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PMT16-02323 City of Menifee Permit No.: PMT16-02323 29714 HAUN RD. Type: Mobile Home <ACCEII MENIFEE,CA 92586 MENIFEE Date Issued: 0 9101/2 01 6 PERMIT Site Address: 29154 LORETTA AVE, MENIFEE, CA Parcel Number: 372-150-016 92584 Construction Cost: $140,000.00 Existing Use: Proposed Use: Description of SITE PREP FOR NEW MOBILE HOME 1908 SQ FT Work: SERIAL#PER037302CA A, PER037302CA B, INSIGNIA#RAD1518321, RAD1518322 Owner Contractor JORGE&INEZ MARTINEZ , 29154 LORETTA AVE MENIFEE, CA 92584 Applicant License Number: JORGE&INEZ MARTINEZ 29154 LORETTA AVE MENIFEE, CA 92584 Phone: 9516798673 Fee Description DIV Amount lSl Manufactured Residential Site Prep 1 196.00 Permit Fee 1 27.00 Plan Check Fee 103 102.50 $325.60 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 underwhich 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 property who builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and )1 am exempt from Iicensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: ' License Class License No. By my signature below I acknowledge that,except for my personal residence Expires Signature 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 o 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 worker's 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 vvvvvv.le info.ca. ov calaw.htm this permit Is issued. / Polity if - Date D I have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED A section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below 1 certify to each of the following;I am the property this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this number are: application and the information I have provided is correct I agree to comply Carrier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy If Expires theaboveidentinedpr pertyformspectionpurposes. (This section need not to be completed is the permit is for one Date— Date / oz 016, dollars($100)or less PROPER NER OR AUTHORIZE NT ❑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 become subject to the CITY BUSINESS LICENSE N worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date 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 FINES 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)7 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY D 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) D Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of California Health&Safety Code,Section 25505 and 25534 concerning Contractor's 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 ONO 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI 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 Iicensure 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 ❑I,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.gov/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 Contractor's State License Law does not apply to an owner of a o 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. D 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 Contractor's 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. 51'C� P( pev : $�'3ob Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION .O.ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK SITE P PROJECTADDRESS 29ISLI A LORZ-,-rTf� A-VC.NUr--Z ASSESSOR'S PARCEL NUMBER 37Z "OI �✓' LOT ✓ TRACT OWNER NAME c�OR-(a Fi � �EZ- �RQ-T1N�Z ADDRESS 2 /Q 154- A L04�r-TA" A-vt�LLE M 6"I FF_F, CA 9zsw PHONE 9S/�(079- $Cv-1,� EMAIL 1 Nay • CD,-ONAO& A900,C&Lf , /L(A APPLICANTNAME O �1 pJIFZ M T �IIN "L ADDRESS � , DOX Z3SJ S k N G' IT C 4 926'OUP PHONE EMAIL I NcZ • L°d f-ONR Pbk kO, C6&, d.,k CONTRACTOR'S NAME gA4 p/J k- OWNER BUILDER? O YES ONO BUSINESS NAME j S �a ADDRESS -200,23 a65eV0I2 A-1/6. pIuGVO CA- 9125"4:77 PHONE _951-639L— 3.3! / EMAIL CONTRACTOR'S STATE LIC NUMBER S�F I413Co LICENSE CLASSIFICATION VALUATION$ 6/ i:262 SO FT /970 L SQ FT APPLICANT'S SIGNATURE DATE 7 Z;7 O �6 DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-572-5777 www.cityofinenifee.us Inspection Request Line 951-246-6213 I Riverside County Fire Department t Fire Protection Planning Section Riverside Olfce:2300 Market St.Ste.150,Riverside.O 92MI Ph.(951)955 777 Fm(951)955 905 Palm 0esen Obits: 77-933 tas 6fontanas Rd.,k 201 Palm Desert,r 92211-4131 m.(760)863-8886 Fax(760)863-7072 Fire Department Clearance/Release Date:8/31/2016 To: ccarlson(cpcitvofinenifee.us: briverapcitvofinenifee.us; mbinnall@citvofinenifee.us Tract/Parcel Map#: 16-MENI-SUP-043 Permit/Lot#: Job Site Address: 29154 LORETTA AVE, MENIFEE ❑ Final For Recordation Release For Building Permit(s) ❑ Shell Final Only(No Tenant) EJ Final For Occupancy El Release For Residential Sprinkler Installation ❑ Building Plan Check Fees Paid, Water Requirement Met-if water applicable ❑ Building Plan Check Fees Not Paid l Residential Sprinkler Plan Check Fees Paid p Residential Sprinkler Plan Check Fees Not Paid ❑ Other Fees ❑ Fees Not Required If you should have any questions, please contact the appropriate Riverside County Fire Protection Planning office for further assistance. SONYA BU FSS Print Name of Plan Reviewer/Inspector Approved Release SONYA BU FSS Sent By:Print Name Form C—Revised 3/0112012 F City of Menifee Building Dept �i aOVSIN qrY STATE OF CALIFORNIA NUMBER: it : ����1 SINESS,TRANSPORTATION AND HOUSING AGENCY n ® aae t JUL 2 9 Lf TIMENT OF HOUSING AND COMMUNITY DEVELOPMENT pp 11 �q qq - "n-4fi" , DIVISION OF CODES AND STANDARDS 3•� Etiel l e c e i ve 11QANUFACTURED HOUSING PROGRAM Y pE� MANUFACTURER CERTIFICATE OF ORIGIN ❑ CHECK IF THIS IS A DUPLICATE MCO-ENTER ORIGINAL MCO NO. MANUFACTURED HOME OR MULTIFAMILY MANUFACTURED HOUSING NUMBER OF ❑ SF (SINGLE FAMILY DWELLING) ❑ MFMH(MULTIFAMILY MANUFACTURED HOUSING) TRANSPORTABLE SECTIONS ` COMMERCIAL MODULAR: OCCUPANCY GROUP MANUFACTURER NAME: MANUFACTURER LICENSE NUMBER: 734H NPI11IRCTUNIW6, VEST, !NC. NF1126458 MANUFACTURER ADDRESS: SUGGESTED RETAIL PRICE: street 'IU, PERRIS, Cif 'ILibi Stets (zip) MANUFACTURER TRADE NAME: MODEL NAME AND/OR NUMBER: DATE OF MANUFACTURE: NAME OF DEALER OR TRANSFEREE(OWNERSHIP TRANSFERRED TO): CALIFORNIA DEALER NUMBER OR DATE OF TRANSFER: ''�LLEV HUNES TRANSFEREE DESIGNATION: rl3iQi!f, I . DEALER OR TRANSFEREE ADDRESS: Street I '! 5TE FI PERRIS, LA 61 '1 Slate (zip) INVENTORY CREDITOR NAME INVENTORY CREDITOR ADDRESS: ' w Fl u —OL i:'NFI oHHNPI 620 t^.Ilt"ET ';I -ET SUITE' 100, FWD%VILLE, Til "i f, v ' Street CI State (zip) �{, SECTION LENGTH WIDTH WEIGHT ` \v\ MANUFACTURER SERIAL NUMBER HCD INSIGNIA OR HUD LABEL NUMBER _^ 7.8 INCHES INCHES POUNDS F'EP,03730210 G RAlii51EU;t 792 162 20,Im O TRANSPORTER NAME. O TRANSPORTER ADDRESS: (Street) -i� (Cay) (slate) (zip) DESTINATION FOR UNIT DESCRIBED ABOVE to NAME Sues ..... Gtl -. .. ._ Slate Z I certify wrier penalty of perjury under'The}ewe 4!fie State of California that the above facts e}e true and correct. O Executed on M (I (Date) F$N 1S, ij.; (C;110-i;-., i'r County) (state) J SIGNATURE OF AUTHORIZED AGENT: { l I k 1�-'�� DISTRIBUTION: ORIGINAL(PINK) FORWARD TO THE INVENTORY CREDITOR,UNLESS THERE IS NONE,THEN FORWARD TO THE PURCHASER(DEALER OR TRANSFEREE). COPY 1(WHITE) FORWARD TO THE DEPARTMENT AT P.O.BOX 1828.SACRAMENTO.CA 9 5 81 2-182 8.WITHIN FIVE(5)DAYS OF RELEASE. COPY 2(YELLOW) DELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS DESTINATION. COPY3(GOLDENROD) TO BE RETAINED BY THE MANUFACTURER. HCD 483.0-Side 1-(Rev.01112) fi RECORDING REQLTE= BY ,•- • •" ,•_•r• de V �yCounty off.Riverside Gary L. OrsoAND VaIEN RECORDED !! II JORGE � T� I III SIIIIII� I I II III'Il lllle,ssor, County k Recorder MARTINEZ 111 l l lull lllllll PO BOX 2351 SUN CITY, CA 92586 M $ Ukin W4 MSC. L A RHI NCHG EYAIA P�• OJ� GRANT DEED : .t0 THE UNDERSIGNED G OR(S)DECIARE(S)THIS IS A BONAFIDF GIFT AND GRANTOR RECEIVED NOTHING IN RETURN R&TIOTT— DOCUMENI]ARYTRANSFERTAXIS $-4- _ 0 unincorporated area [ Cilyof -. Q computed on thefWlvalneafthe interestotpropedymmryed,or is ❑ computed an the Nit value lest the valueofticas mcneombranots x airdngar time of tic,and FOR A VALUABLE CONSIDERATION,receipt of which is hereby acknowledged, JORGE MARTINEZ,A MARRIED MAN,AS HIS SOLE AND SEPARATE PROPERTY SG - hereby GRANT(S) to JORGE MARTINEZ,A MARRIED MAN,AS HIS SOLE AND SEPARATE PROPERTY AND INEZ MARTINEZ,WIFE OF JORGE MAR7INE7-BOTH AS JOINTTENANTS the following described real property in the .City of SUN CITY COOnty of RIVERSIDE . ,State of California: PARCEL 3 OF PARCEL MAP NO.12730.IN THE UNINCORPORATED AREA OF THE COUNTY OF RIVERSIDE,STATE OF CALIFORNIA,AS PER MAP RECORDED IN BLOCK 68,PAGE 7 OF PARCEL MAP,IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY.AP NUMBER:357-560-OOM WHICH HAS THE ADDRESS OF 29155 LORETTA AVENUE,SUN CITY,CALIFORNIA 92584 Dated XLIZ `r STATE OF l COUNTYOF ) Ss. On befofeme, J E TINEZ a 1ary Publi n and for said Coumyand State,personally appear �� effaagmLINFZ NEZ lv�h personally kn m to me (or pravadto me o 9 bee3� s of eadafnctory evidence) to be the person(s) whose near_ /are subwo dbad to the Ph=HOTCNgSS within Instrument and acknowledged to me /rheyexeeutedthe COItRtd>dio(1 T, Sy same In. r/their authorized rapaaty¢es),and that by-I iAow/their sfgnature(s)on the Instrument the person(a),or the entity upon behalf of Ir1010fy PjblC-CoNtimb _ which the person(s)acted,executed the Indiumeot fter a Com* . MYCOMM-Elp NSOP24,2007 WITNESS my hand and offictal a". ✓✓�SignetweviNatuy DdlY)AyCammissailExpinis FOR noTAiH sEAt oR srnas+ MAIL.TAX STATEMENTS TO.PARTY SHOWN ON FOLLOWING LINE IF NO PARTY SO SHOWN, MAIL AS DIRECTED MINE Name StrestAddress Clty,State&Zip 301- ,'GQJMX - Golden West Homes / CMH Manufacturing West, Inc. 3100 N.Perris Blvd.,Perris,Ca 92571 Golden West Perris RESIDENTIAL NFPA 13D- 10 FIRE SPRINKLER SYSTEM INSTRUCTIONS AND PROCEDURES *This document is required to be left in each Home that has a fire sprinkler system installed. PERRIS DIVISION 3100 N. Perris Blvd. Perris, Ca 92571 CORPORATE OFFICE CMH Manufacturing, Inc Post Office Box 9780 Maryville, TN 37804 Golden West Homes / CMH Manufacturing West, Inc. 3100 N.Perris Blvd.,Perris,Ca 92571 INSTRUCTIONS AND PROCEDURES The person responsible for installing the home must connect the water supply line to the fire sprinkler system and install the fire sprinkler cross-over(with multi-units) using the enclosed instructions. A single control valve arranged to shut off both the domestic system and the sprinkler system shall be located and installed by the site contractor. Adequate water pressure shall be available at the home installation site to insure proper operation of the fire sprinkler system. The person responsible for installing the