PMT16-03536 City of Menifee Permit No.: PMT16-03536
29714 HAUN RD.
'�—Accr=L:A? MENIFEE, CA 92586 Type: Mobile Home
MENIFEE Date Issued: 11/0112016
P E R M I T
Site Address: 23740 NORMA DR, MENIFEE, CA 92587 Parcel Number: 350-261-029
Construction Cost: $2,000.00
Existing Use: Proposed Use;
Description of PERMANENT FOUNDATION FOR 36'X 24'MOBILE HOME
Work: SERIAL#: CAFL708A31970CD12 HUD#: PFS1023260
SERIALM CAFL708B31970CD12 HUD#: PFS1023261
Omer Contractor
JOSE LUNA
PO BOX 604
VALLEY CENTER,CA 92082
Applicant License Number.
JOSELUNA
PO BOX 604
VALLEY CENTER, CA 92082
Fee Description Amount($1
Manufactured Permanent Foundation 240.72
Permit Fee 27.00
$267.72
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of emors in the plans and
spedfications 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 BidgPermit-Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjurythat 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 01ram exempt from licensure under the Contractor's State Ucense 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
a I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understa nd that a copy of the applica ble law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professl C cle,is available upon request when
'u"0
compensation,Issued by the Director of Industrial Relations as provided for t�hls application is su I ed or the following website:
by Section 3700 of the Labor Code,for the performance of work for which le
this permit is issued. _ww)y.leginfio.ca. o W.11
Policy# �42!Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNfR OR AtYTbORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ci By my signature below I certify to each of the followling: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 constructip�.I authpAe representatives of this City or county to
Policy# Expires enter the above Win �I peoi,��ectici purpo e
(This section need not to be completed is the permit is for one-hundred t
5/ D:e:
dollars($100)or less P f bp E RT Y OvWAMd 0)AM T H 0 R I Z k rA G E NT
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 LICENSE#
worker's com pensation laws of Ca lifornia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Lab..
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING-FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes u 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
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
forguidelines
CONSTRUCTION LENDING AGENCY u Yes o 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) ciYes aNc,
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guldeand 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
Contractor's License Law for the reason(s)indicated below by the California H ea Ith&Safety Code,Section 25505 a nd 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes m No 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 Contractoes State EPA RENOVATION,REPAIR AND PAINTING HHIP)
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 corn pensation for most work that distu rbs paint in a pre�1978
and the basis for the a Ileged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and com ply with
an Applica nt for a permit subjects the applicant to a civil pena Ity of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing workthemselves or through their
pt'as owner of the property,or my employee with wages as theirsole employees.For more information about EPA's Renovation Program visit:
compensation,will do I I all of or I I portion of the work,and the structure is www.epa.goy/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a 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. a No EPA Lead-Safe Certified Firm is required for this project because:
u I,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 RAP rule please fill out the RRP
Acknowledgement.
City of Menifee
Building & Safety Dept.
NOV 0 1 2016
Received
UT MENIFEE
8L IL ING AND SAFETY DEPARTMENT
PLAN PPROVAL
#16
RE AE
-0 NED BY
DATE
—7 -�Ar)pioval )f these plans shai,- 0I ';v Construed to be a permit for,or an
approval o,any violation of any pr v1sions of the federal,state or city
regulation, and ordinances. This set of approved plans must be kept on the
jobsite un—completion.
STATE OF CALIFORNIA-BUSINESS,CONSUMER SERVICES,AND HOUSING EDMUND G.BROWN JR..GOV RNOR
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
Title Search
Date Printed: Oct 31,2016
Decal #: LBJ5776 Use Code: SFD
Manufacturer: FLEETWOOD HOMES CA INC Original Price Code: ATP City ot Menitee
Tradename: CARRIAGE MANOR Rating Year: Building & Safety Dept.
Model: 3403B 2008 Tax Type: LPT NOV 0 1 2016
Manufactured Date: 10/26/2007 Last ILT Amount: Received
Registration Exp: Date ILT Fees Paid:
First Sold On: 11/14/2007 ILT Exemption: NONE
Serial Number HUD Label/ Insignia Length Width
CAFL708A31970CD12 PFS1023260 36' 11'8"
CAFL708B3]970CD]2 PFS1023261 36' 11' 8"
Registered Owner:
VIRGINIA CASILLAS
10626 LILAC RD
HESPERIA,CA 92345
Last Title Date: 06/2612008
Last Reg Card: 06/26/2008
Sale/Transfer Info: Price$72,715.00 Transferred on 11/1412007
Situs Address:
10626 LILAC RD
HESPERIA,CA 92345
Situs County: SAN BERNARDINO
Legal Owner:
21 ST MORTGAGE CORP
PO BOX 477
KNOXVILLE,TN 37901
Lien Perfected On: 12/03/07 10:18:58
***END OF TITLE SEARCH***
Recording Requested V
First ft.6-6carl Title Compar, Lo DOC #2015-0121827
1 03/26/2015 12:06 PM Fees: 1211,00
RECORDING REQUESTED BY: Page I of 2 Doc T Tax Paid
k-'adison-Avenue Escrow Recorded in Official Records
Order No.4832379 County of Riverside
Escrow No.Tm-54og Peter Adana
Parcel No.350-261-029-2 Assessor, County Clerk&Recorder
AUND WHEN RECORDED&LAIL TO:
—This document was electronically submitted
JOSE LUNA to the County of Riverside for record
Receipted by:�SMEZA r�jly ot Menre
P.O. BOX 604 Safety Dept.
