PMT15-03129 City of Menifee Permit No.: PMT15-03129
29714 HAUN RD. Type: Mobile Home
'�ACCELA? MENIFEE, CA92586
MENIFEE Date Issued:
04/0512016
PERMIT
Site Address: 27758 ADAMS AVE, MENIFEE, CA 92584 Parcel Number: 329-202-021
Construction Cost: $82,000.00
Existing Use: Proposed Use:
Description of INSTALLATION OF NEW MOBILE HOME 26'X 48'
Work:
Owner Contractor
FG PROPERTIES TERRA FIRMA CONSTRUCTION INC
2089 S JANETTE LN 913 MAPES ROAD
ANAHEIM, CA92802 PERRIS, CA92570
Applicant Phone: 9517575731
ENRIQUE FLORES License Number:796315
FG PROPERTIES
2069 S JANETTE LN
ANAHEIM, CA 92802
Phone:9514734201
Fee Description Ply Amount($l
Residential density less than 8.0 dwelling units per 1 1,952.00
acre
SFR DIF 16 Public Facilities 1 1,207.00
Discretionary permit other than single family 1 500.00
residential on greater than Yz
SFR DIF 16 Fire Facilities 1 705.00
SFR DIF 16 Transportation—Roads, Bridges, 1 0.00
Major Improvements
Manufactured Install 1 240.72
SFR DIF 16 Transportation Signals 1 420.00
SFR DIF 16 Conservation and Land Bank 1 0.00
SFR DIF 16 Regional Parks 1 563.00
SFR DIF 16 Community Centers/Parks 1 0.00
SFR DIF 16 Regional Multipurpose Trails 1 316.00
SFR DIF 16 Flood Control 1 0.00
SFR DIF 16 Library Books 1 341.00
SFR DIF 16 Fee Program Administration 1 46.00
Permit Fee 1 27,00 _
Plan Check Fee 103 102.50 -
Plan Check Fee 103 102.50
Administrative Fee 148 148.37
Quimby Single Family Regular Quad 2 1 7,908.00
$14,579.09
AA_BIdg_Pennit_Template.rpt Page 1 of 2
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 ❑I am exempt from Ilcensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class riq T Lt nsel N . By my signature below I acknowledge that,except for my personal residence
Expires—L'A_( L Signature r in which 1 must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑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 7044 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. I� 5� — '�y�it �7/ www.leainfo.ca.aov/mIaw.htmi.
+Policy ItA4 4—1-7 //V 0' Date
/ ❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑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: n e/ application and the information I have provided is correct.I agree to comply
Carrier� -tYU' U� «I/f'L r�/^uv 7 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
( is section need not to be completed is the permit is for one-hundred Date
ollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑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 became subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject tot workers comp nsation provisions of Section 3700 of the Labor
Cade,I sha 'h om l w e rowsio [[ Will the applicant or future building occupant handle hazardous material or a
Applicant Date'?//��"2. -7'( 4 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 O Yes ❑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 PINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),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 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑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 ❑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 1 am exempt from the California Health&Safety Code,Section 25505 and 25534 conceming
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Ayes ❑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(RRP)
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 licensum 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
❑1,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.epa.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 ❑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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,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.
OV6 Nc''1'L
eQ. °' p STATE DF CALIFQRNIA
BUSIR 9 TFj0ORYATI6N AND H60"I G AGENCY
n DEPARTMENT OF HOUSING AND.OQMM9N4TYyB ELOPMENT
3 OI1U$1QN.:Q.F COPES.AND STAf�D3 H H Z U J J
`p4. MANUFACTURED HOUSING P1466FIXM
DE` City of Menifee
MANUFACTURER CERTIFICATE OF ORIGIN Building & Safety Dept.
❑ CHECK IF THIS IS A DUPLICATE MCO-ENTER ORIGINAL MCO NO.
MANUFACTURED HOME OR MULTIFAMILY MANUFACTURED HOUSING NUMBER OF
SFD(SINGLE FAMILY DWELLING) ❑ MFMH(MULTIFAMILY MANUFACTURED HOUSING) TRANSPORTABLE SECTIONS 2.