home must hydrostatically test the fire sprinkler system at a minimum of 50 psi; not to exceed 100 psi for at least two hours without any evidence of leakage. A representative of the enforcement agency must witness the hydrostatic test at home's installation site during the same site visit to inspect the installation of the home or dwelling unit. Pressure and flow requirements for the fire sprinkler system are noted on the "Fire Sprinkler System Information and Installer Certification" label located on the wall or door surface inside the water heater compartment. The installer shall complete the "Fire Sprinkler System Information and Installer Certification" posted within the home. CARE AND MAINTENANCE The owner is responsible for properly maintaining the fire sprinkler system. Golden West Homes will provide a Homeowner's Guide with the fire sprinkler system component instructions and procedures for maintenance with each home. Furthermore,the Authority Having Jurisdiction (AHJ) may have additional regulations and requirements for maintenance,testing, and inspection that must be followed. It is the owner's responsibility to keep the home heated adequately to maintain a minimum temperature o f 400 F to prevent the Fire Sprinkler System from FREEZING. Inspection,testing,and maintenance shall be performed by personnel who have developed competence through training and experience. The property owner or designated representative shall correct or repair deficiencies or impairments that are found during the inspection,test, and/or maintenance. Corrections and repairs shall be performed by qualified maintenance personnel or a qualified contractor. System pipes shall be filled with potable water only. WARNING:Anti-freeze solutions shall NOT be used within sprinkler systems. It is advisable to have the Sprinkler System inspected regularly by a qualified inspection service. Golden West Homes / CMH Manufacturing West, Inc. 3100 N.Perris Blvd.,Perris,Ca 92571 Replace any sprinkler exhibiting corrosion or damage; always use new sprinklers heads of the same type and temperature rating as the replacements. Sprinklers shall never be painted, coated, plated or altered in any other way from the manufactured condition or they may not function properly. Nothing should be hung or attached to the sprinkler head that would disrupt the designed discharged spray pattern. In the event that subsequent construction may obstruct original design spray pattern, additional sprinklers may be required to maintain proper levels of protection. DO NOT attempt to replace sprinklers without first removing the fire protection system from service. To remove system from service, close main control valve (location to be noted by others), open Main Drain Valve and Inspectors Test Valve, and drain water from system. Never connect any device or hose to the Inspectors Test Valve. This valve is for inspection and drain purposes only. A fire protection system that has been shut off after activation should be returned to service immediately. Any control valve(s) on the water supply to the residence for the sprinkler system must be in the full open position for the system to operate properly. If the valve must be closed temporarily to service the sprinkler,verify that it is left fully open and secured when service is complete. To drain the fire sprinkler system, attach a garden hose to the drain line located at the manifold/riser location. Open drain/test valve and drain water away from the home. 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