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PMT15-03308 City of Menifee Permit No.: PMT15-03308 29714 HAUN RD. �jjC�L/� MENIFEE,CA 92586 Type: Mobile Home `"""twt". MENIFEE Date Issued: 1 012 612 01 5 PERMIT Site Address: 33295 SWEETWATER CANYON RD, Parcel Number: 384-070-014 MENIFEE, CA 92584 Construction Cost: $3,250.00 Existing Use: Proposed Use: Description of RETRO-FIT PERMANENT FOUNDATION TO EXISTING MOBILE HOME Work: SERIAL#: 14172A HUD#: CAL222238A SERIAL#: 14172B HUD#: CAL222239B Owner Contractor JOSEPH ORTEGA MARTIN FAMILY MOBILE HOME IMPROVEMENT 33295 SWEETWATER CANYON ROAD INC MENIFEE, CA 92584 41507 CHERRY STREET Applicant Phone:9512961777 ARNOLD BLACK License Number:864633 WEST COAST MOBILE HOME IMPROVEMENT 41507 CHERRY STREET MURRIETA, CA 92562 Fee Description ON Amount($) Manufactured Permanent Foundation 1 240.72 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,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be forfeited. AA_BIdg Permit_Template.rpl Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law forth I hereby affirm under penalty or perjury that I am licensed under provisions of following reason: Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence i Professions lode and m license is in full farce and t. - which I must have resided for at least one year prior to completion r License Clas, ! Lice,!r�� Improvements covered by this permit, I cannot legally sell a structure that I hav Expired- / —(� Signature Kt-wex _ -a- , built as an owner-building if it has not been constructed in its entirety by license contractors. I understand that a copy of the applicable law, Section 7044 of th WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application submitted or at the following Web site: ❑ 1 hereby affirm under penalty of perjury one of the following declarations: http:I/www.lepinfo.ce.aov/celaw.html. I have and will maintain a certificate of consent of self-insure for workers' compensation,Issued by the Director of Industrial Relations as provided for by Date Section 3700 of the Labor Code, for the performance of work for which this permit is issued. Property Owner or Authorized Agent Policy# ❑ By my Signature below, I certify to each of the following: I am the properl ❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read IN section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comp) permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildin construction.I authorize representatives of this city or county to enter the above Carrier Ale C-✓, //l&_ � identified property for the inspection purposes. Policy#12 V &grxpires lJ�� l Date Property Owner or Authorized Agent (This section need not be completed if the permit is for one-hundred dollars($100)or less) City Business License# ❑ 1 certify that in the performance of the work for which this permit is issued,1 HAZARDOUS MATERIAL DECLARATION shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or E workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the subject to th orkers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I ZshrthvAth ply ith those provisions. ❑YES ❑NO Applic �rP' Date; (d 'b Will the intended use of the building by the applicant or future building occupant require a permit for the construction or modification from South WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the oute DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ❑NO CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) hazardous material reporting. OWNER BUILDER DECLARATIONS DYES ❑NO I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT next to the applicable item(s)(Section 7031.5.Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION.REPAIR AND PAINTING(RRP) 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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors provisions of the Contractor's State License Law (Chapter 9 (commencing with receiving compensation for most work that disturbs paint In a pre-1978 Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit: www.epa.gov/lead or contact the National Lead Information Center at ❑ I, as owner of the property, or my employees with wages as their sole 1-800424-LEAD(5323). compensation,will do( )all of or( )porting of the work, and the structure is 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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name: 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 Firm Certification No.: purpose of sale). ❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn Is required for this project because: contractors to construct the project(Section 7044, Business and Professions Code:The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. i� BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL O RESIIDD•E"""NTIAL O MULTI-FAMILY OBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION /a LTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PPLUMBING O RE-ROOF-NUMBER OF SQUARES / DESCRIPTION OF WORK .-{, l7 '—• a ♦ u l I � ('1L O VVL IC-0 lit. S s e n g` - fs r s t1,7 PROJECTADDRESS �3� CS J p/�/ (.(JG, ��( �/ G/UJ ! �11 t, (j DU ASSESSOR'S PARCEL NUMBER -3�0 '--(' P/1 41`S/ LOT TRACT PROPERTY OWNER'S NAME V p5U /l ¢' t t r o- ©r •G w Building & Safety ept. ADDRESS `3 s- �wegF /z n "1WI e,11/ Oeni ee ase -OCT 2•6 20 / PHONE 6 f -5 d J 6 6 /n -3 EMAIL // / APPLICANT N!/A J' !ME / c CI L J�F GaGR L 0ply' �-EM%e L PWf,/ ADDRESS " /-U G� '1" �/ /lI u/ rle f�, &L S 6 z PHONE (,�1F) y ua • 7 7a i EMAIL CONTRACTOR'S NAME rYdtJ I G•` �v(ram_ OWNER BUILDER? /O YES . NO BUSINESS NAMEU)r5f eo(10;7-� (J�I �P l �Uh'I �' <>-YI'I 90Lkywtoo ADDRESS I/S D 7��/lE( rC �{. ✓ /1P1 �L° C�cc t % �h PHONE(2,6 1 O"IAi 77 7 EMAIL CONTRACTOR'S STATE LIC NUMBER �Cy /n fj 3 LICENSE CLASSIFICATION ` - 7, ,/ N` T VALUATION$ �r�J L� SO FT r L SO FT APPLICANT'S SIGNATURE ✓ GC ;� =�� � DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOIC E PAID AMOUNT AMOUNT a Qta a OCASH 0 CHECK N OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH 0 CHECK B OCREDITCARD VISA/Mc OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 City of Meniteee t. Building &Safety OCT 1-6 2015 WarPived SITE PLAN 35,9 C7(s- (PLC SITE ADDRESS 3 l 5 CJ{�l�C� (.C��+ find r- �CtG?�%y"7� /��. �� I r J,7 ASSESSORS PARCEL NUMBER` I " D (`I Q / U PmwdonorthGrow REARPROPERTY'LBNE LLJ U_ V LL f'a66 ' U- s s® i I D D I E E R R E E �i 4 R T f S Fi I� I Y Y I _':ITY OE MEN FEE I L 9 WILDING A SAFETY DEPARTMENT - - - -- -- t N 1(� FLAN tPRO AL E u , REVIEWED B tYJmtT �bla�l \� °fib ' Approval of these plan shall not be construed to be a permit for,or an approval of,any violatio ra,{�a e o Jty regulations and ordinances. This set of oad so be� _ jobsite until completion. /V: 1�o,f se L r'� d� STATE OF CALIFORNIA-BUSINESS,CONSUMER SERVICES,AND HOUSING AGENCY EDMUND G.BROWN JR.Governor DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT &)SING.1 Division of Codes and Standards O ^d� g��aF Title Search e Date Printed: 10/23/2015 City Of Menifee Building 8, SafetY Dept, Decal #: LAB3011 Use Code: SFD Manufacturer: 03110 LANCER Original Price Code: AMB OCT 2.6 2015 Tradename: LANCER Rating Year: Model: NII Tax Type: LINT Received Manufactured Date: 07/29/1981 Last ILT Amount: Registration Exp: Date ILT Fee Paid: First Sold On: 08/10/1981 ILT Exemption: NONE iL Serial Number HUD Label/Insignia Length Width V 14172A CAL222238A 60' 14' `wy 14172B CAL222239B 60' 14' U Record Conditions: PPF Exempt Registered Owner: O JOSEPH R ORTEGA LINDA S ORTEGA (Joint Tenants with Right of Survivorship) A 33295 MCBOB RD 0 MENIFEE,CA 92584 Last Title Date: 09/02/1999 Last Reg Card: 09/02/1999 Sale/Transfer Info: Price$19,500.00 Transferred on 08/21/1998 Situs Address: 33295 MCBOB RD MENIFEE,CA 92584 \\\ Sims County: RIVERSIDE 1 Legal Owner: SOUTH PACIFIC FINANCIAL CORPORATION � 121 S MOUNTAIN AVE UPLAND,CA 91786 Last Title Date: 09/02/1999 Lien Perfected On: 08/23/1999 19:34:37 *** END OF TITLE SEARCH *** City of Menifee I Building & Safety Dept. OCT 2S2015 � Received �. RECORDItIG ITECVESIEO av ,.:)IJtiVE,.�f--. W 8Tewa ?r7n(ItaaTlt rc rrer.co 352666 AND WHEN RECORDED MAIL FMS DEED AND.UMESS r , OTHERWISE SHOWN BELOW.MAIL TAX SFATEMENIS TO' RECEIVED FOR RECOFID O F AT S-oo AM PAID T.i SJoseph RC Doc.TmndmTax AUG 21 1998 33295 HCBOb Road L Meni fee, CA 92584 J RIv_Co_Recorder ACE ABOVE TFUS LINE FOR RECORDS"USE-- 359 330 057 F 3 °L1 Order No.Ord No. nIN Escrow a Loan 14M 24025 GRANT DEED THE UNDERSIGNED GRANTOR(s)DECLARE(s) DOCUMENTARY TRANSFER TAX is S 142.90 CRY TAX S Of computed on full value of property=rveyea or O Computed on hill Value less value of liens or encurnbrances remaining at thrt of sale. O UnlT7 cgxxafed area: O City Of ,and FOR A VALUABLE CONSIDERATION. receipt at which is hereby ocknowledged. rts� HationaT Mortgage Association_tion organized and under laufs of the UnXted States of hereby GRANT(S)to America Joseph R. Ortega and Linda S. Ortega, husband and wife as joint be to ntne; the following described [cal property to the County Of Riverside State of C:alifamio: SEE Tnr..AT. tRSC2t1PT ON A7.'IACEM EMMO ARID MM A PART EMMOM AS AN EDUMMr ^A^ J t I August 14, 1998 "MW ' l Dated STATE OF —I Pa1Rlf OnO�---µ�.2--iaerora Perso^oEV appeared --- —_`--�_ — rrrr.. �'• . air"".4 SgCEY PNORR � m___on Itl__. ___ ;•' ��' tFeteY PrplV SSMpI TYnf pe «tolN known to rrq[p proved to e e boat of IOMfpctOry �y�'�•� f.J. RFI pl E1�6 W25-09 a evvo n o)to be Line petson(s)(vtt naate(s)a/ twillvnrlWrumerNIXtdrxJlnowleageA lnntel /sne/IIt2Ye Wed r IhefarlB fntta/her/iltwaWhonred capad . t f / _:,. bIItcQtvta Slli QoIfg yyIrhY;eh(5 7I hOaI t B0 fnl Ile o,lin,enmy p50 (s)OCIE1 Wdthe n0Wt WITNESS my iron tcta zerX � . (Iru o-eo ra Mcol•.ob.w seal) rt-Im(1/ey MAIL TAX STATEMENTS AS DIRECTED A80VE I^ J � _ 507145219 SCHSDIILH A (CONTSt148D) a _ a THE LAND REFERRED TO HEREIN IS SITUATED IN THE STATE OF CALIFORNIA, COUNTY OF RIVERSIDE, AND IS DESCRIBED AS FOLLOWS: THAT PORTION OF PARCEL 6 OF PARCEL MAP 8949, AS SHOWN BY MAP ON FILE IN BOOK 39 PAGE(S) 38 AND 39, INCLUSIVE, OF PARCEL MAPS, -43 RECORDS OF RIVERSIDE COUNTY, CALIFORNIA, MORE PARTICULARLY DESCRIBED AS FOLLOWS- BEGINNING AT THE NORTHEAST CORNER OF SAID PARCEL 6; THENCE SOUTH 89 DEG. 49' 11" WEST, 669.43 FEET ALONG T7i6 NORTHERLY LINE OF SAID PARCEL 6 TO THE NORTHWEST CORNER OF SAID PARCEL 6; THENCE