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PMT17-01808 City of Menifee Permit No.: PMT17-01808 29714 HAUN RD. Type: Mobile Home <A-CCEI-A MENIFEE,CA 92586 MENIFEE Date Issued: 06/08/2017 PERMIT Site Address: 27765 WATSON RD, MENIFEE,CA 92585 Parcel Number: 329-201-008 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of INSTALLATION OF NEW MANUFACTURED HOME, 1,176 SF.SILVERCREST SM-07-4424 Work: SERIAL#: 17600FHA100871A HUD#: NTA1755234 SERIAL* 17600FHA100871B HUD#: NTA1755235 Owner Contractor ROBERT FOWLER TERRA FIRMA CONSTRUCTION INC 27765 WATSON ROAD 913 MAPES ROAD MENIFEE, CA 92585 PERRIS,CA 92570 Applicant Phone:9517575731 BRUCE EVANS License Number:796315 TERRA FIRMA CONSTRUCTION INC 913 MAPES ROAD PERRIS, CA 92570 Fee Description ,City Amount(Sl 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,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 perjurythat I am under provisions of with a licensed contmctor(s)pursuant to the Contractors State License Law). 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 1s in full force and effect. S the following reason: License Class c- I U rise NP. By my signature below l 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 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 Cade,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.eov/calaw.html. this permit is issued. Policy# Date ave 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 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 an the property owners behalf.1 have read this number are: f�rTv1� , �c,� application and the information I have provided is correct.I agree to comply Carrier C--J-f �1ULSc.I'flp4lVCs "Y" "/ with all applicable city and county ordinances and state laws relating to / .y a— building construction.I authorize representatives of this city or county to Policy 04 DS� �)r Expires U^ / 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 in I certify that in the performance of the work for which this permit is issued, Ishallnotemolov 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 th�e^^v' rkers compe a on provisions of Section 3700 of the Labor Code,Ishajt pi I ions. Will the applicant orfuture building occupant handle hazardous material or Applicant//: Date h/ d\, / 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 o 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 oft 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 Cade) ❑Yes o No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements underthe State of I hereby affirm under penalty of perjury that I am exempt from the 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(RRP) 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 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.eov/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. o 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 70",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 Menifee DATE $^ PERMIT/PLAN CHECK NUMBER - `50S TYPE: O COMMERCIAL .el ESIDENTIAL 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 O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Mj9 I) U c� 7n/ r CI of enifee fety Dept. 2 S TSt3/U N� t d% & a PROIECiADDRESS Buil T�p ASSESSOR'S PARCEL NUMBER2 2-9- 9-` -(�l p LOT TRACT JUN 8 2017 OWNER NAME A&Pfil r L , f5o(.t)(_9-R— I JP tui {Ved ADDRESS PHONE `! EMAIL APPLICANT NAME '\�nnY ADDRESS 13 ems snnl�(.4_o e; S 25 PHONE 9�^ �S /�S��j EMAIL CONTRACTOR'S NAME �1iI-'�/�IICX(CkU I OWNER BUILDER? 6 YES/NO BUSINESS NAME ADDRESS PHONE -%5��7-� %�S��pj /I EMAIL CONTRACTOR'S STATE LIC,,NNUMBER / SC) CLASSIFICATION �j' {l VALUATION $ S© V SQ FT I J v L SQ FT APPLICANT'S SIGNATURE ff V DATE o I DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP AMOUNT u-1. 1, PAIDAMOUNT U CASH U CHECK# J CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0CASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 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 CALIFORNIA NUMBER:BUSINESS,CONSUMER SERVICES AND HOUSING AGENCY 8820424 �®!9(� p ,, DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT Q O 2 0 4 2 4 DIVISION OF CODES AND STANDARDS MANUFACTURED HOUSING PROGRAM MANUFACTURER CERTIFICATE OF ORIGIN ❑ GHECK IF THIS IS A DUPLICATE MCO-ENTER ORIGINAL MCO NO )El HOME OR MULTIFAMILY MANUFACTURED HOME NUMBER OF q��p Clty of Menifee v SFD(SINGLE FAMILY DWELLING) ❑ MFMH(MULTIFAMILY MANUFACTURED HOME) TRANSPORTABLE SECTIONSrding & Safety Dept. COMMERCIAL MODULAR' JUN 0-8 O 2017 OCCUPANCY GROUP / MANUFACTURER NAME. MANUFA RER LICENSE NUMBER. received MANUFACTURER ADDRESS SUGGESTED RETAIL PRICE' (Street) (City) (State) (zip) MANUFACTURER TRADE NAME MODEL NAME AND/OR NUMBER', DATE OF MANUFACTURE: NAME OF DEALER OR TRANSFEREE(OWNERSHIP TRANSFERRED TO). CALIFORNIA DEALER NUMBER OR DATE OF TRANSFER. TRANSFEREE DESIGNATION' DEALER OR TRANSFEREE ADDRESS (Strcret) (City) (State) (ZIO INVENTORY CREDITOR NAME. INVENTORY CREDITOR ADDRESS. (Street) Ci:y) (State) 10p) SECTION LENGTH MANUFACTURER SERIAL NUMBER HCD INSIGNIA OR HUD LABEL NUMBER WIDTH WEIGHT 1. (INCHES) INCHES) POUNDS 1 77 TRANSPORTERNAME TRANSPORTEK ADDRESS (Smt) 'CIO ISwe) (21P1 DESTINATION FOR UNIT DESCRIBED ABOVE FtCBERT . SHfEL BY FOWLER. 