PMT16-02325 City of Menifee Permit No.: PMT16-02325
29714 HAUN RD.
�XCCEL/7 MENIFEE,CA 92586 Type: Mobile Home
MENIFEE Date Issued:
09/01/2016
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 INSTALL FOR NEW MOBILE HOME 1908 SQ FT
Work: SERIAL#PER037302CAA, 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 ,Ott Amount fsl
Manufactured Install 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_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 XI am exempt from licensure under the Contractors 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 I 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 workers 7044 of the Business and Professions Cade,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 wwwJe info.ca. ov calaw.htm
this permit is issued.
Date
Policy# -
PROPERTY OWNER OR AUTHORIZED A T
o I have and will maintain workers compensation insurance,as required by
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: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires the above identified pr per y for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPER• f OWNER OR AUTHORIZEDC44NT
❑I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers 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
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 D Yes ❑No
UNLAWFUL,AND SHALL SUBJECTAN 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)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oYes DNo
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 D 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 underthe State of
California Health&Safety Code,Section 25505 and 25534 concerning
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 oYes o 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 IRRPI
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 licensure 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
o 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.eoa.aov/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 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 bemuse:
o 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.
=N5TA L: #a'ti l9`1 1a
r-OM enifee
DATE PERMIT/PLAN CHECK NUMBER WTI`up- Q �
TYPE: O COMMERCIAL O RESIDENTIAL ' 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
PROJECTADDRESS 2 I5q A L02ET74 AVE)IJU
ASSESSOR'S PARCEL NUMBER 3- Z 'I 5V 1D 1(0 LOT / s0 TRACT O I(p
OWNER NAME joa2GE ILIA/_-rwccZ
ADDRESS LUr.-O7'tAk AVENLLe M N(FEE eA- 9Z5°v
PHONE (0?9-8 (0;73 EMAIL
APPLICANT NAME ) NEB k A 21-I r+Ez
ADDRESS A0, LSC-K 235/ Sold C(( CA g2-5B(p
PHONE q51 -V79--f(� EMAIL I 'JGZ. C �Np•C� (q(•{a��CO/4
CONTRACTOR'S NAME
fL.Af"UOhN (L.ANGEL_ OWNERBUILDER7 OYES ONO
BUSINESS NAME S T D IG N
ADDRESS 2_SaZ4 R_QjeW! 2 A✓Et ju_iE uevo 92�Jlp7
PHONE 9!91 -(.34- 3 319 EMAIL `
CONTRACTOR'SSTATEE��LICNUMBER S5i43(4D LICENSE CLASSIFICATION
VALUATION$ �yL, Q�IG�° y SOFT gd Q L SQ FT
APPLICANT'S SIGNATURE DATE 7 Z
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT O CASH C CHECK# C CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES C NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
Riverside County Fire Department Fire Protection Planning Section
Riversitle OMce:2300 Mallet St.Ste.150.Riverside.CA 92501 Ph.(951)95SC]]]Faz(951)955<886
Palm Desert OMce: 77-9331es Manrai,as Rd.,F 201 Palm Desert.CA 92211-4131 IN.(760)863-8806 Fax(760)863-7072
Fire Department Clearance/Release
Date:8/31/2016
To: ccarlson(o)citvofinenifee.us: brivera@citvofinenifee.us; mbinnallifticityofinenifee.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)
Final For Occupancy
Release For Residential Sprinkler Installation
❑ Building Plan Check Fees Paid, Water Requirement Met-if water applicable
❑ Building Plan Check Fees Not Paid
Residential Sprinkler Plan Check Fees Paid
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
Farm C—Revised 3/01/2012
` City of Menifee
$ Building Dept ?
' S1NCs '
OV 9!Y STATE OF CALIFORNIA - .NUMBER:
SINESS,TRANSPORTATION AND HOUSING AGENCY
O III ,,, Z JUL 2 9 I�TMENT OF HOUSING AND COMMUNITY DEVELOPMENT
0 10�" w DIVISION OF CODES AND STANDARDS_
�pANUFACTURED HOUSING PROGRAM
MANUFACTURER CERTIFICATE OF ORIGIN
❑ CHECKJF THIS IS A DUPLICATE MCO-ENTER ORIGINAL MCO NO.