VALLEY CENTER, CA 92082
SPACE ABOVE THIS LINE FOR RECORDEFUS USE NOV 0
TYR -00 —h -4�- GRANT DEED
THE UNDERSIGNED GRANTOR(S)DECLARE(S)THAT DOCUMENTARY TRANSFER TAX IS$27.50 and Claeceived
X computed on full value of property conveyed,or
0 computed on full Val-ue less_liens or enc&m�ranccs remaining at the time of sale.
El unincorporated area: --- L& Henifee,and
FOR A VALUABLE CONSIDERATION,receipt of which is hereby acknowledged,Tammie Coronado,a single woman
and Vanessa Coronado,a single woman,as joint tenants
hereby GRANT(S)to Jose Luna a Married Man
the following described real property in the County of Riverside,State of California:
Lot 65 Block"I" Lake Elsinore Lodge Subdivision No.3,as shown by Map on file In Book 13, Page 13
and 14 of Maps,records of Rivemicle County,State of Califonnia
More commonly known as:23740 Norma Drive,Vacant Lan enifee,CA 92587
Date FgtLyary26,2015 ;16'-"9*1,,ifee,CA 9117
Tarrant ad.
rA notary—public or other officer completing this certificate 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 documenL
STATE OF CA
COUNTYOFCnaVM CCS-1z\— IS-S-
On Ma176--, �5 I befbrcrne,'� \' CAOV-'�a' 1-ke-fn-z- k'3t--r'Mr'A P4611 C
personally appeared \40,npssm
C'r)ir tn�n A en who
proved to me on the basis of satisfactory evidence to be the person(4 whose nameor4glue subscribed to the within instrument
and acknowledged to me that heQtbay executed the same in hisA&hew authorized capacity(i9s), and that by lus(ptheff
signamre(�on the instrument the person(A,or the entity upon behalf of which the person(A)acted,executed the instrument-
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and
correeL
A M�ERA
'PCTOR' Z
ission#19 79�5
6"*'�
WITNESS my h�nd and official sea], VOTORIA MERAZ
Commission#1967985
c_C I�
domia z
SiFntura--6�� eJ 0'-- (Seal) Notary Public-Califamia
z Contra Costa county
MVCOmm ExPiresFa1126.2016t
Mail Tax Statement to:SAME AS ABOVE m Additz Noted Below
Tr7 iCD� K-�� T�J -3- -V R-7 jR. L�3, IH:
DEPARTMENT OF
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM
Land Use&Water Resources NOV 0 -12016
Western Riverside County Eastern Riverside Cou
3880 Lemon Street-Suite 200- Riverside-CA-92502 47-950 Arabia Street-Suite A-Indio-PAPpyed
Phone:(951)955-8980 -Fax:(951)955-8988 Phone:(760)863-7570-Fax:(760)863-7013
Property Information: APN: SO- a (0 1 -D ��q- Date of Inspection: 3/4/2015
1. Owner: Address: 23740 Norma Drive — City: Ouail Valley
FAILURE TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT OWNER FROM OBTAINING
ENVIRONMENTAL HEALTH APPROVAL
2. Show design and location on a scale of 1:20 or 1:40 of the sewage disposal system and 100%expansion area in relation to
attached dwellings,structures,wells,rocks.watercourses, etc.
3. a, I examined existing subsurface sewage disposal system at the 4kove location on 3/4/2015 and determined that
the tank capacity is 750 gallons and that there is 150 sq.ft.of leach line bottom area. There are
bedrooms in the dwelling and there are fixture units.
b. There are 1 leach line(s),each 50 ft,long. 12 Rock D Plastic Chamber
d. There are 0 Seepage pit(s),each in.diameter,and ft.TD. ft.BI
a. The leach bed is ft.by ft.,total sq.. .of leached area.
4. a. Construction of septic tank(Please check one of the following): .
M Concrete D Fiberglass 0 Steel D Other.,
b. Internal dimensions of septic: Length 7 ft. Width 4 ft. Depth 5 ft-
c. Condition of tank(please check yes or no for each question): Inlet Tee present? J0 Yes El No
Tank Structure deteriorated? El Yes 0 No Outlet Tee present? 10 Yes El No
Effluent Filter Present? 0 Yes 0 No Two compartments? 0 Yes El No
d. Condition of D-Box: Level? Ll Yes CI No Replaced? 0 Yes El No Septic Effluent? 0 Yes D No
5. a. While pumping the tank,did effluent flow back into tank from absorption system? C3 Yes 12 No
b. Prior to pumping,was the liquid level in the tank above the outlet tee? 0 Yes UJ No
c. Was the area around the lids oxidized? 11 Yes 0 No
d. Is design of system gravity feed? 0 Yes 0 No
e. Were well(s)observed on this or adjacent property? 0 Yes 13 No
If yes,indicate distance of well from: Septic tank ft. Leach lines Seepage Pits fl.
f. Distance from spflngs,lakes,and natural water courses(check all that apply)
13 Septic Tank ft. C3 Leach lines ft. 13 Seepage Pits ft.
g. Is s4wer is within 200 it.of system and abuts property line? 0 Yes M No
Additional Comments: There is no warranty on leach lines or seepage pits.
h. How long has dwelling been vacant?(if applicable) months weeks 0 NIA
6. a. 3 It is my opinion that the system appears to be in good working order and can be expected to function propedy with
proper maintenance. No repairs are necessary at this time.
b. El It is my opinion that the system is not in good working order and will not function properly without the following
repairs:
I certify under penalty of peduiy that the foregoing is true and correct.
Signature: Print Name: Wayne C. Rice Enterprises
Contractor License NcL 583643 ExpitationDate: 1213112015
Pumper Co.: Phone Number 951-538-8283
Address: P.O. Box 642 CitY:Lake Elsinore ZIP: 92530
Rev.10112
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