PMT17-02516 City of Menifee Permit No.: PMT17-02516
29714 HAUN RD.
"f4CCELA—> MENIFEE, CA 92586 Type: Mobile Home
MENIFEE Date Issued: 08/22/2017
PERMIT
Site Address: 27151 BORGARDUS RD, MENIFEE,CA Parcel Number: 384-110-004
92584 Construction Cost: $103,840.00
Existing Use: Proposed Use:
Description of INSTALL FOR REPLACEMENT OF NEW MANUFACTURED HOME 1512 SQ FT
Work: SERIAL#PER037809CA A/B, INSIGNIA#RAD1526496/7
Owner Contractor
CHRISTOPHER SANDOVAL&CHELSEA K DAVID GOODWIN MASONRY
KOUTHOOFD 798 HARDING
13296 WAGON CREEK RD HEMET, CA 92543
Applicant Phone:9513235719
JAMES MATTHEWS License Number:633914
DAVID GOODWIN MASONRY
798 HARDING
HEMET, CA 92543
Fee Description Qttv Amount 1$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 varied 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 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 Contractors State License Law for
Professions Code and my license is In full force and effect. the following reason:
License Class Uce a No. _ _ By my signature below I acknowledge_that,except for 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.Ieginfo.ca.gov/calaw.htmi.permit is issued.
Policy It Date
194ve 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 insurance carrier and policy owner or authorized to act on the property owners behalf.1 have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier.5� -� co za^p yj.S_ G(/y]/%. with all applicable city and county ordinances and state laws relating to
J building construction.I authorize representatives of this city or county to
Policytt I �2r, / ) Expires J —1 �Z enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑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 p
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work s come n provisions of Section 3700 of the Labor
Code,I sha fo ' h c3m y' th s rovlsions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAIL TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑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($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE TABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes o No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school? ,
(Section 3097 Civil Code) ❑Yes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythat I am exempt from the permitting checklist.I understand my requirements underthe State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(Section 7033.5 oyes D 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 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
o 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.epa.zov/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 applyto 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:
D 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 RR
Acknowledgement.
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
(Z ;,L,,, XNEW OPLUMBING ORE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORKr -mayla-F444 ee Lkme m5+*(•
PROJECTADDRESS ®� �4J 6 q,LZ Meyv*e. c,49 58`r
ASSESSOR'S PARCEL NUMBER 3g y -11 a - coy LOT TRACT
PROPERTY OWNER'S NAME rr C✓ 3 V I1 /� • K 4AvoF
ADDRESS )° -/ Cree K d C'6 110 r4 r A •2
PHONE EMAIL S'p.n y LOn
APPLICANT NAME DgV4
ADDRESS --7 5 .Z, srw
PHONE �yJrJ) ��� S7Q(� EMAIL --
CONTRACTOR'S NAME , /\ VOA,4wryOWNER BUILDER? OYES IKNO
BUSINESS NAME QW, 6 1 R
ADDRESS !� ,$ CA. 1,$"Y
PHONE �q��� _?a.3 'sZ q/ EMAIL EIFJ-J�-�pp rr I o aM
T
CONTRACTOR'S STATE LIC NUMBER -�'�3`��`�' LICENSE CLASSIFICATION
VALUATION$ pTyc) SQFT � Z LSQFT
APPLICANT'S SIGNATURE i DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT OCASH OCHECKN OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
- _4 I:�G;!IIIBC
1Uiif}lii CEGt STATE OF CALIFORNIA NUMBER:
BUSINESS,CONSUMER SERVICES AND HOUSING AGENCY 1
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT e7 11
JUL 19 2017 DIVISION OF CODES.AND STANDARDS
MANUFACTURED HOUSING PROGRAM
Re; 4UF` TUBER CERTIFICATE OF ORIGIN
❑ CHECK IF THIS IS A DUPLICATE MCO-ENTER ORIGINAL MCO NO.
