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PMT17-00098 City of Menifee Permit No.: PMT17-00098 29714 HAUN RD. �A-CCEL/> MENIFEE,CA 92586 Type: Mobile Home MENIFEE Date Issued: 01/17/2017 PERMIT She Address: 25468 KUFFEL RD, MENIFEE, CA 92585 Parcel Number: 330-19D-024 Construction Cost: $10,000.00 Existing Use: Proposed Use: Description of SITE PREP FOR 2ND UNIT Work: Owner Contractor ROBERT SIPES LANK ENTERPRISES INC 25468 KUFFEL ROAD P O BOX 891416 MENIFEE, CA 92585 TEMECULA, CA 92589 Applicant Phone:9516767114 CARLY ROZZO License Number:458947 LANIK ENTERPRISES INC P0 BOX 891416 TEMECULA. CA 92589 Fee Description OQt t Amount 1$1 Manufactured Residential Site Prep 1 196.00 Permit Fee 1 27.00 $223.00 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_Templale.rpl Page 1 of 1 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 contractor(s)pursuant to the Contactors State License Law). Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Lawfor Professions Code and my license is in full force and effect. the following reason: License Class s�� 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 contactors.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 www.leginfo.ca.gcy/calaw.html.permit is issued. Policy# Date cave 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 workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: C application and the information I have provided is correct.I agree to comply Carrier d I/ I hrCA 1)< - L(/L with all applicable city and county ordinances and state laws relating to yA —� building construction.I authorize representatives ofthiscity orcountyto Policy#LLWCE. Expires I_ '.1 D enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT D 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# workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 370D of the Labor Code,I shall fo with amply those provisions. —f (( Will the applicant or future building occupant handle hazardous material or a Applicant Date _I l�1� mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE T tEW K MPENSATION COVERAGE IS o Yes o No UNLAWFUL,AND SHALL SUBJECT A PLOYER 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 o Yes D 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) o Yes o 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 Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning 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 IRRP) 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 Cade)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 ❑1,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.eramov/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 ❑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. ❑No EPA Lead-Safe Certified Firm is required for this project because: o I,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. i & SAFETY PERM IT/PLAN CHECK APPLICATION �Wen'fee DATE I- -1 PERMIT/PLAN CHECK NUMBER TYPE: ❑COMMERCIAL Q RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW [-]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES City of J Ing & Safety D Pt. DESCRIPTION OF WORK TC- /yam 1 7 .2ol7 PROJECTADDRESS J 7 2� g/1 + p T—��Y``-"� 01Q ASSESSOR'S PARCEL NUMBER 3 3 G -( I D — Vim—y LOT TRACT PROPERTY OWNER'S NAME 06L + _/ ADDRESS �' � '� 1 9 d / L(/�ll'/� VI PHONE EMAIL APPLICANT NAME �Gt7))✓\� I / (,, ADDRESS ` _YI�� 7 '` 'MC PHONE q�j lD EoMAIL v t r,�C ( rav-1 CONTRACTOR'S NAME InIVi -yl S OWNERBUILDER? ❑YES210 1 i BUSINESS NAME ADDRESS T V oX/ l.� e PHONE EMAIL v�CONTRACTOR'S STATE LII(C NUMBER L'�� ` `(� LICENSE CLASSIFICATION v-' VALUATION$ (D (J D(J SO FT �� L SO.FT APPLICANT'S SIGNATURE -� DATE _ l -7 — I ,! - DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN y`' SMIP INVOICE AMOUNT - PAID AMOUNTlama O CASH O CHECK# :)CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC OWNER BUILDERVERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinemfee.us Inspection Request Line 951-246-6213 RECORDING REQUESTED BY DOC # 2012-0522300 Stephen A.Bowers,Esq. 10/31/2012 02:51P Fee:15.00 5757 W Century Blvd Page 1 of t Recorded in official Records Suite 700 County of Riverside Los Angeles CA 90045 Larry N. Yard ANDMAI AXST STATEMENTS �IIIIIIII�I��l��11�11111111IN111�11111111111111111h soy T Robert G.Sipes and Cheryl Coy as Co-Trustees of S R U PAGE SIZE I DA I MISC I LONG RFD I COPY 1 Sipes and Coy Trust PO Box 681 AIN Menifee CA 92586 M A I L 465 426 rPZI NCOR SMF 124EXM APN NO.330190024-2 T: CTY UNI QUITCLAIM DEED THE UNDERSIGNED GRANTORS DECLARE THAT THE DOCUMENTARY TRANSFER TAX IS$0.00,CITY TAX$ This conveyance transfers the Grantors'interest into a Living Trost,R&T 11930. computed