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PMT17-00372 City of Menifee Permit No.: PMT17-00372 29714 HAUN RD. Type: Mobile Home �A>CCEL/-> MENIFEE,CA 92586 MENIFEE Date Issued: 0 311 4/2 01 7 PERMIT Site Address: 31292 BRADLEY RD, MENIFEE, CA Parcel Number: 360-220-003 92584 Construction Cost: $150,000.00 Existing Use: Proposed Use: Description of INSTALL FOR INSTALLATION OF NEW MOBILE HOME 2,146 SQ FT Work: SERIAL#FLE220CA17-37218A, FLE220CA17-37218B, FLE220CA17-37218C Owner Contractor ROBERT PULIDO AGENT 33080 MAGNOLIA ST 31548 ELECTRIC AVE LAKE ELSINORE, CA 92530 NUEVO, CA 92567 Applicant Phone: 9514423238 DON LETEY License Number: 17-PEOP-00005 31548 ELECTRIC AVE NUEVO,CA 92567 Phone:9514423238 Fee Description q Amount I$ Manufactured Install 1 240.72 Permit Fee 1 27.00 _ Plan Check Fee 51 51.25 $318.97 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 slated,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_Sldg_Permit Template.rpt 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 Contractors State License law). Chapter9(commencing with section 7000)of Division 3 of the Business and 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: 2%f, 4 AW?A 17Y d(�D AAA-&/L08e License Class License No. '+5 e1Z'M&9W ArE I DEWC—E 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 WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by ❑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 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.le i f .ca calaw.html. this permit is issued. PolicyR 64TA Date Z g 1 7 D I have and will maintain workers compensation insurance,as required by PROPEROWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which A 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 constmct)on.1 authorize representatives of this city or county to Policyp Expires enter the ove-9e ifled property for inspection purposes.(This section need not to be completed is the permit is for one-hundred Date 8 I /-7 dollars($100)or less PROPERTY O%Frkil OR il THORIZED AGENT o 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 q 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,1 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 o Yes POO UNLAWFUL,AND SHALL SUBIECFAN 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[DST 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 forguidelines CONSTRUCTION LENDING AGENCY o Yes /g(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) yf.Yes o No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the California Health afety ode, Contractors License Law for the reason(s)indicated below by the &S Section 25505 and 25534 concerning hazardous mate- r o checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Business and Professions Code).Any city or county that requires a permit to .Wes 0No PROPERTY OVItER B l7 construct,alter,improve,demolish or repair any structure,prior to its Date ! ER AUORIZED 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 D 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 Contractors State License Law does not apply to an owner of a D 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 pmject because: ❑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. BUILDING • SAFETY PERMIT/PLAN • • ♦ APPLICATION I I 4j• 3: Wenifee ( DATE PERMIT/PLAN CHECK NUMBER TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY MOBILE HOME 0 POOL/SPA --I SIGN SUBTYPE: O ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL 0 MECHANICAL O NEW O PfL/UM�}B-SING O RE-ROOF-NUMBER OF SQUARES''` Q DESCRIPTION OF WORK /(I SfA/1 A 1//1'OK Of II4 ''AW O 16/FA C 1V VG GC . 9'W � .trne/II/rIi pvyc+rl ll�y PROJECT ADDRESS ASSESSOR'S PARCEL NUMBER 3b 0 ^Z H2O^O/O 6 LOT TRACT OWNER NAME y 1p PeIll do ADDRESSj 'b 0 �0 /C/1UO��✓G �(;t- 9J, 3 t� PHONE �'j )' S^S I �J'J Z{ EMAIL /'/Ow"s J11wk,90, e0w APPLICANT NAME A,J L E 1 Y ADDRESS 315," EGEr-TnI c '4VC I/Edv M 9z54-/7 PHONE (QS"'/ g¢Z-3Z38 EMAIL Oh Je-bt ® 4JI010.Cosi CONTRACTOR'S NAME OWNER BUILDER? .'YES 0 NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ (SO oco I , U/5q FT 214-Io L SQ FT 104 630 APPLICANT'S SIGNATURE DATE 277 17 DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE ^'�y PAID AMOUNT r AMOUNT II (/ 0 CASH C CHECKq v CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH ^CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES ;% NO City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 STATE OF CALIFORNIA NUMBER: _ BUSINESS.CONSUMER SERVICES AND HOUSING.AGENCY DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT DIVISION OF CODES AND STANDARDS MANUFACTURED HOUSING PROGRAM MANUFACTURER CERTIFICATE OF ORIGIN CHECK IF THIS IS A DUPLICATE MCO•ENTER ORIGINAL MCO NO MANUFACTURED HOME OR MULTIFAMILY MANUFACTURED HOME NUMBER OF 3 )E n I SFD(SINGLE FAMILY DWELLING) [IMFMH(MULTIFAMILY MANUFACTURED HOME) TRANSPORTABLE SECTIONS COMMERCIAL MODULAR' OCCUPANCY GROUP MANUFACTURER NAME. MANUFACTURER LICENSE NUMBER: Fleetwood Homes, Inc. MF 1200755 MANUFACTURER ADDRESS. SUGGESTED RETAIL PRICE. l?(QQ7 Jurupa Ave. ,,,)Riverside Istate) CA (7jD)92504 MANUFACTURER TRADE NAME: MODEL NAME ANDIOR NUMBER DATE OF MANUFACTURE. Vogue II 2202V40564K 02/28/2017 NAME OF DEALER OR TRANSFEREE(OWNERSHIP TRANSFERRED TO) CALIFORNIA DEALER NUMBER OR DATE OF TRANSFER' TRANSFEREE DESIGNATION' D3/04/2D17 LAKE PERRIS REALTY DL1266703 DEALER OR TRANSFEREE ADDRESS: �qq9p3g5 RED MAPLE LANE,SUITE 106 T(�IORENO VALLEY CA 92551 (y(tpTyrj (CRy7" (State) lip) INVENTORY CREDITOR NAME. COD INVENTORY CREDITOR ADDRESS. (Street) (City) (State) (zip) SECTION MANUFACTURER SERIAL NUMBER HCD INSIGNIA OR HUD LABEL NUMBER LENGTH WIDTH WEIGHT 11A1 INCHES) INCHES )POUrvCD'• 1 FLE220CAl 7-3721$A PFS1181742 652 162 31,100 2 FLE220CA17-37218E PFS1181743 676 160 30,700 3 FLE220CA17-37218C PFS1181744 654 162 28,750 TPANSPORTER NAME' Quality Home Transport TRANSPp�R�TER ADDRESS: Hemet CA 92545 2750 W.Acacia tSlreeU (01y) (Stale) 0p) DESTINATION FOR UNIT DESCRIBED ABOVE. (NAME) ISIMM 101 (Slant /S ) I certify under penalty of perjury under the laws of the Slate of California that the aoove facts are true and conect. ��1e4�P 03/04/2017 a1 Riverside Riverside CA (Date) (city) (Covnlq) IState! SIGNATURE OF AUTHORIZED AGENT' DISTRIBUTION: ORIGINAL(PINK) FORWARD TO THE INVENTORY CREDITOR.UNLESS THERE IS NONE.THEN FORWARD TO THE PURCHASER(DEALER OR TRANSFEREE). COPY 1 I WHITE) FORWARD TO THE DEPARTMENT AT P.O.BOX 1828.SACRAMENTO.CA 95812.1828.WITHIN FIVE(5)DAYS OF RELEASE. COPY 2(YELLOW) DELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS DESTINATION. COPY 3(GOLDENRODI TO BE RETAINED BY THE MANUFACTURER HCD 483.0.Side 1(Rev.07115) THIS SPACE FOR RECORDER USE ONLY STATE OF CALIFORNIA BUSINESS,TRANSPORTATION AND HOUSING AGENCY GDEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT DIVISION OF CODES AND STANDARDS MANUFACTURED HOUSING PROGRAM RECORDING REQUESTED BY: WHEN RECORDED MAIL TO: NAME Roberto Pulido ADDRESS 31292 Bradley Rd. CITY,STATE,ZIP CODE Menifee Riverside CA 92584 ONLY THE ENFORCEMENT AGENCY MAY RECORD THIS DOCUMENT NOTICE OF MANUFACTURED HOME, MOBILEHOME OR COMMERCIAL MODULAR — INSTALLATION ON A FOUNDATION SYSTEM Recording of this document by the enforcement agency indicates compliance with California Health and Safety Code Section 18551(a). This document is evidence that the enforcement agency has Inspected the installation and issued a Certificate of Occupancy,form HCD 513C,for the unit described herein,upon the real property described with certainty below, as of the date of recording. When recorded, this document shall be indexed by the county recorder to the named owner of the real property and shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real property. ALL INFORMATION BELOW MUST BE ENTERED BY THE ENFORCEMENT AGENCY PROPERTY INFORMATON ENFORCEMENT AGENCY INFORMATION Roberto Pulido City of Menifee REAL PROPERTY OWNER NAME(S) ENFORCEMENT AGENCY ISSUING PEW eat CERTIFICATE OF OCCUPANCY 31292 Bradley Rd. 29714 Haun Rd. MAILINGADDRESS MUNGADDRESS Menifee Riverside CA 92584 Menifee Riverside CA 92586 CRY COUNTY STATE DP CODE CRY COUNTY STATE LP CODE SAME PMT17-00371 95) 672-6777 INSTALLATION ADDRESS(if dlBerart) BUILDINGPERMTNO. TELEPHONENUMBER (]I EVIDENCE OF UNIT LIENHOLDER(S)RELEASE,OR CONSENT TO INSTALLATION CRY COUNTY STATE ZIPCODE PROVIDEDIATTACHED—SEE REVERSE SIGNATURE OF ENFORCEMENT AGENCY OFFICIAL DATE OWNER INFORMATION DEALER INFORMATION SAME Lake Perris Realty UNITOWNER(II ako property--.wde'SANET DEALER RARE Of note dealer sale,wb TIONET DL1266703 MAIUNGADDRESS DEALERUCENSENUMBER 25025 Red Maple Lane, Suite 106 CRY COUNTY STATE MPCODE DEALER BUSINESS ADDRESS Moreno Valley Riverside CA 92551 CITY COUNTY STATE ZIP CODE MANUFACTURED HOME/MOBILEHOMEICOMMERCIAL MODULAR UNIT DESCRIPTION Fleetwood Homes, Inc. Vogue II/2202V40564K 02/28/2017 MANUFACTURER'S NAME MDUEL NAAFI NUMBER MCNUFACTURE DATE FLE220CAl7-3721 BA/B/C SERIALNUMER(S) 56'x 40' PFS1181742 /43/44 LENGTHXWIDTH CA INSIGNWSAUD LABEL NUMBER(S) 360-220-003 8818490 ASSESSORSPARCELNUMBER HCD REGISTRATION DECAL NUNEER WONUMBER(New Mtonly) REAL PROPERTY LEGAL DESCRIPTION Pareel;3 of Pa�eel Map Pic. 6450, in the eity of Menifee, Gaunty of Riverside, State of Balifbirnia, as shown by Pareel Map 01 file in Rook 19 Page 21 of Parcel Maps Riverside County California DISTRIBUTION—Original to COUnly Recorder,One Copy to HCD;One Copy to Appliranl;One Copy to EMorcement Agency HCD 433A(Rev. 10/2011) GENERAL GUIDE AND INSTRUCTIONS ON REVERSE