibregoing paragraph
is trUe and correct.
L.VILLA
Commission No 2003245
`I.V1'T-N1,*.SS my hand and offlicial sea[. NOTARY PU*Llti�IIFORNIA
SAN nERNARDINO 00 2017
Sinn Holt Ytiawry Public
4kj)D1'r10LNAL OPTION.M., UNFORNIATFON
II INSTRUCTIONS FOR COMPLETINU THIS FORM
vol"phel"! uv L'I'lfordo ......w union I "r.,butqu rash "'I
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