SOUTH O DEG. 16' 09• EAST, 330.00 FEET ALONG THE WESTERLY LINE OF SAID PARCEL 6; THENCE PARALLEL WITH THE NORTHERLY LINE OF PARCEL 6, NORTH 89 DEG. 49' 11^ EAST, 669.52 FEET TO A POINT ON THE EASTERLY LINE OF SAID PARCEL 6; THENCE NORTH O DEG. 17' 09^ WEST, 330.00 FEET ALONG THE EASTERLY LINE OF SAID PARCEL 6 TO THE POINT OF BEGINNING. e e Y _2_ DEPARTMENT OF BUILDING&SAFETY i HEADQUARTERS COUNT- 'OF RIVERSIDE City o fee 02 p.:-S.3'+ '•f P M{T:na,". PERMIT TlPE ' . Building & Safety Dept. _ A1 .1:9:1 ;agd¢zTioyidl+Iriformaflon:: MOBIL-NOMf'fN�PAILATIQN. .:. T 26 2015 .;=. F" Relocofed O . ,'3 Unifi."vEtT`oIT1o`':. Total Fees O i '.';PI6 P Moving Sewogp;SysJein; permission is hereby granted to move the ::• ,;:,,,;z•:•:,, n^r::. . ... .. 11. p . ... structure, described below, in :: Width Length Hei ht Number of U2 ;Cut' Sections ;Fi!l H3 lefol:Fees $ Present Location Community Count -`REMTION.'INSPECTION: Destination 10 Preserit;lacbtion Total Fees Cotr irtuntty County r_ wTotal Fees ;$ b SP Job A dress t1 Zip., Owner errpiT of C 1Pjj nit D�" + Disft Of P.C. Cam y i 'G ponce !f / rQ t _ y Plari:Eheck . . i Parcel No} - - Lot Sized y� Use of Perm t j� � S / _` ' Remipeetion t 5el packs U c Perm l v ;'Ftict'ory dG ,0G Le�¢f�Dj0cript n � �Q TYpe UniT rkb. /. Bond ne Grp $ Grading Final Dote Inspector Requirement Mobile home # - Cscrow Company branch G Relocations City ZIP - r' D Address Total Fees $ Tel. cam ' Check o Nc Owner/Agent ; Date Address City Zip 1. R ' eived by i Re rrrtit Con /Mo er —� Tel 71V work comp ess C Z_� .yes no I7 Q - Celwrlen of wmkim 120 don -cedi�T Igorr rri�the-pcformance of the wok 1: whSeh thFi peimli n 7hF.lf olw mutoipebrmmo txcamevMd�s rqr mrmmerked wphm I'10 dayf t r istUed a7fpor emptdy�nY pbwri to onYr nnei vmpbemmesv6 tbv IQr1'!Olile'1AT.RS Zcm,)ftrlsa Ncn lO= Loh( o• -Itiuelry;optec shotpll work_m mninM on nvhlhn penmt Wllt-be donUTnbtterdarxe,alti�il Plan end ip 8raerslJe Knty an iFs StoieoECB Jarmo Iheilby cNhfylhCt thelndlndvpl w?+b(i<epv ' •Ow 5i9naiure - 'spedtKal.arii''hai:dane'su in-dcwrdenee wuh-5enion.SSdP of die Bui_IMss:ohd Profestiorn Code BI the .1KIder Slpnero 4ore vF Caularva.... _ .. . FORM 284.208A 5-77(D- s.:. m.. FIELD . ,. t DEPARTMENT OF BUILD(NG'8 SAFETY e to pP:'$b;:y' •.PERMIT pg ; ..'., '+ ,' ;' '[OUNTYO�RtVERSIDE - - ., 1l3l31CiTHpUSING' ::';'' ;:, _ MOBILE HOME INSTALLATION YN MH'M taniif' New.... .._ .. �� a o.. ...,::�•:a s::-.;r..,. -'`..:: . '.'. ..�.�...,. ., . :. ...• .gi=e �e Si tom..,. } + r dotal Fees ' $ '•. d0 Moving s°sLs T:r' .11" . p Permission is hereby gronted to move the tollF.ees€'=,:;; ;;:•5;::''..;' - structure, described below,in Width- Length Height = Number of #2 Sections t- titoI-Fees "$ . #3 Y e: ' Present Location RELOCA71pN lN5PECTION Community County Destinotion - �A -ommunity;'.._ County Total Fees hJ'ermtt No .,. Jo6 A Tess _ SP# -:ZtP'; Owner y r Com nity Valuori n Dist O P.C. r rt" lah:Check L ' '. .6�:i2r ' C�fJ7r� .r �'. Use of Permit Parcel,No.. tot Size $elnspetlion P ff� r it- f C�v �' • ..gip Use Pem+il N uilr;: LegV cn rah d'G ' D - // Bond e rp Type I Unit airy. Grod'ing $ _ ''- " • /� Engineer License Fin 1 0)� ✓ I Env.Assmf. -- MribileRo a {/ # ��r Requirement -Escrow Company - - ` Branch s " T i Relacdtions . G Address City Zip_. . 'al Fees $.. •:cost'' '-Check"I MO I NC Owner/Agent Tel. ' .: Rgeeived By , ��5 Dafe Address City Zip .Rely rcriirlsl Cont /Moyer r _ Tel :: .. . r .o c _. ter% / /. c!'W rkeri' comp. Age ss C ��� ��y Tip. no � v I ,>� L;'` •v i'.VC/r✓" ✓.,e^%.,mot^ C'``tx v<.