MANUFACTURED HOME OR MULTIFAMILY MANUFACTURED HOME NUMBER OF
El SFD(SINGLE FAMILY DWELLING) ❑ MFMH(MULTIFAMILY MANUFACTURED HOME) TRANSPORTABLE SECTIONS
COMMERCIAL MODULAR:
OCCUPANCY GROUP -
MANUFACTURER NAME: MANUFACTURER LICENSE NUMBER:
MANUFACTURER ADDRESS: SUGGESTED RETAIL PRICE:
(S"n - - - _ z (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: -
(Same,) -T_ LN a; .. (City) (State) (Zip)
INVENTORY CREDITOR NAME:
INVENTORY CREDITOR ADDRESS:
(Street) - (City) - - (State) (ZIP)
secno" MANUFACTURER SERIAL NUMBER HCD INSIGNIA OR HUD LABEL NUMBER LENGTH W WEIGHT
INCHES' INCHEE S (POUNDS)
TRANSPORTER NAME:
TRANSPORTER ADDRESS:
(Street) --L_ (City) (State) - (Zp
DESTINATION FOR UNIT DESCRIBED ABOVE: -
... State Z
I certlTy ah8er jieiie'Ity�df perjurylinder the lati§of the Sts[eof Gal'rfomia Mat the above fads are true end correct.
Executed on at
s(Aatp3 (Carty) (state)
SIGNATURE OF AUTHORIZED AGENT: --
DISTRIBUTION: ORIGINAL(PINK) FORWARD TKTHE INVENTORY CREDITOR,UNLESS THERE IS NONE,THEN FORWARD TO THE PURCHASER(DEALER OR TRANSFEREE).
COPY i(WHITE) FORWARD TO THE DEPARTMENT AT P.Q:-BOX 1826,SACRAMENTO,CA 95812-1828,WITHIN FIVE(5)DAYS OF RELEASE.
COPY 2(YELLOW) DELIVER TO THE TRANSPORTER T(YMCOMPANY THE UNIT TO ITS DESTINATION.
COPY 3(GOLDENROD) TO BE RETAINED BY THE MANUFACTURER.
HCD 483.0-Side 1(Rev.07/15)
COUNTY OF RIVERSI " E
DEPARTMENT OF ENVIRONMENTAL HEALTH
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM
Land Use&Water Resources
Western Riverside County Eastern Riverside County
3880 Lemon Street•Suite 200•Riverside•CA• 47-950 Arabia Street•Suite A•Indio•CA•92201
92502 Phone:(760)863-7570•Fax(760)863-7013
Phone: (951)955-8980•Fax: (951)955-8988
Property Information: APN: rLf/ —Irb - [J Date of Inspection: `,9 -/(o
1. Owner: 14--t4 )4L.. Address: t tty:
FAILURE TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT OWNER FROM OBTAINING
ENVIRONMENTAL HEALTH APPROVAL
2. Show design and location on a scale of 1:20 or 1:40 of the sewage disposal*system and 100% expansion area in relation to
attached dwellings,structures,wells,rocks,watercourses,etc. +1
3. a. I examined existing subsurface sewage disposal system at the above location on ! and determined that
the tank capacity is -750 gallons and that there is sq.ft.of leach line bottom area. There are
NU SWiefi eG _ bedrooms in the dwelling and there are fixture units.
b. There are leach line(s),each r' ft.long Depth --I/— ft. Rock ❑Plastic Chamber
d. There are Vr Seepage pit(s),each ay ft.in diameter,and ft.TD. —4 ft.BI
e. The leach bdd is � ft.by />( ft.'Yto`taal �jr sq.ft.of Ied area. Depth Is -V— ft.
4. a. Construction of septic tank(Please check one of the following):
f(Concrete ❑ Fiberglass-7 ❑Steel ❑Other:
-
b. Internal dimensions of septic: Length /t 5 ft. Width 3r S ft. Depth Is 14 ft.
City ci i.4enifee
c. Condition of tank(please check yes or no for each question): Inlet Tee present? )8y^.� (es El No Building Dept
Tank Structure deteriorated? ❑Yes XNo Outlet Tee present? 2TYes ❑No
Effluent Filter Present? ❑Yes ANo Two compartments? J*Yes ❑No JUL 19 2017
d. Condition of D-Box: Level? ❑Yes ❑ No Replaced? ❑Yes ❑No
Septic Effluent? ❑Yes ❑ No Depth _ ft. /� ` x
5. a. While pumping the tank,did effluent flow back into tank from absorption system? ❑Yes xR e c e 6 v e o 1
b. Prior to pumping,was the liquid level in the tank above the outlet tee? ❑Yes KNo
c. Was the area around the lids oxidized? ❑ Yes >(No
d. Is design of system gravity feed? AYes ❑ No
e. Were well(s)observed on this or adjacent property? Ayes ❑No ��g
If yes,indicate distance of well from: Septic tank�� ft. Leach lines Pho Seepage Pits Nf 1 ft.
