PMT17-01574 City of Menifee Permit No.: PMT17-01574
29714 HAUN RD.
<ACCEL/� MENIFEE,CA 92586 Type: Mobile Home
MENIFEE Date Issued:
08/01/2017
PERMIT
Site Address: 25195 BUNDY CANYON RD, MENIFEE, Parcel Number: 362-120-006
CA 92584 Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of PERMANENT FOUNDATION ON REPLACEMENT MOBILE HOME, 1325 SF
Work:
Owner Contractor
CORY BOWERS EARTHWISE HOMES&SOLAR
25715 LA ESTRELLA ROAD 34135 CAMERON DRIVE
WILDOMAR, CA 92595 HEMET,CA 92544
Applicant Phone:9517677600
ELLIOTT NISSIM License Number.771362
EARTHWISE HOMES&SOLAR
34135 CAMERON DRIVE
HEMET, CA 92544
Phone: 9518330933
Fee Description Qtv Amount ISI
Manufactured Permanent Foundation 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 constmction 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_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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions Cade and my license is in full force and effect
L the following reason:
License Class a(Q2— Li se No. l� By my signature below I acknowledge that,except for my personal residence
Expires Z (' Signature in which l must have resided for at least one year prior to completion of
Improvements covered by this permit.I cannot legally sell a structure that 1
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 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 Cade,is available upon request when
compensation,Issued by the Director of Industrial Relations as provided for this application is submitted or at the fallowing website:
by Section 3700 of the Labor Cade,for the performance of work for which www.leeinFo.ca.eov/calaw.htm1.
this permit is issued.
Policy N Date
p4 have 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 ❑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 an the property owner's behalf.I have read this
number are: application and the information I have provided is correct 1 agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
PolicyN r2i�_Expires Z g( 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
o I cerflfy 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 If
worker's corn pen .NT.w of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to workers comp nsation provisions of Section 3700 of the Labor
Code,I h Worthwith,co with those provisions. /' / Will the applicant or future building occupant handle hazardous material or
mc� DC ( mixture containing a hazardous material equal to or greater that the
Applican Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes o No
UNLAWFUL,AND SHALL SUBJECF 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 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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY O Yes n 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 wads which this permit is issued outer boundary of a school?
(Section 3097 Civil Cade) o Yes o No
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD
hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the 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(RRPt
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 fora 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
❑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.euv/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. D 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
4 '
,Menifee
DATE LSJ / / PERMIT/PLAN CHECK NUMBER - 0k5
TYPE: O COMMERCIAL 44ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O-PLU'"M'BIING O RE-ROOF-NUMBER OFSQUARES IWFI
DESCRIPTION OF WORK A.J/ -�a��- IIQU Building DE, I
,, MAY 1
////
PROJECTADDRESS 2S-19S BCPAbY �-" AO I a
ASSESSOR'S PARCEL NUMBER Q_3lo�-1W-06)0 LOT TRACT e i " `-+
OWNER NAME .BOLP3C3ZS f
ADDRESS
PHONE arjj EMAIL
APPLICANT NAME QLIOT A tegf
ADDRESS \ 3<431; CA'UG72-0) 'Z)P-
PHONE _�IS"l) 19-;i3-C93.3 �/�� EMAIL f�.CJf�S'(/-QC�G�'F.IQIL.CL�'T
CONTRACTOR'S NAME egmeoS, 15 'C we5- OWNER BUILDER? O YES V`NO
BUSINESS NAME
ADDRESS
PHONE �957� 833-t�33 EMAIL 9WE
CONTRACTOR'S STATE LIC NUMBER 771-3(0L LICENSE CLASSIFICATION
VALUATION$ OEF� QFT ` t .t�� LSQFT GG
APPLICANT'S SIGNATURE DATE 5- i 0- /-7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O 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
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Jv City of Menifee _A
Building Dept 4,
--'�- MAY 19 2017 r
Received
S
CITY OF MENIFEE fi / Q�Qy
BUILDING AND SAFETY DEPARIE
PLAN APPROVAL r>�1
REVIEWED BY�
DATE
"Approval of these plans shall not be construed to be a permit for,or an
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans mug#.l�}it ,t�4v.^K pfuPUk't� t�
jobsite until completion. Sio' a- NpiASC.
4 i 325 Sg Fy y6 d 2kx,4s.
W
E54. PGYer
STATE OF CALIFORNIA .NUMBER.BUSINESS;CONSUMERSERVICES AND HOUSING AGENCY
.
DEPARTMENT F HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
MANUFACTURED HOUSING PROGRAM
MANUFACTURER CERTIFICATE OF ORIGIN
❑ CHECK IF THIS IS DUPLICATE MCO-ENTER ORIGINAL MCO NO.
IM(ympurACTURED HOME OR MULTIFAMILY MANUFACTURED HOME NUMBER OF
SFD(SINGLE FAMILY DWELLING) ❑ MFMH.(MULTIFAMILY MANUFACTURED HOME) TRANSPORTABLE SECTIONS 2 .
COMMERCIAL MODULAR:
OCCUPANCY GROUP
MANUFACTURER NAME: MANUFACTURER LICENSE NUMBER:
SKYLINE HOMES, INC. 90002
MANUFACTURER ADDRESS: SUGGESTED RETAIL PRICE:
499 W. ESPLANADE SAN JACINTO CA 92583
(Street) (City) (State) (ZIP) $91,151.00
MANUFACTURER TRADE NAME 2018 YEAR MODEL MODEL NAME AND/OR NUMBER: - DATE OF MANUFACTURE '
AMBER COVE AME. COVE K638—CT 07/28/17
NAME OF DEALER OR TRANSFEREE(OWNERSHIP TRANSFERRED TO): CALIFORNIA DEALER NUMBER OR DATE OF•TRANSFERT
ELH, INC. TRANSFEREE DESIGNATION: 08/01/17
EASY LIVING HOMES 1180181
DEALER OR TRANSFEREE ADDRESS:
(Street)34135 CAMERON DR. HEMET(City,) CA (st2te)92544 (zip)
INVENTORY CREDITOR NAME:
N/A
INVENTORY CREDITOR ADDRESS
(Street)N/A
(City) (Slate) (Z,p)
s�TTON 'MAIUgG; UE13 SERIAL NUMBER HCD'INSIGNI9 OR HUD-LABEL NUMBER LENGni W(opi , wtEt�tlT
1 6771-0169—K—B PPS 1188962 672 142 18,135
2 6771-0169—K—A PPS 1188963 672 142 19,305
TRANSPORTER NAME
TRANSPORTERADDRESS:
(Street) (City) (Stale) (Sp)
DESTINATION FOR UNIT DESCRIBED ABOVE
NAME Street G Slalo
I certify under penalty of perjury under the laws of the State or California that the above facts are We and correct
Executed on 08/01/17 et SAN JACINTO RIVERSIDE CA
(Dale) (County) (Slate)
DANN STARK, DIVISION MANAGER
SIGNATURE OF AUTHOR RED AGENT:
DISTRIauTION: ORIGINAL(PINK) FORWARD TO THE INVENTORY CREDITOR UNLESS THERE IS NONE,THEN FORWARD TO THE PURCHASER(DEALER OR TRANSFEREE).
COPY I(WHITE) FORWARD TO THE DEPARTMENT AT P.O.BOX 1828,SACRAMENTO.CA 95 612-18 2 8.WITHIN FIVE(5)DAYS OF RELEASE
COPY 2(YELLOW) DELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNITTO ITS DESTINATION.
COPY 3(GOLDENROD) TO BE RETAINED BY THE MANUFACTURER
HCD 483.0-Side 1(Rev.07115)