• •`tepi(y:alioi+ln`ihe.'peilotriwP.of the Work for which thls permit is .Ahis pemii shall-bMotre voitl if work is not mmmenced within 120 days.Casarion of work for M days .r.. .. ue lsholl;rid+:empidybny'person.inpny lrgnaer m.jn become sub- .- shall olw4amc perminob"nsewid. .: ..: iolh'eworken compeswllont afire io.. -` 1 hereby a94Y:&6i"ol!work in mnnKlron w rra lth ifii.peimu:will be done In ardanae whit the bws of - 'ewers Caantyond thesiawof Ccilfornlp lher4WvEiifyih?Iihe fntllwdual4A%b aporad the pions and r Qw SlgiwlorE - - spedfiimians has d'rie so nsa•�ordaitcear lh 5enion 5541 otirti:0us nea arM PiofessfansCodcuf the Iderstgrmtu, "' swreofCaUmna - .. FORM 284.208A 5.77©� µa - i- ;� *Ave INSPECTOR •10 _ OPERATION GATE INSPECTOR, _ - dl -.:CiU1LDING APPROVALS MECHANICAL APPROVALS ' t` ' }" Bdyi'.;'• 33 Vemilaw.co ilen - ♦`.. T! ` 'ag'•:$.•�r- :��5'Flrra•._:':.-... :r.: • : .. a Rmumsd Ducn cs.:LL ..max.>..:...:•- ..- .. .. it','!„?bG(pd9:i.G�c_:: 35 Furnace"Compon.. '37 Yymbui4*WA'-- ib:,U�ia�yo,d�9ebrin�" _ 58 C.ampreswr . `� `•s :'Ji°% 'RbofOeiRr''•'.` 39 Appl.Cleoronce - ^l:..:.:: ........ nre Do 0 a ;nett •[ V6d1s 41 Smoke Delerrmn Dcwre 1 '•% _9"j rggeFire WnB 42 Comnicrcml Nood n':y10 `fihp'tbce ..P. cl a1 F:nol - / f °10A; :flrepl0.Y ::'T L;. OPN ADDITIONAL INFORMATION w not .i 12A 'Drvwo11 i 13 finish Grade S �+ INSULATION MCI, P —� Vol* _ ... lA lVdls(Balls, 12S Ceiling IBns61 12C 'Ceding iBlm„(1 - I PLIFMHING AP15R4bvALs - .. .._�• i$ C"ound Plumb 1 y. `19 -swot Dnpowl . .. t - - - - 21' Worer Noolet 22 VAnt.Soimner' 23 Wcrer Se": - . 24 Gay Test SEWAGE SYSTEM SIZE & LOCATION - � — • T9nl. i'n L.L�c I REAR OF PROPERTY LINE I ELECTRICAL APPROVALS - 76 power Pok I 27 Wndail Semka Em,we i' 29 W.;ng i 29A• 6,a.nd'vlg Vhre • —_ P'L P/L ' 19B '8onding } 1' StP.E 7 NAME _ F DEPARTMENT OF BOILDING AND SAFETY COUNTY OF RIVERSIDE 4 NOBILEHOME INSTALLATION APPLICATION :TRAILER PARK DISTRICT NO >k I/ INDIVIDUAL LOT NAME OF YARK ADDRESS TELEPHONE 140. OWNER/AGENT �< < ADDRESS �✓� �` SPACE NO. MOBILEHOME INSTALLER �:�� '.' ADDRESS �� L TELEPHONE NO. ' INSTALLERS CONTRACTO 'S LICENSE NO �. n �%� tnDTHm-� LENGTH(LESS HITCH DATE OF MANUFACTURE OF MOBILES*/� �RELDCATE. MANUFACTURER NEW STATE INSIGNIA g_ IT MODELS " Z OR HIID LABEL: U-UNIT { SERIAL NUMBER - 7-2 ROOF LIV AD WIND LOAD t i n ni / Q1/ILJ APT LICANT ' APPLICANT (SIGNATURE)" (PRINT NAME) PARK OWNER/MANAGER . PARK OWNER/MANAGER- (PRINT NAME) (SIGNATURE),' ' p �� ZON F CASE N0�_- E COMMUNITY 1 -sLcG��� ✓ _ . _ /f �, Af ' LEGAL DESCRIPTION 7R SETBACKS: FRONT Z� - SIDE �o REAR d0 !!!( �/ ; p� k - DATE �-T '�/ SIGNATURE OF LAND USE OFFICIAL F"'� _ 1 wro uar ORM10041a, DEPT.OF aulwINs 4 Masve 284-77 Rev. 8/77 eIVERaltxOmet �I GC M S G n rt m .Hm... m H ° lYil R °J .M H P d I rj 1 o t i i x � z (�4 LENGTH = M6 I H ' :. 01. Y O) t7C i. LD H.'O y.'� y v L.v m n . S qy W M m Y M A IdIH j 40 m N µ P7 A C] 79 H .v �. • m A in, 0 fD Fi 1" K tw C y n O Y b m n. w m V• D p N nw .Y - 'd c w 'O Y N w e 0 IO R' O ^r• �� w m O .G. T" n Y a H H N ? O G f- R F !'. H P P rt H µ .. OQ N R n w t4 1't w H O. B m FµA I N I •• OY 7 M O P `G _ T. .i •ra f~ n .O m Y O E'.w I,s w C I R QQ R O O YC F` m W R O m N MH £ w• R' A C6 w N w fD •C �. is ry R ad m w f' R T.' O w ID O m 7- R ID µ P• P- m H C .