on the full value of the interest or property conveyed,or is _computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale. Unincorporated area: City of Romoland.County of Riverside and State of California FOR A VALUABLE CONSIDERATION,receipt of which is hereby acknowledged, Robert Sines and Cheryl Cav as husband and wife City of Menifee Building & Safety Dept. hereby REMISES,RELEASES AND FOREVER QUITCLAIMS to JAN 17 .2017 Robert G.Sines and Cheryl Coy as Co-Trustees of Sines and Coy Trust, • the following described real property in the City of Romoland.County of Riverside.State of California, Received Parcel No.3 and Lettered Lots"I"and"C",as shown on Parcel Mao No.12994,on Me in Book 97,Paee 50 of Parcel Maps,Records of Riverside County,California. Also known as: 25468 Kuffel Road Romoland CA 92585 p --�— Dated:e_day of '�Sprt-Inbf.P l a— Signed: o�ieJyC Robert Sin Signed: Cheryl Coy STATE OF CALIFORNIA ) )ss. COUNTY pOFGRIVERSIDE ) On I` 0 Ott/ before me, ,17�A�.'1'!�N ,Notary Public, personally appeared 0 T $f ES itN D CND eAY who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s)Ware subscribed to the within instrument, and acknowledged to me that)WEik Wthey executed the same in Xs/hdr/their authorized capacity(ies), and that by ~r/their signature(s)on the instrument the person(s),or the entity upon behalf of which the person(s)acted,executed the instrument. I certify under penalty of perjury under the laws of the State of California that the foregoing paragraph is true and correct. W ITNES y h d and oflici seal. d0HN HART—.. comrnission 0 1905966 19,�, Notary Public-California Signature (Seal) OWWq14 Orange County Comm.Ex res Seg 30.2014 MAIL TAX STATEMENTS AS DIRECTED ABOVE i �—¢- 549020 , .�n. lb O eY: n GYOIt:i UN ITLE COMPANY Mnnw119at 17-00 AND WHEN RECORDED,MA1L TO: 519o9 RECEIVED FOR RECORD —=s AT&,OOW aCLOCK CHERYL CAY DE I 8 - 25m KUFFEL ROAD ROMOLAND. CA 92585 PAID of °cam.aMbm s DOG.lrSH6119l 1dk Recorder RN,Co. Recorder Fees$ rN19 BPACE fOn eE('gpeErrB UBE Ole.Y GRANT DEED aer �; /✓�L 08901 ASSESSOR'S PARCEL NO.: 330-19"2A underst ed Grerdar(s)deelare that the DOCUMENT TRANSFER TA1(ist Tm.E oRDER No.:-R171929.2 S 128.70 my $ City ESCROW No.: 8383.8 _ uted on the(till value of the Interest of properly conveyed, or _ computed on the full value less the value of lions or encumbrances remaining thereon at the time of sale. V , OR transfer Is EXEMPT from tax for the following reason: FOR A VALUABLE CONSIDERATION, mcelpt of which Is hereby acknowledpd, DANIEL L, GREGORIO and AMADA GREGORIO, Husband and Wife rJ hereby GRANT(S)to CHERYL CAY, a merrtad woman, as her sole and separate property all that real property situated in the County of Riverside, State of Califomie, described as: PARCEL NO.3 AND LETTERED LOTS or AND"C',as shown an PARCEL MAP NO. 12984;on file In Book 87 page 60 of Parcel V" Maps, Records of Riverside County, Callforris. Ij Dated October 27, 1998 STATE OF CALIF RNIA, COUNTY OFt rtl k �{ti LPL - ON 11. tv• 9 Deters me auutll ew DANIEL L.GREGORIO ` Nafary Public. Personab appeared A • ada -s-�.l e. �K AMADA GREGORIO immv (or pared me on th basis 01 ealefeclary eridance) to be the pereonts)whose name(s oubscilbed to the within tesbmn O end edomiedged b me that b0shel" executed the serrr a in 131"Itbatr a Morized capacity(les), and fret by plelhorMe slgnabse(s) on tfe i nshnsnent the persah(s), or the entity upon behalf of which the Person(s)ailed, executed ELPJkK (WAU(En the InsWment. Cow#1053923 WITNESS mY hand and otAclal seal. a Notary Ph arOhra 24 pnrEt"7sOf MCOU CWMy Sigtnatae (� If fp.Cerrhm GySaAPR6.1999 MAIL TAX STATEMENTS TO: (na area for official notary seal) enunr Aran CA 09AM rant I CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT t` r State of ,< t County of On h before me, ��, OAIE NAVE.TNLE OF OFFICER•EG.'JANE UOE NOTARY PUBLIC- personally appeared CC?'C[ ( .[ t i z cif Sj_' F.ISI OF R(SI ❑ personally known tome OR proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/800%executed the same In hls/t#r*iir autherized I" capacity(ies), and that by his/hyitor signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. IZAM WAU(FR 0;�.7� COWA.#IMM3 WITNESS my hand and official seal Notory Plbtic -COMOW0 MYIMM IDECOUNN F�pIMAPR8.1999 SIGNATURE OF NOTARY OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and cn+ild prevent fraudWenl wellachnwnt of ibis form. CAPACITY CLAIMED BY SIGNED DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER — -- .. Tm E OR TYPE OF DOCUMEW TIILEISI ❑ LIMITED PARTNER(S) ❑ GENERAL PARTNER(S) NUMBER OF PAGES ❑ ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIANICONSERVATOR DATE OF DOCUMENT ❑ OTHER: