PMT17-01575 City of Menifee Permit No.: PMT17-01575
29714 HAUN RD.
�!-1CCEL/-> 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
CA92584 Construction Cost: $1,000.00
Existing Use: Proposed Use:
Description of INSTALL FOR 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($1
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 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,orwhere the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg Pernit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I 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:
License Class 3(C2- U se No. V By my signature below l acknowledge that,except for my personal residence
Expires Z ro 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
❑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.leeinfo.ca.zav/calaw.html.
this permit is issued.
Policy# Date
PA have and will maintain workers 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 insurence 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
Carrier C�v`-' with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 2a�-p_Expires rZ QJ( 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 certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compen5at4orlailIrspf California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to workers comp nation provisions of Section 3700 of the LabaJJJJ
Code,I orthwith co with those provisions. I Will the applicant or future building occupant handle hazardous material or a
Applican Date m& &< < 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 D Yes o 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 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 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) 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
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 ciYes ❑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(RRPI
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 70315 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
o 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.eoa.eoy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o 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. o No EPA Lead-Safe Certified Firm is required for this project because:
D 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 RAP
Acknowledgement.
APPLICATION& SAFETY PERMIT/PLAN CHECK
r
Menifee
DATE E15 /,7 (7 PERMIT/PLAN CHECK NUMBERPt-tw` — S
-16
TYPE: O COMMERCIAL VIRESIDENTIAL 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 PLUMBING��,,��0 RE-ROOF-NUMBER OF SQUARES ILP>'� (�,f�j,Y+
DESCRIPTION OF WORW44 1AJW 71 ?// Cti(IT City Of Menif Ie
•''
ul Ing De t
PROJECTADDRESS ZSl4,S AVA.1J9y (WtlW M a953"k MAY 19 2017
ASSESSOR'S PARCEL NUM13ERR wI' 2-(2D-00& LOT '- TRACT Receiv
OWNER NAME L`�9W4r=2S C 0 f
ADDRESS
PHONE gSC ' r EMAIL C--55
APPLICANT NAME Q.("((n' A1GS3(/•-�
ADDRESS 841.-
PHONE 6?E) 033-6933 EMAIL te,C014 CONTRACTOR'S NAME a0we (3E dvouE5 JSbw- OWNER BUILDER? O YES CY6
BUSINESS NAME
ADDRESS �'4+
PHONE � EMAIL
-s
c (CONTRACTOR'S STATE LIC NUMBER (3(O2- LICENSE CLASSIFICATION 13 (l44
7i OEoj
VALUATION$ - SQ FT ) L SQ FT
APPLICANT'S SIGNATURE _ DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT CASH C%CHECK# C>CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH ^CHECK# 0CREDIT CARD VISAIMC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-6 72-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
.,of t7 k i6iriw savwe--r5
Ment�ee CA y258N
36a 1 a oCo
- 1.11 Ares a3D°x $Zo'
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL sM�
`S + REVIEWED B DATE
*Approval of these plans shall nut be construed to be a permit for,or an
approval of,any violation of any provisions of the federal,state or city 1
regulations and ordinances. This set of approved plans must be kept on the
site until completion.
d
c
w
X /
3 w
N� JCS
%L-k-wn11
Pr
Pruposcel yo
5� a NOtASer
zbM zb; Pi� ��
Tye;
ti
City of Menifee nn 1� 0 F H.
Building & Safety Dept. X� Roo C� Urt ULW 4
JUN 2 3 2017
Received
STATE OF CALIFORNIA NUMBERBUSINESS,CONSUMER SERVICES AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT 88191 4
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
I�PT '
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) (Slate) (zip) $91,151.00
MANUFACTURER TRADE NAME:2018 YEAR MODEL MODEL NAME AND/OR NUMBER: DATE OF MANUFACTURE:
AMBER COVE AMB. COVE K638—CT 07/28/17
NAME OF DEALER OR TRANSFEREE(OWNERSHIP TRANSFERRED TO): CALIFORNIA DEALER NUMBER OR DATE OF-TRANSFER;
ELH, INC. TRANSFEREE DESIGNATION: 08/01/17
EASY LIVING HOMES 1180181
DEALER OR TRANSFEREE ADDRESS:
(Street)34135 CAMERON DR. HEMET(Clty) CA (StateP2544 (ZP)
INVENTORY CREDITOR NAME:
N/A
INVENTORY CREDITOR ADDRESS:
(Street)N/A (City) (State) (➢p)
SECTION - - - LENGTH WIDTH WEIGHT --
S MANUFACTURER SERIALNUMBER HCD INSIGNIA OR HUD LABEL NUMBER INCHES INCHES OUND
1 6771-0169—K—B PFS 1188962 672 142 18,135
2 6771-0169—K—A PFS 1188963 672 142 19,305
TRANSPORTER NAME
TRANSPORTER ADDRESS:
(Sheet) (City) (Stale) (zip)
DESTINATION FOR UNIT DESCRIBED ABOVE:
NAME Sheol CI Stale
1 certify under penalty of petryry under the laws of the State of California that the above facts are true and correct.
08/01/17 SAN JACINTO RIVERSIDE CA
Executed on at
(Date) (County) (Sale)
DANN STARK, DIVISION MANAGER
SIGNATURE OFAUTHORI2FD AGENT:
DLSTRIBUTION: ORIGINAL(PINK) FORWARD TO THE INVENTORY CREDITOR UNLESS THERE IS NONE,THEN FORWARD TO THE PURCHASER(DEALER OR TRANSFEREE).
COPY CWHITET FORWARD TO THE DEPARTMENTAT P.O.BOX 1828.SACRAMENTO.CA 95812-1828.WITHIN FIVE(5)DAYS OF RELEASE.
COPY2(YELLOW) DELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS DESTINATION.
COPY 3(GOLDENROD) TO BE RETAINED BY THE MANUFACTURER
HCD 483.0-Side 1(Rev.07115)
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
LAND USE APPLICATION OFFICE USE ONLY
PE CODE: FEE:
❑ 38.. Lemon Street•Suite 20D Riverside•CA•92501-(951)955-8980 I
❑47-950 Arabia Street•Suite A•Indio•CA 92201-(760)863-7570 G^�A APN;,z ,
EHS# ON# LMS# PM 1 '7—� - Z
TRIPM LOT# USE OF PERMIT:
SECTION A
r'
Name i ✓." ` L>'
Ci
OWNER: Address
Phone ^��-�J` L7 Email rIC4� i[2Gi CGJ�✓I
A ent/Contrector
Company Name
AGENT/ Cit Zi
CONTRACTOR: Mailing Address
Phone Email ,
Site Address
zs�f$ icy c. CI .9r e� Z �ZSS3 L
PROPERTY INFO:
WaterA encyell /r Lot Slze k ��
NJ
APPLICANT'S SIGNATURE:
SECTION B Below I For Office Use Only
CHECK BOX IF REQUIRED
If an box Is checked,this a lication shall be considered denied unfit the infoO Floor IPlanandlor Plumbing Layout ReQpired
[I Holding Tank Agreements Required ❑Special Feasibility Bodng Repoit.Required City of.Menifse 1
❑Certificate of Existing OWTS Required(C-42) ❑Detailed Contour Plot Plan Required(l to aFk UEWSafety Dept.
❑WQCB Clearance Required -
❑Soils Percolation Re ort Re uired
SITE EVALUATION INSPECTION REMARKS:
EHS INITIALS/DATE: �OCE)MR
-01
SECTION C
0 NEW ❑REPAIR/REPLACEMENT []EXISTING ❑PUMP ❑ATU ❑CONNECT TO SEWER FIXTURE UNITS# BDRMS#
Project#
Soils PercolatIonlBoring Report By:
Date:
Date: License#
C-42 Certification By:
Sepfic tank cap.:
Soil Rate: Tested Depth: Max. trench depth:
Sq.Ft.Bottom Area: Total Linear FL: une(s):
Length: feel - Each 3 feet wide
Sidewall Allowance: Ft.Rock/ Sq.ft.Running foot Rock below drain line: _tn. or ❑Plastic Chambers
Leach Lines/bed special design for slope: ❑ NIA ❑Overburden Factor. -
Pit Diameter. No.pits: Depth below Inlet(bI): Pit Total Depth: Max.allowable depth:
CONSTRUCTIONIINS ALLATION REMARKb: /_ 0 • tin 5 pain ew igm
y (ulrrjlLL /LQ WI11 7/Pr.�. .
