PMT17-01046 City of Menifee Permit No.: PMT17-01046
29714 HAUN RD. Type: Mobile Home
�!-�CCEL/�> MENIFEE, CA 92586
MENIFEE Date Issued:
04/11/2017
PERMIT
Site Address: 26139 MCLAUGHLIN RD, MENIFEE, CA Parcel Number: 331-040-057
92586 Construction Cost: $6,000.00
Existing Use: Proposed Use:
Description of INSTALL OF REPLACEMENT MOBILE HOME, 1778 SF
Work: SERIAL#: 17600FHA100816A HUD#: NTA1749880
SERIALM 17600FHA100816B HUD#: NTA1749881
Owner Contractor
KELLEY&JEREMY PEBLEY TERRA FIRMA CONSTRUCTION INC
26139 MCLAUGHLIN ROAD 913 MAPES ROAD
MENIFEE,CA 92586 PERRIS, CA 92570
Applicant Phone:9517575731
BRUCE EVANS License Number:796315
TERRA FIRMA CONSTRUCTION INC
913 MAPES ROAD
PERRIS, CA 92570
Fee Description Qyt Amount fbl
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.
AA_Bldg_Pennil 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 ❑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:
License Class CA/ U ense No. 1`� By my signature below I acknowledge that,except far m g p y 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
D 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
by Section 3700 of the Labor Code,for the performance of work for which this application is submitted or at the following website:
this permit is issued. www.leginfo-ca-goy/calaw.hurni.
Policy# Date
�aveand maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,forthe 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 i�squ�ed.My workers compensation t suranc r�rier,�n�policy owner or authorized to act on the property owners behalf.I have read this
number are:C/`� N� 1C_�t�Q(�r-'7'"7 application and the information I have provided is correct.I agree to comply
CarrlRr D �/� ,S "/ L7�� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#� Expires_ I �__ enterthe above identified property for Inspection purposes.
(This section need not to he completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
1 shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It
workers compensation laws of California,and agree that if I should become
subject to the workers compensation provisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION
Code,I shad ) 'h coo=pl Nth ovisions. q� Will the applicant or future building occupant handle hazardous material or a
Applicant Date_ !�yH 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 Oyes ONO
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building
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
forgutdelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑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) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 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
checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to DYes ❑No
construct,after,improve,demolish or repair any structure,prior to its Date
Issuance,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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with
than($500). required practices.This includes rental property owners and property
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.eoa.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 ❑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
completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.:
not built or improved for the purpose of sale. D No EPA Lead-Safe Certified Firm is required for this project because:
0 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.
PERMIT/PLANBUILDING & SAFETY APPLICATION
Menifee
DATE Ay- PERMIT/PLAN CHECK NUMBER 1'010
TYPE: O COMMERCIAL �e RESIDENTIAL C MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION C DEMOLITION O ELECTRICAL O MECHANICAL
C NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK (, &t f-
S/ {�'j"(,0•/�-J
PROJECTADDRESS Lb 3 ! Mc- Lnnu w
ASSESSOR'S PARCEL NUMBER 33 ^ 6 'V-'fls} LOT TRACT , City of Meni}De
OWNER NAME SZ(_ A" 7 APR
ADDRESS 2,6 f 3 MC &W` O-91-I "A-2 �J�l
PHONE jJ1 - 41 36 d EMAIL
APPLICANT NAME ,ice a_ J Cd-
ADDRESS 13 WItT
PHONE 17S(r a-SF S�/'_72 EMAIL
CONTRACTOR'S NAME �(p./J OWNER BUILDER? OYES C,Ie--
BUSINESS NAME
ADDRESS I crS dW S r 9�}�
PHONE QSt— �S '}---,5 EMAIL L�
CONTRACTOR'S STATE LIC NUMBER 63( LICENSE CLASSIFICATION G -(
VALUATION$ b 60 O � SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
7 _
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ^ PA OCASH
IDAMOUNT O� O
AMOUNT 1a CHECK# OCREDITrdRD V6A/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLETTER O YES 0 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 CAL!FORNIA NUMBER:
BUSINESS,CONSUMER SERVICES AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT 6 L J U N
DIVISION OF CODES AND STANDARDS
MANUFACTURED HOUSING PROGRAM
MANUFACTURER CERTIFICATE OF ORIGIN Clty of M ety D
Y.