27'FS WATSON ROAD R,".;1 G(A!in NAME) (S4eel) (CI ISb:m ) I certify under penalty of perjury under the laws of the State of California that the above tads are true and correct. Exocalea (Dale) fBdy) !Coudy) (Slab) J SIGNATURE OF AUTHORIZED POEM: OISTRIBI/TIDN: ORIGINAL(RNK) FORWARD TO-THE INVENTORY CREDITOR.UNLESS THERE IS NONE.THEN FORWARD IC THE PURCHASER(DEALER OR TRANSFEREE) COPY I(WHITE) FORWARDTOTHEDEPARTMENTATPO.BOX1828.SACRAMENT0,CA 9MI2-1828,WITHIN FIVE(5)DAYS OF RELEASE COPY 2(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.OA15) " Ma " Williams since 1969 man tf f e t u r e d 6 o m es, Inc. City of Menifoo Building & Safety Dept. June 5,2017 JUN 0 8 201 To Whom It May Concern: Receiver "Ma"Williams Manufactured Homes authorizes the placement of a 2017, Silvercrest Home. The home serial numbers, 176—OOF—H—A10087IA& 176—OOF—H— A100871B,HUD Numbers NTA 1755234(A) &NTA 1755235 (B)to be placed on a permanent foundation at the address below: 27765 Watson Rd. Menifee, CA 92585 APN 4329-201-008-1 This is for customer Robert L.Fowler and Shelby J. Fowler is to be financed. If you have any other questions please feel free to call me at(951) 791-9883 Regards, g"e, /4� Jared Garcia "Ma" Williams Manufactured Homes Inc. 35325 Highway 74 Hemet, California 92545 Tel951.926.1581 Fax 951.926.9622 11 ".1 ill '. 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 Countyof 12tV¢ 151c1� }SS On Ju nz , 20I1 before me,JkDeC,,r1 1r1t.� UJof�ls ��oirt� $'u6�r� (here inse name and title of th officer) personally appeared, � �t�re GGr'u�w who proved to me on the basis of satisfactory evidence to be the person(j) whose name( s e subscribed to the within instrument and acknowledged to me that o/thpy executed he same i is i/tl�r authorized capacity(ip4), and that byQhh�/th Ir signature(g) on the instrument a person( , or the entity upon behalf of which the person 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. WITNESSmy hand and official seal JENEAN HAYOEN WOODS Signature Commission#2062108 `z =� Notary Public-California z Z Riverside County M Comm.Ez ires Mar 23,2018 A (SEAL) City of Menifee RECORDING REQUESTED BY: DOC#2017-0110149 Building & Safety Dept. First American Title Company 03/17/2017 04:04 PM Fees: $18.00 Page 1 of 2 JUN 0-8 2017 Recorded in Official Records WHEN RECORDED MAIL DOCUMENT AND TAX County of Riverside STATEMENT TO: Peter Adana Pi C e v�(� Assessor-County Clerk-Recorder Robert L. Fowler 27765 Watson Road "This document was electronically submitted Menifee,CA 92585 to the County of Riverside for recording- Receipled by:TERESA#134 APN: 329201008-1 TITLE ORDER NO.: 5181305 ESCROW NO.: 37464-2 THIS SPACE FOR RECORDER'S USE ONLY �Lke_1O 2_ GRANT DEED The undersigned Grantor(s)declare(s)that the DOCUMENTARY TRANSFER TAX IS: $00.00 County $00.00 City _computed on the full value of the interest of property conveyed,or _computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale. X OR transfer is EXEMPT from tax for the following reason:children to parents The undersigned Signature of declarant or agent determining tax Firm Name FOR A VALUABLE CONSIDERATION,receipt of which is hereby acknowledged,Robert L. Fowler and Shelby J. Fowler, husband and wife, and Jason Duncan and Catherine Duncan, husband and wife (who acquired title as Robert L. Fowler and Jean Fowler,husband and wife,and Jason Duncan and Catherine Duncan, husband and wife) HEREBY GRANT(S)to Robert L. Fowler and Shelby J. Fowler, Husband and Wife as Joint Tenants � �ViJOS g Ilk All that real property situated in the City of Menifee,County of Riverside,State of California, described as: Complete legal description as per the exhibti"A"and made a part hereof. Commonly Known As: 27765 Watson Road, Menifee, CA 9 February 8, 2017 �d�b Robert L. Fowler Sh I rrrb . F i J O111y J Duncan bt1fierine Duncan A notary public 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 valid of that document STATE OF CALIFORNIA } COUNTY OF On m 4 r Un 1 -7 . 201-7 ,before me,��};�r- } v+a r a Notary Public personally appearedRnarT L. �)f0 jjgj_ ke(6 �owler Toson Duncan?e.,d�rC�e-�6ertna DJneart who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s)1s(are subscribed to the within instrument and acknowledged tome that I elshelthey executed the some in NsIbar/their authorized capacity(ies),and that by hiail witheir 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. DEBORAH SPRINGER Commission 9 2106150 Signature� r2L�- gam-`+ (SEAL) Notary Public-California ' Riverside County 110My MAIL TAX STATEMENTS AS DIRECTED ABOV Comm.Expires May 6,2019 DOC#2017-0110149 Page 2 of 2 City of Menifee Building & Safety Dept. JUN 0 0 201? Received Exhibit"A" Legal Description A.P.N.: 329-201-008-1 Real property In the City of Menifee, County of Riverside, State of California,described as follows: LOT 40 OF ROMOLA, IN THE COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS SHOWN BY MAP ON FILE IN BOOK 13, PAGES 8 AND 9 OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY.