PMT16-03511 City of Menifee Permit No.: PMT16-03511
29714 HAUN RD. Type: Mobile Home
<A—CCEU� MENIFEE,CA 92686
0,1 SA.— MENIFEE Date Issued: 02/2712017
P E R M I T
Site Address: 31175 GEARY ST,MENIFEE, CA 92584 Parcel Number: 358-15D-017
Construction Cost: $50,000.00
Existing Use: Proposed Use:
Description of INSTALL FOR NEW MOBILE HOME
Work:
Owner Contractor
ORVAL DICK LANIK ENTERPRISES INC
35344 WANKI AVE P 0 BOX 891416
WILDOMAR, CA 92595 TEMECULA, CA 92589
Applicant Phone:9516767114
ASHLEY TAYLOR License Number:458947
LANIK ENTERPRISES INC
P 0 BOX 891416
TEMECULA, CA 92589
Fee Description ON Amount(S)
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 carded 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.
Ad\_Bldg_Perrnit-Ternplate.rpt Page 1 of I
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 ocintractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and 0 1 am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
f 63 -�-;
License Class LIC"s-a�._r y mysignature below I acknowledge that,exceptformy personal residence
Expires Signature 6!!� 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
a 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
this permit is issued. www.leginfo.ca.goy/calaw.html.
Policy# Date
,_Q+1rave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature below I 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 an 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 cor —
�_S-oa*qA� C with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#.yff U05+-61-6ExpIres �0 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($1130)or less PROPERTY OWNER OR AUTHORIZED AGENT
ci 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 UCENSE# 0�,:�3CJ
worker's compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the orker's compen t' n provisions of Section 3700 of the Labor
Cod I c rs. Will the applicant or future building occupant handle hazardous material or a
� I�
App 54gaR� Date mixture containing a hazardous material equal to or greater that the
amountsspeci ed an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0yes Irv.,
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND aVILFINES UP TOONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
forguidell
CONSTRUCTION LENDING AGENCY ci Yes X
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) 0yes e-No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACIMD
permitting checklist.I understand my requirements underthe State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazar4ous materia
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 a ing.
construct,alter,improve,demolish or repair any structure,prior to its _27FOEM Date L-2
Business and Professions Code).Any city or county that requires a permit to
issua nce,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's 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
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
ci 1,as owner of the property,or my employee with wages as their sale employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is ww%v.epa.goy/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 ct 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 Certificattion No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. a No EPA Lead-Safe Certified Firm is required for this project because:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contraictoes 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.
Lin;M
991001 NOW
,-�Menillee
DATE PERMIT/PLAN CHECK NUMBER PLAn 0
TYPE: OCOMMERCIAL FIRESIDENTIAL [—]MUL11-FAMILY RIMOBILEHOME []POOL/SPA []SIGN
SUBTYPE: DADDITION []ALTERATION E]DEMOLITION E]ELECTRICAL F1 MECHANICAL
[:]NEWE]PLUMBING El RE-ROCIF-NUMBER OF SQUARES
DESCRIPTION OF WORK ffid6�f Qlf' Of
Bullcin-g' & =ept.
PROJECTAIDDRESS 31175 Geary Street,Menifee,Ca.92584 OCT 2 7 ,2016
ASSESSOR'S PARCEL NUMBER 358-150-017 LOT wceived
PROPERTY OWNEWS NAME DanielArcher
ADDRESS 40480 Marsha Ct,Hemet Ca.92544
PHONE (951)292-8450 EMAIL danny52185@gmaii.com
APPLICANT NAME Gordon Lank
ADDRESS P.O.BOX 891416,Temecula,Ca.92589
PHONE (951)676-7114 EMAIL Lan!kEnterprises@hobmaii.com
cowmcrolrS NAME Gordon Lanik OWNERBUILDER? [-]YESR]NO
BUSINESSNAME Lanik Enterprises
ADDRESS P.O. BOX 891416.Temecula,Ca.92589
PHONE (951)676-7114 EMAIL
CONTRACTOR'SSTATE LIC NUMBER 468947 LICENSE CLASSIFICATION A&B
VALUATION$ SQ FT LSQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CTIYOF MEIjIFE"USINESS UCENSE NUMBER
BUILDING PL4NNING ENGINEERING FIRE � GREEN SMIP f,Ncg�q
INVOICE PAIDAMOUNT 0 CASH 0 CHECK# OCREorrCARD MSA/MC
AMOUNT I I I
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK If 0 CREDIT CARD VISAIMC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LEITER 0 YES 0- NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.citVofmenifee.us Inspection Request Line 951-246-6213
DOC#2016-0491892
RECORDING REQUESTED BY: 11/04/2016 04:19 PM Fees:$18.00
Page 1 of 2
First American Title Company Recorded in Official Records
County of Riverside
Peter Alcana
WHEN RECORDED MAIL DOCUMENT AND TAX Assessor-County Clerk-Recorder
STATEMENT TO:
-This document was electronically submitted
Daniel K.Archer
to the County of Riverside for recording-
31175 Geary Street Receipled by:YVONNE 9046
Menifee, CA 925114
APN: 358150017-4
TITLE ORDER NO.:5208549
ESCROW NO.: 37539-2 -
_JP-A.' 0,)L(b-007 GRANT DEED THIS SPACE FOR RECORDER'S USE ONLY
The undersigned Grantor(s)declare(s)that the DOCUMENTARY TRANSFER TAX IS:$ 123.75 County $00.00 City
XX computed on the full value of the interest of property conveyed,or
—computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale.