CHECK IF THIS IS A DUPLICATE MCO-ENTER ORIGINAL MOD NO,
MANUFACTURED HOME OR MULTIFAMILY MANUFACTURED HOME NUMBER OF
y
)[l SFD(SINGLE FAMILY DWELLING) ❑ MFMH(MULTIFAMILY MANUFACTURED HOME) TRANSPORTABLE SECTIONS`
COMMERCIAL MODULAR: Received
OCCUPANCY GROUP Y Y�i(�J
MANUFACTURER NAME MANUFACTURER LICENSE NUMBER:
MANUFACTURER ADDRESS SUGGES I-ED RETAIL PRICE:
:_?9
(SIMI) (City) istalel (Zip)
MANUFACTURER TRADE NAME: MODEL NAME ANDIOR NUMBER: DATE OF MANUFACTURE:
li y"r-.n- - nRADFORD
NAME OF DEALER OI:TRANSFEREE(OWNERSHIP TRANSFERRED TO) CALIFORNIA DEALER NUMBER OR DATE OF TRANSFER:
. tijl „ .._ _ _ TRANSFgtFA DESIGNATION:
DEALER OR TRANSFEREE ADDRESS
Scent %!:iu C' _ O
INVENTORY CREDITOR NAME
IN�EIKT{iR GP.EDU(IR.AL1f11RE� _ _
(Stra�q fCi:r) I�I,ncl (pip)
QttO" MANUFACTURER SERIAL NUMBER HCO INSIGNIA OR HUD LABEL NUMBER F "" Y11DM wE'HT
I t'__ Ia1Lli6EtpOUwSI
-: 14-A 1008161-'`.
TRtJ SROR MA NAME'
TRANSWRTER ADDRESS
isvee') :41iI ISI.w) (LP)
DESTINATION FOR UNIT DESCRIBED ABOVE:
JURFAY ,? KFi I-F PF-A- i r• .. I' ;4A
INANE IsveM .Gr= IS'atul ZT
1 certify=IerpeeaRY of p.YJury under the laws of the Stets of Cw,f mla twi me above fans aro van ar. Cez. t
E.ma
(Cowry) (Sum) _—
IDere!
!G�
SIGNATURE OF AIANC)R12EDAGENT.
pISTRIBIlTION: ORIGINAL(PINK) FORWARD'1VTNEIN%eNTORY CREDITOR,VNIPSS THERE IS NONE.THEN FORWARD TO THE PURCHASER(DEALER OR TRANSFEREE)
COPY I(WHIM) rORWARDTOTHF DEPARTMENT AT P.O.BOX IM,SACRAMSNTO.CA M12-UM.WITHIN FIVE(S)DAYSOF RELEASE..
COPY 2IYELLOW) OELNER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS BES TINATION
COPY3(0000ENRO0) TO BE RETAINED BY THE EUNUFACTUREFL
HCD483.0-81de 1(Rev.07115)
City of Menifee
Building & Safety DeFa.