SECTIO D�.CI
,UCLTr K+("Zl
N D
This Application is Approved ❑Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth in
Section C above. o construction is permitted in the required reserved 100°/Expansion area. Dale:
EHS Signature: �(A r/L.�, -
DisVibubbn:WHRE-Office Fie;YELLOW-&tlg.Dept PINK-pppll[ant
Lic.#C42'9880D]
��� N
1 COLJNTY OF RIVERSIDE
DEPA�TMENT OF LNVIRONMENTAL HEALTH
ONSITE WASTEWATER TREATMENT �:C)TT
Commerciall Sq.Ft.of Leach Line
Connect to�ewer Concrete Pump Chamber
Connect to Existing
Installation' ' — of leach lines are not to exceed it in depth
� , Install rise raPe,2ieaving lids acoessible for cleaning.
ns
Recording Requested By DOC #2017-0190234
First American Title Company 05/11/2017 03:27 PM Fees: $28.00
Page 1 of 2
RECORDING REQUESTED BY: Recorded in Official Records
First American Title Company County of Riverside
AND WHEN RECORDED MAIL TO: Peter Aldana
Cory R. Bowers Assessor-County Clerk-Recorder
Jane Holzer-Bowers
Toni Lynn House "This document was electronically submitted
25715 La Estrella Rd. to the County of Riverside for recording"
Wildomar, CA 92595 Receipted by: CAROL#914
THIS SPACE FOR RECORDER'S USE ONLY:
Title Order No.: 5446190 Escrow No.: 003628JM
7741'05Z6 -otsl GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S) City of Menife
Building Dept
DOCUMENTARY TRANSFER TAX is$165.00
[X] computed on full value of property conveyed, or MAY 19 20VI
[ ] computed on full value less value of liens or encumbrances remaining at time of sale.
[X] Unincorporated area [ j City of AND R e^\s e i"
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, V Ul
Cary T. Lewis and Jackie L. Bauer, Husband and Wife as Joint Tenants,who acquired title as Cary T. r
Lewis a Married Man as his sole and separate property and Jackie L. Bauer,a Married Woman as her
sole and separate property and Jacqueline R. Silkotch,a Married Woman,as her sole and separate
property,who acquired title as Jacqueline R. Silkotch, an Unmarried Woman
hereby GRANT(s) to: O
•
Cory R. Bowers and Jane Holzer-Bowers, Husband and Wife as Joint Tenants as to an undivided 50%
interest and Toni Lynn House,a Widow as to an undivided 60% interest,as Tenants in Common
the real property in the County of Riverside, State of California, described as:
The Northeast Quarter of the Southeast Quarter of the Northwest Quarter of the Southwest Quarter of section
20, township 6 South, range 3 west, San Bernardino base and meridian; excepting therefrom the North 100 feet 4
thereof as shown on certificate of compliance no. 465 recorded August 14, 1978 as instrument no. 170709, of '�•/
official records of Riverside County, Califomia. r
Also Known as: 25195 Bundy Canyon Rd. (Vacant Land), Menifee, CA 92584 down
362-120-006-2
DATED: May 3, 2017
Signature Page attached hereto
and made a part hereof
MAIL TAX STATEMENTS TO PARTY SHOWN BELOW;IF NO PARTY SHOWN,MAIL AS SHOWN ABOVE:
I Title Order No.: 5446190 DOC#2017-0190234 Page 2 of 2
Escrow No.: 003628-JM
A.P.#362-120-006
Signature Page
Cary T—Eevvis JaNuelindJR. Silkotch
cie L. Bauer
A notary blic or other officer completing this certificate verifies only the identity of the individual who signed the document
to which thipus certificate is attached,and not the truthfulness,accuracy.or validity of that document.
STATE OF CA '
COUNTY OF K L1/Cf S(jle.
On _ (/IGt�Y<Fr V-017
before me, )� 1,; CIC- rw
A Notary Public personalty appeared
Cary T.Lewis and Jackie L.Bauer
Jacqueline R.Silkotch
who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s),is%re subscribed to the within
instrtjutIment and acknowledged to me thatjxllfoetthey executed the same In *!VA Itheir authorized capacity(ies),and that by
pis`l wltheir 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.
WITNESS my hand and official seal.
Signatur V / ,(!- = o hiCi
(Seal)
LUCIA CASTANEDA
COMM. #2157459 z
W m Notary Public-California o
z Riverside County
Comm F, ires Jule 21,2=