__
COMMERCIAL MODULAR-
'OCCUPANCY GROUP
MANUFACTURER LICENSE NUMBER:
CHAMPION HOME BUILDERS INC 12?8438
MANUFACTURER ADDRESS: SUGGESTED RETAIL PRICE
(Street) N. SMfTH AVENUE, CORONA, CA..92880' slate N/A
. MANUFACTURER TRADE NAME MODEL NAME AND/OR NUMBER: DATE OF MANUFACTURE:
SILVERCREST SUMMIT PLUS �16
NAME OF DEALER OR TRANSFEREE(OWN ERSHIP TRANSFERRED TO)- CALIFORNIA DEALER NUMBER OR DATE OF TRANSFER:
_. _. .._. ... . .,.. . -_ _.. .. . TRANSFEREE.DESIGNATION:
DEALEROR TRANSFEREE ADDRESS: . . .. -
25 HWY.- 74 -HEMET, CA 92545 Stara
INVENTORY CREDITOR NAME:
OTRY-ESCROW
I INVENTORY CREDITOR ADDRESS:
M&% N.,-MAIN ST.g. ,. .RONA CA 92a Oe - -....,.. . .
stele00
31
'TRANSPORTER NAME; - '
ROBEIkT HAVENS TRANSPORT
TRANSPORTERADDRESS;
(Sn,,?06M WAALEW ROAD SPACE 186, APPLWOkLLEY, CA 92307 )State) �)
.13ESTM71ON FOR UNIT DESCRIBEDAllOVE ..
NAM G PROPERTIES 1 7758 ADAMS AVE,AWNIFEE,CA 92584 Stare
I certify under penalty of perjury under the leave of the State of Callfornle that the above fads we true and correct.
F�ecufeb on 02110/16 - w _ CORONA RIVERSIDE, CALIFORNIA
uY) (Counts (State)
SIGNATURE OFAUiHORMEDAGENT: .
pISmaunoN OWBINAL(PI . FO ARO - SINVENTORY CREDITOR,UNLESS THERE IS NONE;THEN FORWARDTO THE PURCHASER(DEALER OR TRANSFEREE).
COPY 1 )) FORWARD THE DEPARTMENT AT P.O.WX 1828.SACRAMENTO,CA 888124828,WITHIN FIVE(S)DAYS OF RELEASE
COPY2 MEN DELIVER TO THE TRANSPORTERTO ACCOMPANY THE UNR TO ITS DESTINATION.
COPYS C ENROD) TOBERETAINEDBYTHEMANUFACTURER.
HCO 483.0-Side 1-(Rev.01/12)
ALL PURPOSE ACKNOWLEDGMENT City of Menifee
Building & Safety Dept.
A notary public officer or other officer completing this certificate APR 0 5 2016
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
ceived
State of California )SS
Country of t2 t\;u 1 i ck— )SS
On tY 1artk 2-1, Zo I y' before me,iqt e 4 ri 1'tc iAzvi Nc�a"-i
(here insert ame and title of the offic br)
personally appeared, K L1/ L✓1 �=-{ q
who proved to me on the basis of satisfactory evidence to be the person(o whose name(?)
Is subscribed to the within instrument and acknowledged to me that 0,/4i /tl�y executed
the same in>6/60ttOr authorized capacity(), and that by pi �§ theyrsignature()on the
instrument the person(s', or the entity upon behalf of which the person(;;acted, executed the
instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing is true and correct.
WITNESS my hand and official seal
JENEAN HAYOEN WooDS
Signatu Commission rr 2062108
i Notary Public•California i
Riverside County '—
My Comm.Expires Mar 23.2018
(SEAL)
DOC # 2010-029114f City of Menifee
! 06/24/2010 00:00N Fee:1S.Wilding & Safety Dept.
Papa t of 1
RECORDING REQUESTED BY Recorded in Official Records APR 0 5 2016 County of Riverside
AND RECORDED Larry U. Hard „�q 20 PROPERTIES,ANET INC. As sas sar, County Clark & Recorder
ELANl7TG. IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIn1ecelyed
2069 SO. JANETTE LANE
ANAHEIM, CA 92802
S R I U PA El SIZE DA MISC LONG RFD COPY
M A L 465 426 COR COR SMF NCHG
A.P.N.: 329-202-021-5 TRA#: T: CTY UNi
GRANT DEED �
THE UNDERSIGNED GRANTOR(s)DECLARE(s)THAT DOCUMENTARY TRANSFER TAX IS:COUNTY L 0. vO
X] computed on full value of property conveyed, or
7� computed on full value less value of liens or encumbrances retraining at time of sale,
] unincorporated area; [ ] City of ROMOLAND , and
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
ENRIQUE FLORES, a Married Man as his sole and separate property
hereby GRANT(S)to FIG PROPERTIES,INC. A CALIFORNIA CORPORATION
the following described property in the City of ROMOLAND,County of Riverside State of California;
LOT 113 OF ROMOLA, AS SHOWN BY MAP ON FILE IN BOOK 13, PAGE S OF MAPS, RECORDS OF
RIVERSIDE COUNTY.