MANUFACTURED HOME OR MULTIFAMILY MANUFACTURED HOUSING NUMBER OF -
❑ SP1D(SINGLE FAMILY DWELLING) ❑ MFMH(MULTIFAMILY MANUFACTURED HOUSING) TRANSPORTABLE SECTIONS `
COMMERCIAL MODULAR: - -
OCCUPANCY GROUP
MANUFACTURER NAME: - - MANUFACTURER LICENSE NUMBER:
CKH MANUFACTURING HEST, INC. MF1126458
MANUFACTURER ADDRESS: SUGGESTED RETAIL PRICE:
Sheet 3100 NORTH PERRIS BLVD, PERRIS, CA 92 1l Slate ZI
MANUFACTURER TRADE NAME: MODEL NAME AND/OR NUMBER: DATE OF MANUFACTURE:
GOLDEN HEST GOLDEN EXCLUSIVE 71CO14276630HIR 93/10/16
NAME OF DEALER OR TRANSFEREE(OWNERSHIP TRANSFERRED TO): CALIFORNIA DEALER NUMBER OR DATE OF TRANSFER:
PACIFIC VALLEY H014ES TRANSFEREE DESIGNATION:
n la4(.
DEALER OR TRANSFEREE ADDRESS: -
sheet3100 NORTH PERRIS BOULEVARDGTE A PERRIS, CA a )I State - (zip)
INVENTORY CREDITOR NAME:
2iST MORTGAGE CORPORAI ION
INVENTORY CREDITOR ADDRESS:
ATTN: IIIPENTURY FINANCE / MYRA SHARP, 620 6LARRET Sl'REET SUITE IBO, RHp%PIECE, T6i 379i+1
Sheet CI Slate (zip)
SECTION LENGTH WIDTH WEIGHT
MANUFACTURER SERIAL NUMBER HCD INSIGNIA OR HUD-LABEL NUMBER NCHES_- . ...INCHES... _. P.OUNDS
1 PER037302CA A RAD151B321 792 162 31,250
2 PER037302CA D RAD1518322 7.92 .162 : 28,100
TRANSPORTER NAME: - O
RFPINETT 7 11fR TRANSPOP.T
TRANSPORTER ADDRESS: 1\ '
(Street) P.O. BOX 569, MCDONOUGH, GR 3025.3 (car) (Stale) (tin)
DESTINATION FOR UNIT DESCRIBED ABOVE: ry ,
NAME _ _.__Street __.. _ __ _.CB _...- - BM. Zi
r1L IL CI fIN'11LJ V 1'IV t YI I1 il.i V 1'C . L !1 1' \I\ Ell ll.J.l YYY
I codify un`�er penaify arf pe0ury under'the5awso i'heS`haie of Z'al(�Omla lhetyhe abbve�acts a}e true and cbrrecl. O
Executed on al 1
viif1h ��PyER/R/ppI5r1'IJI(�/R<)1oDEQ,.�CA (covnry) (sea)
SIGNATURE OF AUTHORIZED AGENT: t l I (All-^`—h,9
DISTRIBUTION: ORIGINAL(PINK) FORWARD TO THE INVENTORY CREDITOR,UNLESS THERE IS NONE,THEN FORWARD TO THE PURCHASE R(DEALER OR TRANSFEREE).
COPY 1(WHITE) FORWARDTO THE DEPARTMENT AT P.O.BOX 1828.SACRAMENTO.CA 95312-1828.WITHIN FIVE(5)DAYS OF RELEASE
COPY 2(YELLOW) DELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS DESTINATION. '
COPY 3(GOLDENROD) TO BE RETAINED BY THE MANUFACTURER.