APR 1 i 20V
Received
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DOC # 2010-0242878
f 05/26/2010 96:00A Fee:28.00
Page l of 2 Doc T Tex Paid
RECORDING REQUESTED BY: Recorded in Official Records
Wastem ResatucaoTeb County of Riverside
Larry N. uard
AND WHEN RECORDED MAIL TO:
Mr.a dMrs.JeemyPebley. I IIIBIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIililll
26139 McLaughlin Road
Sun City,CA 92586
S R U PAGE SrZE DA WSC LONG RFD COPY
M A L 465 426 CDR SMF ICHG aaM
Tlae Order No.: 28969 T: CTY UNI D2\O
TRAIN 026-199 GRANT DEED
THE UNDERSIGNED GRANTOR(S)DECLARE(S)
DOCUMENTARY TRANSFER TAX 16$148,50 /'\
(X]computed on full value of property conveyed,or Cr
[ (computed on full value less value of liens or encumbrances remaining at time of sale. Q26
j c [XJ City of Menifee AND
FOR A VALUABLE CONSIDERATION,receipt of which is hereby acknowledged,
Charles A.Bent and Carrie A.Bent,Husband and Wife as Community Property
hereby GRANT(s)to:
Kelley Pebley and Jeremy Pebley, Wife and Husband as Commanity Property with
Right of Survivorship
the real property in the City of Menifee,County of Riverside,State of California,described as:
Parcel 3,as shown by Parcel Map 13223,on file in Book 75,page 81,of Parcel Maps,Records of Riverside
County,California
Also Known as: 26139 McLaughlin Road,Sun City,CA 92586
AP#:331-040-057-5
DATED March 71,2010 AA
STATE OF RNfA / K • y�0"/V
COU TY OF Ch s A Bent
On -
Befo ,4
A N�.y a Pub��ic m it d!tw� tui peraorWly aPPaared me A.Bent
AV e.A
� llyy 1 PW _
who proved to me on Iha m�kPs of saltlfaciory Midencl,to be the,
Pemon(s)whose names)Isprgsubs th tha within Iltatrument
and a lodged W me IdRrdd helsne esawletl the same NM A-MILLER
his/Mr art authorized rapacay(ias), and that by hlsme at Cornmbdon 1 1732311
aignatum s) on the instrument the pamon(s), or the entity upon . Notary Public•California
behalf of which the Person(s)acted,executed me Instrument. Riverside County
I certify under PENALTY OF PERJURY under the Iw.s of the State Nor29,2e11
of Celdmnla that the foregoing paragraph Is true and wrract.
WITNESS my ham
and
doofficial seal
Signatur.c (This area for official notarial seal)
MAIL TAX STATEMENTS TO PARTY SHOWN B LOW;IF NO PARTY SHOWN,MAIL AS DIRECTED ABOVE:
RIVERSIDE,CA Document:DD 2010.242878 Pa-le:l of 2
Printed on:4/82016 9:26 PM
Branch:NCS User:RADE
X
EXHIBIT "A"
LEGAL DESCRIPTION
Real property in the City of Menifee,County of Riverside,State of California,described as
follows:
PARCEL 3,AS SNOWN By PARCEL MAP 13223,ON FILE IN BOOK 75 PAGE 81,OF
PARCEL MAPS,RECORDS OF RIVERSIDE COUNTY,CALIFORNIA.
APN:331-040-057-5
RIVERSIDE.CA DocumenttDD2010.242878 Paget oft
Printed um9/8/2016 9:261'M
" Ma " Williams
since 1969 1" a Y1 (�j
April 10, 2017
To Whom It May Concern:
"Ma" Williams Manufactured Homes authorizes the placement of a 2017, Silvercrest
Home, Serial# 176-OOF-H-Al00816A& 176-OOF-H-A10081613, HUD#NTA 1749880
(A)&NTA 1749881 (B),home to be placed on a permanent foundation at the address
below:
26139 McLaughlin Rd.
Menifee, CA 92585
APN#331-040-057-5
This is for customer Kelley Pebley and Jeremy Pebley and is to be financed.
If you have any other questions please feel free to call me at(951)791-9883.
Regards,
At
Claudia Saunders
"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 011.52.651.61: .1091
ti
ALL PURPOSE ACKNOWLEDGMENT
A notary public officer 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 document
State of California )SS
County of )SS
On -A O , t IL 20l"I before me,J f Jje ,jef-` LQCCXAst tQeAk'
/ (here n name and title off the officer)
personally appeared, l '1c u�,� y�� I -� A Ard z.t
o roved to me on the basis of satisfactory evidence to be the person whose name
is( e subscribed to the within instrument and acknowledged to me that kte/Fhe/tt)�y exe uteri
the same in Ws/ er ly�ir authorized capacity(*j, and that byks/fermi/oir signature) on the
instrument the person(p3, or the entity upon behalf of which the person(sl 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 HAYOEN WOODS
Signature
`'� "� Commission#2062108
lip
: Notary Pubiie•CalNornia z
z Riverside County
M Comm.Aires Mar 23.2018
- - - - - - - - - - - - -
(SEAL)