ENRIQUE F70RES
Document Date: June 23, 2010
STATE OF CALIFORNIA )SS
couNTY of RIVERSIDE )
On .TUNE 23. 2010 before me, MARILYN PRICE ,a notary public in and
for said state,personally appeared ENRIQUE FLORES who proved to me on
the basis of satisfactory evidence to be the persons)whose names)is/are subscribed in the within inurameat and acknowledged m me that he/she/they
executed the same in his/her/their authorized capacity(ies),and that by his/her/their signature(s)on the instrument the person(s),or the entity upon behalf of
which the persons)acted,executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the Sate of California that the foregoing paragraph is we and correct.
WITN SO
my hand and official seal.
rA MARILYN PRICE
Commleslon 11830485
SignamrILYN PIS x Notary Public-CelMornle
Riverside County
M Comm.Ex Tres den 12,ZniAl)
Mail Tax Statements to: SAME AS ABOVE or Address Noted Below
Order.Non�Order Search Doc:RV:2010 00291146 Page 1 of 1 Created By:wesbrown Printed:4/412016 4,43,19 PM PST
Recording.Requested By,, DOC # 2006-0354186
First Amerl an Title company 0Page I of 08:00p Ft Paid 00
Page 1 of 2 Doe T Tax Paid
Recorded In Official Records
Riverside Resale County of Riverside
Larry U. Ward
AND WHEN RECORDED MAIL TO: Assessor, CcumtY Clerk & Recorder
IIIIII IIIIIII IIIII III IIIIIII III IIIIIII III Hit IIII IIII
ENRIQUE FLORES
23741 LODGE DRIVE
QUAIL VALLEY, CA 92587
M U I PA SI OA PCOR M COR I SMF 4MISC.A R L COPY LONG REFUND NC
A.P.N.: 329-202-021-5 TRA#: Order No.: 731400-02 Escrow No.: 17362-MP `
GRANT DEED CM
THE UNDERSIGNED GRANTOR(s)DECLARE(s)THAT DOCUMENTARY TRANSFER TAXIS:COUNTY 77.00
X] computed on full value of property conveyed, or
1 computed on fall value less value of liens or encumbrances remaining at time of sale,
X] unincorporated area: [ ] 1 ANT] and
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
MICHAEL BERTETTO, an Unmarried Man
hereby GRANT(S)to ENRIQUE FLORES, a Married Man as his sole and separate property
the following described property in the Area of RCIA40 ' 4), County of Riverside State of California;
LOT 113 OF ROMOLA, AS SHOWN BY MAP ON FILE IN BOOK 13, PAGE 8 OF MAPS, RECORDS OF
RIVERSIDE COUNTY.
MICHAEL BERTETTO
Document Date: February 7. 2006
STATE OF CALIFORNIA )SS
COUNTY OF RTVF.RCTDF )
OnMAY 4. 2006 before me, d1.t.,XT.!rA VT.I1 .412A A, NO
TARY PUBI M
,!h personally appeared
personally known ro me( roved me on the basis of satisfae ory evidence)m be the person(s)whose names is re subscribed to the within inswment
and acknowledged to me Ne to a/they executed the some ir�erhhelr authorized capachy(les)and that by I is er/their signature(s) on the instrument
the person(s)or the entity upon behalf of wh' the person(s)acted,executed the instrument.
WITNESS my h official s
Signature
tl
This area for official notarial seal.
AMPO A VIt1AFANA
eommtwon N 15MVI
M NokmV
Rd1e•CpYlpsltY
MV0*l6
COM.6rpt�tc�
Mail Tax Statements to: SAME AS ABOVE or Address Noted Below
Order:Non-Order Search Doc:RV:2006 00354186 Page 1 of 2 Created By:wesbrovm Printed:41412016 4:43:18 PM PST
�Tf LARRY W. WARD Recorder
P.O.Box 751
COUNTY OF RIVERSIDE Itivcmide.CA 925024)751
' ASSESSOR-COUNTY CLERK-RECORDER (951)486-7000
http:/Mvcrsidc.axrclkrcc.com
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.ofNotary:
Commission#: /S3�if S/
Place of Execution: 6Zrl// Cry C1 lr�C
Date Commission Expires:
Date: MAY 16 2006
Signature:
s
Print Name:
ACR 186P-AS4RE0(Rev.01/2005)
Order:NorFOrder Search Doc:RV:2006 00354186 Page 2 of 2 Created By:wesbrown Printed:4/4/2016 4:43:18 PM PST