HCD 483.0-Side 1-(Rev.01112)
RECORDING REQUESTED BY County of Rrverside�V V�
Gary L. Orso
AND VMEN RECORDED MAIL TO Assessor, County Clerk & Recorder I
JORGE MARTINEZ III �� I IIII I I II I III I IIIII III III
PO BOX 2351 1
SUN CITY, CA 92586
M $ U PAGE arc OA PCOR NOfAR SXR taaC.
l A R L COPY LONG qE UND NCHG EXpM
1 GRANT DEED 37215000" _ .IO
TFTE UNDERSIGNED G OR(S)DEC ARE(S)THIS IS A BONAFIDE GIFT AND GRANTOR RECEIVED NOTHING IN RETURN R&T 17
DOCUMI+Nr'ARYTRANSFERTAXIS $•40-
® uninwrporated area 0 Gtyot
Q computed On the fullvaMeofthe inremtorpropeny mmeyed,oris
C1 computed On the full value leis the vafueofliens or encumbrances renminingat time of sale,and
FOR A VALUABLE CONSIDERATION,receipt of which is hercby 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 MARTINEZ,BOTH AS JOINT TENANTS
the following desmbed real property in the City of SUN CITY
COnnty 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:357-560-008-6
WHICH HAS THE ADDRESS OF 29155 LORETTA AVENUE,SUN CITY,CALIFORNIA 925M
Dated r-,07 / 17a0'74
STATEOF
COUNTY OF } SS. •� � .
On before me, L
TINEZ
a Lary Pubti n and for said Coumyand State,pemmnellyappeare
Cl - fzo —7�1 INEZ NEZ
O�ir �i/�i/. /_.si —r
personally personally k�or proved to me a p bads of eafiafaciory
evidence) to be the persan(s) whose nem e /are subseAbed to the - pHyu(S W)FCH pSS fl
within Instrument and acknowledged to me ihet rt/they executed the �Aftp fl l{.IA365S1 1®l
same In hlat"w/their authorized capecity[es), and that by-bis/her/their y z
signshue(s) on the Instrument the person(a),or the entity upon behalf of 5
which the person(s)acted,executed the Instrument ftenIde CO{Rtly
MyCOMM.bVkSs SOP 24.200171
WITNESS my hawndd and offieW seal.
��g!%['!�= L;ommWsiofi Expires FOR rroran sEnL oR ST i
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE IF NO PARTY SO SHOWN, MAIL AS DIRECTED ABOVE
Name Street Address City,State&Zip
.^.Or-65i]Or97bX
Golden West Homes/ CMH Manufacturing West, Inc.
3100 Perris Blvd.,Perris,Ca 92571
A. QA-FSS-26
APPROVAL EXPIRATION
DATE RQCO DATE
FEB 2S 15 WROVED
OCTJi'15
APPROVAL NO.
803-1346
Golden west
Perris
FIRE SPRINKLER SYSTEMS MANUAL
APPENDIX
PERRIS DIVISION
3100 N. Perris Blvd.
Perris, Ca 92571
CORPORATE OFFICE
CMH Manufacturing, Inc.
Post Office Box 9790
Maryville, TN 37804
CITY OF MENIFEE
NIF Community Development
Department
Robert A. Brady—Interim Community Development Director
DATE: August 5, 2016
TO: Building and Safety Department
Attn: Craig Carlson
Bernice Rivera
FROM: Tamara Harrison, Associate Planner
RE: Building Plans for PMT 16-02323-02325 (Plan Check#1) 29154 Loretta
Avenue Second Unit Permit(APN: 372-150-016)
The Community Development Department has reviewed the set of building plans that were
submitted to Building and Safety (PMT 16-02323-02325 [plan check #1]). The following items
must be addressed prior to the Community Development Department's sign off on its portion of
the building permit issuance approval:
Prior to Issuance of a Grading Permit, Building Permit and Prior to Building Permit Final:
1. SUP 2015-043 is currently within the required 10-calendar day appeal period. Any
building permits issued during the appeal period will be at the applicant's own risk. The
appeal period will end on August 15, 2016.
2. Perris Union High School District and Menifee Union School District. See the
attached school fee request form. Please take this school fee request form to the Perris
Union High School District and Menifee Union School District for payment of mitigation
fees and provide proof of payment to the City of Menifee Community Development
Department.
Should you have any questions please contact me a (951) 672-6777 or by email at
tharriso n(a'DcitVofinen ifee.us.
Sincerely,
City of Menifee Community Development Department
o
Tamara Harrison, Associate Planner
G1TY O,.
�j
August 5,2016
Scott A. Mann
Mayor
To Whom It May Concern:
Greg August
Mayor Pro rem The following information is provided for the school district to determine mitigation fee
District 1 amounts:
Matthew Liesemeyer Applicant: Jorge and Inez Martinez
Councilmember Application Type: Building Permit for Second Unit Permit
District 2 Permit Number: SUP 2016-043
Location: 29154 Loretta Avenue, Menifee CA 92584
Lesa Sobek Assessor's Parcel Number: 372-150-016
Councilmember Tract/Lot:4.69 ACRES: PM 68/7 PM12730 LOT/PARCEL:3
District 3
Description: Square Footage:
John V.Denver Second Unit Home 1,980 sq.ft_
Councilmember
District BUILD] �p
BUIL®ING AREA
VERIFIED
Date X6116
PRIOR TO THE ISSUANCE OF THE PERMIT REFERENCED ABOVE, applicants are required to
submit written evidence from:
Menifee Union School District
Perris Union High District
to City of Menifee authorizing the issuance of building permits.
By
Tamara Harrison,Associate Planner
29714 Haun Road
Menifee,CA 92586
Phone 951.672.6777
Fax 951.69.3843
www.cityofinenifee.us
Perris Union High School District
"Growing Together Through Edncarion"
SCHOOL FACILITIES FEES
155 East Fourth PUHSD APPLICATION: 3198 Date: 8/8/2016
Street Perris,California Building Dept.Permit#: SUP2016-043
�
92570-2124 Project Address: 29154 LORETTA AVE
M
Main Number ENIFEE,CA
951-943-6369 ! Tract#(s): PM 12730 APN: 372-150-016 Lot#(s): 3
SupeOffice PP ant's A licant's Name: JORGE/INEZ MARTINEZ A PP licanfs Phone: 951-679-8673
Office I
Fax 951-940-5378
Applicant's Address: PO BOX 2351
Business SUN CITY,CA
Office
Fax 951-940-5301 Type Development:
Personnel SFD/Mfficeobile/Condo �Y� ' CFD Commercial 11
Fax 951-943-9952 /'
Adlt Replacement ❑ Senior 12a1c Apt.Building Fj
Number of Units/Lots: I Total Square Feet**: 1980
**If final building permit is over 20 feet more or less than this number,applicant must adjust the fee paid accordingly.
I certify that the above information is true.
Board Date: YW;t O Applicant:
of
Trustees
Joan D.Cooley CERTIFICATION TO THE DEPARTMENT OF BUILDING SAFETY
Edward Agundez
Dr.Jose Luis Araux I This certifies that the school facilities fees imposed persuant to(X)California Government Code Section 53080;O Pre-legal
Carolyn A.Twyman . authority in the amount of $0.94 times 1980 square feet,or $1,861.20(lotal amount of fees),and have been paid to
David G.Nelissen the District for the above-listed properties,and that building permits
for this square footage in this proposed development may now be issued by yourjurisdiction.
NOTICE OF 90-DAY PERIOD FOR PROTEST OF FEES: Pursuant to section 66020 of the California Government Code and
other applicable law,you have a period of ninety(90)day from the date of payment of school fees,mitigation payments or
District other extractions to protest the validity thereof. This ninety(90)day period commences upon such payment of performance of
Superintendant any other requirement,as provided in Section 66020. Any such protest must be in writing and received by the Board of
Dr.Jonathan L. Trustees of the Perris Union High School District within ninety(90)calendar days of the date of the CDC above.
Greenberg I
EFFECTIVE PERIOD OF CERTIFICATE OF COMPLIANCE: This COC is valid for a period of ninety(90)days from the
date of issuance. Upon application by the applicant,the Board of Trustees of Perris Union High School District may
determine,in its sole discretion that good cause exists to grant an extension to the foregoing period. The Board may grant an
extension for any number of days up to and including thirty(30)days. The applicant may apply for up to three(3)such
extensions. At such time as this COC expires,if a building permit has not been issued for the construction of the
corresponding dwelling unit,the applicant will be reimbursed all amounts paid,without interest,that were paid to obtain this
COC. This COC shall be deemed to be a separate COC for each Lot/DU specified above.
Date: 8/8/2016 Prepared by:
Approved by:
PERRIS UNION HIGH SCHOOL DISTRICT RECEIPT
155 E. 4TH STREET Receipt Date: 08/08/2016
PERRIS , CA 925700000 Receipt Number: 203
Received From: Receive /A
Customer Number: j
Customer Name: JORGE/INEZ MARTINEZ Signature
Accounts Receivable (951)9436369
ounnrii'y k cj''li
DEVELOPER FEES TRACT PM 12730; LOT 3; CK 127 1,861.20 1.00 1,861.20
TOTAL: 1,861.20
Account Information (Internal Only)
ccount IjAccrual Number IAmount Trans Type
25-500-9010-0-0000-0000-8681 1,861.201 2
JORGE MARTINEZ 90-3582/1222 127
INEZ MARTINEZ
PO BOX 2351
SUN CITY,CA 92586-1351
PAY To THE 7�/ (� I
ORDER OF i
D me evt<< p «7��,��wdr�dsrXf�a�t���r�«A65 8
(Mbank.
MEMO'5',,b"/
ii: 1222358211: 15450847199011' i27
Menifee Union School District
30205 Menifee Road,Menifee,CA 92584 RESOURCE." 9961
CERTIFICATE OF COMPLIANCE
PAYMENT OF SCHOOL FACILITY FEES
Date: 8/8/2016 Certificate#: 16-17 1012
Developer/Applicant: Jorge and Inez Martinez Telephone#: 951-679-8673
Bldg.Dept. Plan Check#: SUP 2016-043
Address: 29154 Loretta Avenue
Location of Project: Menifee Tract/Lot#: PM12730 Lot/Paroel 3 Parcel#: 372-150-016
RESIDENTIAL SPACE Number of Square Feet
CFD 94-1 x 1.92 sot If Total:
1,980 $2.61 sq ft. effective July 13,2016 Total: $5,167.80
COMMERCIAL&INDUSTRIAL SPACE
effective 5126114 x $0,3890 Total: $0.00
The above representations as to square footage am true. Developer/Applicant agrees that if it is later determined
that such representations are untrue,then this certificate shall automatically terminate and the City shall be notified.
NOTICE:THERE IS A 90-DAY PERIOD FOR PROTEST OF FEES. Section 66020 of the Government Code
enacted as Assembly Bill 3081,set forth as Chapter 549,Statutes of the Stale of California.1996 effective January 1,
1997.requires that this school district provide a written notice to the project applicant at the time of payment of school
fees,mitigation payments or other exactions. This notice is to advise you that any protest in regard to such amounts
or the validity thereof in accordance with Section 66020 of the Government Code and other applicable law,
commences with such payment or performance of any other requirement as described in Section 66020 of the
Government Code. Additionally,this notice advises that the protest thereof must occur within 90 calendar days
vthereafter.
' DEVELOPIEWAPPLICANT
I
ies that the above named Developer Applicant has paid school facility fees in compliance with Govemment
ion 65995 enifee U.S.D.agrees that building permits for this square footage in the proposed
e-nt m y no be issued by your Ldsd?A
Bruce H.Shaw
Director of Facilities
COC Template 16-17
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