�� µ w H 10, Y, C7 1�0 O R - m n N- 1.: Y..t C 3 H .O. W H w F w n w H o. m• H 10 m ,m ¢ - I ' H m N FH'• -�.,, N Y' O•D m .R N - FFN++ m (D M w R C ?C F' m m ti "D+ Y n N e K `P O W Of N 'C3 P O �C m• x m^b µ M m 5`Y�• p to 1 R R •• rt 'J 'v m to0r1 Y m 'O vm 'O M'm N N. 1-.l\ mRao APPLICATION CERTIFICATE DEPARTMENT OF BUILDING AND SAFETY - - PERMIT a COUNTY OF RIVERSIDE Effective July 1. 1980, Chapter 1301 Section 19825 of-the Health and Safety Code requires the execu- print f the following and sign helorable declarations prior to the issuance of a building permit. Please tion LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of th��ness and Professions Lode and nO' license is i u ��ce�Yff License Class ticense-No ect. :-•"'�-- _��'' Date on tractor OWNER-BUI DER DECLARATI 1 [ hereby affirm that I am exempt from the Contractor's License Law for the following reasons: 0 I, as owner of the property, or my employees with wages as their sole compensation. will do the work, and the structure is not1 intended oa- offered for sale. If 1 sell within one year of compteiion, I understand I a17 have the burden of proving I did not build or !• improve for the purpose of sale (Sec. 7031.5. B.6P.C.). Qi, as saner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B.dP.C.)• I am exempt under Section B.BP.C. for this reason: D to Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-insure,8004de)Certificate ertificato of Workers' , Compensation Insurance, or a certified copy thereof (S Policy No...�o;l O Insurance 0 rtified C041Y.is hereby furnished. - arti Te9CERTT�FJ�CATE with the Cau of RiveysjdekAapartment of Building and Safely. Applicant /•��� __ a F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE .(This seed on need not be completed.if permit valuation is for S100.00 or less.) it is anloy y personthat in ain taleman perfer ormance 6ec the ome work subk actrtohthe Workeich this rs'mCompensation�laws hoflCalif not ornia. - I further understand that if after making this Certificate to of Exemption, I should become subject to a or code, must forthwith comply with such provisions the Workers' Compensation provisions of the l [ . or this permit shrill be deemed revoked. Date APplicant- CONSTRUCTION LENDING AGENCY 1 hereby affirm That there is a construction lending agency for the performance of the work for . which this permit is issued.(Sec. 3097, Civ. Code). Lender's Name . . Lender's Address '- ' - DIYI SIGN OF INOUSTRFAL SAFETY PERMIT LERTIFICRTION - "` - 0 I hereby certify that no excavation five (5) or more feet+in depth into which a person is re- quired to descend, will be add ,nfcanto ork,Cori demolftioth work o orrdi-smanized tlingsthe of, will and be no - building, structure., more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Sec 347i Title 8, C.A.C.) (� As owner-builder. I will not employ anyone to do work less whichsuch woulderson hasuarperme a Ptrto doit I rsuchhwork Division of Industrial Safety, as noted above, from that division. �] Division of Industrial Safety Permit No. Bate Applicant CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY I certify I have read this application and state that the information given is correct. I agree to comply with all state laws and county Riverside, ances Department Buildingto dand Safetytoyrenter and uponauthorize pro- representative of a County of Riverside, D ���0 t�ns. per for w ch aye applied for this permit for the Purpose of nature b pp an ant to r At pp can / gent ante 284-20GO 7/BD _ .. . .. ..