—OR transfer is EXEMPT from tax for the following reason:
The Undersigned
Signature of declarant or agent determining tax Fin Name
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Orval E. Dick and Betty J. Dick,
Husband and Wife as Joint Tenants
HEREBY GRANT(S)to Daniel K.Archer a Single Man
All that real property situated in the City of Menifee, County of Riverside,State of California,described as,
Complete legal description attached hereto as Exhibit"A"and made a part hereof.
Commonly Known As: 31175 Geary Street,Menifee, CA 92584
June 20,2016 �Xw'-'o -�z
Orval E. Dick
Betty J. Dick i U
A notary public or other officer wmplefing this cerfifficate verifies only the Identity of the individual who signed the document to which this cedificate Is
attached.and not the truthfulness,accuracy or validity of that document
STATE OF CALIF_QRNIA
COUNTYOF K IV�FR_S lbg
On M J0 e _�-T A 0 1 to before me, LD&ae, a Notary Public
personallyappeared 86-�Tf -X 73$" ORVAL F-. )31(vi<
who proved to me on the basis of satisfactory evi dence to be the pers�Q)whose name(s)f4g�ubscnbed to thewithin instrument and
acknowledged to me that he"4Eey)axecuted the same In hwhe�uthorized ca�acity(ies).and that by4hke(�ignaturiiw on the
instrument the person(s),or the ently upon behalf of which the person(s)acted,executed the instrument.
I certify under PENALTY OF PERJURY under[he laws of the State of California that the foregoing paragraph Is true and correct.
WITNESS my h 7a)"d official se2--7,,:-'
Signature (SEAL) CYNTHIA LOGUE t
COMM.#1991
Notilly
It 8fifERM00UNTY
um.Eg wr.17.2016
MAIL TAX STATEMENTS AS DIRECTED ABOVE
DOC#2016-0491892 Page 2 of 2
EXHIBIT "A"
LEGAL DESCRIPTION
Real property in the.City of Menifee, County of Riverside, State of California, described as follows:
LOT 1413LOCK B OF UPTON ACRES NO. 7 AS SHOWN BY MAPPN FILE IN BOOK 14, PAGE 100
OF MAPS IN THE OFFICE OF THE COUNTY RECORDER OF RIVERSIDE COUNTY, CALIFORNIA.
APN: 358-150-017-4
" Mall Williams
since 1960d, man ufaclared Gmejs, (nc.
February 21, 2017
To Whom It May Concern:
"Ma" Williams Manufactured Homes authorizes the placement of a 2017, Silvercrest
Home, Serial # 176-OOF-H-AI00789A& 176-OOF-H-AlOO789B, HUD#NTA 1745032
(A) &NTA 1745033 (B),home to be placed on a permanent foundation at the address
below:
'31175 Geary Street
Menifee, CA 92584
APN#358150017-4
This is for customer Daniel K.Archer Il and is to be financed.
If you have any other questions please feet free to call me at(951)791-9882.
Regards,
Darnion Croston
"Ma�'Williams Manufactured Homes Inc.
35325 Highway 74 Rosarito Beach
Hemet, California 92545 Mexico
Tel 951.926.1581 Intersection of Toll Road and Free Road
Fax 951.926.9622 Tel 011.52.661.613.1091
ALL PURPOSE ACKNOWLEDGMENT
A notary public: offic:er or other offimr completing this certificate
verifies only the identity of the individual who signed the document to
which this certificate is attached, and not the twthfulness. amuracy
or validity of that document
State of California }SS
County of !��Wz-rs 4e� }SS
before me, cpe,,�yll I\Joiav"j
(here insere name and title of the offlcer)
personally appeared, bavv"�.ioyA t-e-12oQ C r o s kpy-)
who
0 proved to me on the basis of satisfactory evidence to be the person(A wl�iose.name(s�
I JW6 subscribed to the within instrument and acknowledged to me that fielqKeft6y executed
the same in of nierfr/tb4ir authorized capacity(!O), and that by�rft6ir signatureA on the
instrument the person(o, or the entity upon behalf of which the personfi6) 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 HAYDEN W ODS
Signatur COMMISSiDn#20602108
< Notary Public-California
Z Z
Z Rivarside County
SMYCOMM. frog Mar 23.2018
(SEAL)
STATE OF CALIFORNIA NUMBER:
BUSINESS,CONSUMER SERVICES AND HOUS NIS AGENCY 881874�2
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
MANUFACTURED HOUSING PROGruCluvi
MANUFACTURER CERTIFICATEW ORIGIN
PHECK IF THIS IS A DUPUCATE.MC.O-ENTER ORIGINAL MCO NO.
MANUFACTURED HOME OR MUL TIFAMILY MAMILIP&TURrD HOME. NUMBER OF
)J-1 SFD(SINGLE FAMILY DWELUNG) MFMR(MULTIFAMILY MANUFACTURED HOME) TRANSPORTABLE SECTIONS-
COMMERCIAL MODU
OCCUPANCYGROUP
MANUFACTURER NAME: MANUFACTURER LICENSE.NUMBER;
CHAMPION HOME BUILDERS INC 1218438
MANUFACTURER ADDRESS: SUGGESTED RETAIL PRICE:
299 N.SMITH AVENUE,CORONA,CA,92880 NIA
(Street) (City) (State� (zip)
MANUFACTURER TRADE NAME MODEL NAME ANQ/OR NUMBER: DATE OF MANUFACTURE
SILVERCREST I BRADFORD 021`14/17
NAME OF DEALER OR TRANSFEREE(OWNERSHIP TRANSFERRED TO): CALIFORNIA DEALER NUMBER OR DATEOFTRANSFER:
TRANSFEREE DESIGNATION:
MA WILLIAMS MANUFACTURED HOME SALES 912-55 02(15117
DEALER OR TRANSFEREE ADDRESS�
(&51 .
?5 HWY.74, HEMET,CA 92-545 (city) (slate) (ZAP)
INVENTORY CR9DrrOR NAME.
NORTHPOINT COMMERCIAL FINANCE
INVENTORY CREDITOR ADDRESS:
(�lFT Oq
.2,75 RAINWATER DRIV5.SUITE 450,ALF`.HA,§, A,GA300., (State)
g
�W W
176-00E-H-AlQ0789A NTA 174SD32 576 160 Z7,384
176-ODF-H-AlOO789B NTA 1745033 576 160 26,334
ROBERT HAVZNS.TRANSPOP
TMSPORTERADDRESS:
20683 Waalew Road Space 186Apple Valley,CA 92307
(SI'"t) - -mly) (slatal (Zip)
DESTINATION FOR UNIT DESCRIBED ABOVE,
DANNY ARCHER, 311 T, MENIFEE, CA 92584
PvC%ml .4?fGEARY STREE (aw)
I certify under penalty of pedury under the laws of the State of Callftanki that the above facts are true wd correct.
0211,5fl 7 CORONA, RIVERSIDE. 'CALIFORNIA
paw) (munty) . (St.(.)
SlGiVITURE OFAUTHORIZED AGENT.
DISTRIBUINON ORlGINA-(PINXr F-0?i�ARJiYrO THE-INVIENTORY CREDITOR UNLESS THERE IS NONE,THEN FORWARD TOTHE PURZHASER(DEALER ORTIVU45FEREE),
Copy i(WHinn Fo=TO THE DEPMTMENT AT P.O.BOX 1820,SACR�IEWO.CA 95612-1828,WITIBN ME(5)DAYS OF RELEASE
T
OOFY2fYEULOW) 0 TO THE TRANSPORTER TO ACCDIV[Pmy THE UNIT TO ITS 09STIUkTIOR
MPY3(GOMENROD) TO BE RETAINED BY THE MANUFACTURER
HCD 483.0-Side 1(Rev.07116)
I,DANNY ARCHER AUTHORIZE MY HOME
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TO BE BUILT AS SHOWN BELOW:
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