f. Distance from springs,lakes,an natural water courses ck all that apply)
.Septic T n ft. Al-each lines !� ft. ❑Seepage Pits _ ft.
g. Is sewer within 200 ft.of structure and property line? ❑Yes ANo
Additional Comments: Ale) l/,'u ,S/jZ- &) fK__n/
h. pppHow long has dwelling been vacant?(itepplimble) months _ weeks N/A
6. a. yq It is my opinion that the system appears to be in good working order and can be expected to function properly with
proper maintenance. No repairs are necessary at this time.
b. ❑ If is my opinion that the system is not in good working order and will not function properly without the following
repairs:
I certify under penalty o'fpeeg/ffiet the fore in 's true and correct. /
Signature: l�v Print Name: 7�✓UG` 97/,�G✓!�'��l
Contractor License No.: 4j'33-7 a Expiration Date: _
Pumper Go.: �j� u� G; s�_ �! Phone Number:�s� ���_yy-C/7i
Address: ��s o, -/fl� �f/G City: Gf%jr/lj�� Zip. jz ''q5
Rev.10/12 r�-�
RECORDING REQUESTED BY: DOC #2017-0087980
First American Title Company 03/02/2017 01:56 PM Fees: $28.00
j City of Menifee Page 1 of
1 Building Dept Recorded in Official Records
WHEN RECORDED MAIL County of Riverside
Peter Aldana
STATEMENT Tf}F1{I; JUL 19 20V Assessor-County Clerk-Recorder
Chris Sandoval
27151 Borgardus "This document was electronically submitted
Menifee, CA 92584 Receive to the County of Riverside for recording"
Receipted by: MARIA#309
APN: 384-110-004-9
TITLE ORDER NO.: 5343298
ESCROW NO.: 37884-2
THIS SPACE FOR RECORDER'S USE ONLY
W w GRANT DEED A /al .00
The undersigned Grantor(s)declare(s)that the DOCUMENTARY TRANSFER TAX IS:$ County$00.00 City
XX 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.
_OR transfer is EXEMPT from tax for the following reason:
The Undersigned
Signature of dedarant or agent determining tax Finn Name
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,Joan L. Young,a widow
HEREBY GRANT(S)to CHRISTOPHER SANDOVAL AND CHELSEA K. KO=0OFD, HUSBAND AND
WIFE AS JOINT TENANTS
All that real property situated in the Ned of Menifee, County of Riverside, State of California,described as:
Complete legal description attached hereto as Exhibit"A" and made a part hereof.
Commonly Known As:27151 Borgardus, Menifee, CA 92584
November 21,2016
JoarU. Young
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
attacheQandnotthe truthfulness,accuracy or validity of that document
STATE OF CALIFORNIA ]
COUNTYOF k2 Ver" ldff� }
On e cC7Yt 6e_r 13 0,o l t before me, 18 VO Lun ,a Notary Public personally appeared 00 Al L (,�"06(_
who proved to me on the basis of satisfactory evidence to be the p rson(s)wh se name(s)Ware subscribed to the within instrument and
acknowledged to me that he/shenhey executed the same in his/herttheir authorized capacity(ies),and that by his/her/their signature(s)on the
instrument the person(s),or the entity upon behalf of which the persons)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 coned.
WITNESS my hartqAiP/d officiaallgs�eay/f/lf/� Qf/n�/�/t
Signature ( J�"rn'�(", y`' '� (SEAL) A(Ny M.MDW�
Carmlakn i 200DINI2
i Notary Pvb k-GMomle z
z IlhweMi County
M Comm.Expires Dec 14.2111
MAIL TAX STATEMENTS AS DIRECTED ABOVE
DOC#2017-0087980 Page 2 of 2
EXHIBIT "A"
LEGAL DESCRIPTION
Real property in the City of Menifee, County of Riverside, State of California,described as follows:
PARCEL NO. 1,AS SHOWN BY PARCEL MAP NO. 5233 RECORDED 1UNE 5, 1973 IN BOOK 8
PAGE 91 OF PARCEL MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA.
APN: 384-110-004-9