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PMT17-02630 City of Menifee Permit No.: PMT17-02630 _ 29714 HAUN RD. Type: Mobile Home �!-�CCEL/-> MENIFEE, CA 9258E MENIFEE Date Issued: 10/30/2017 PERMIT Site Address: 23560 CASSANDRA DR, MENIFEE, CA Parcel Number: 350-231-043 92587 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of INSTALL FOR NEW MOBILE HOME, 1248 SF Work: SERIAL#:31720349AT INSIGNIA#: CAL276128 SERIAL#:31720349BT INSIGNIAM CAL276129 Owner Contractor JILBERTO RIOS 28867 ESCALANTE ROAD MENIFEE, CA 92587 Applicant License Number: JILBERTO RIOS 28867 ESCALANTE ROAD MENIFEE,CA 92587 Phone:9513589173 Fee Description Qtyr Amount ISI 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. CONDITIONS Condition Comment 1 RIV.CO. EVHS APPROVAL REQUIRED 2 RIV.CO. EVHS APPROVAL REQUIRED 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 Code and my license is In full force and effect. the following reason: License Class License No. By my signature below I 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 I 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 this permit is issued. www.leginfo.ca.gov/callanaw.htm1. Policy# 4'-' C A-- Date/ obgl7 ❑1 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 D By my signature below I certify to each of the fallowing: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.I have read this number are: application and the information I have provided Is correct.I 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 Policy# Expires enter the above identifiedd pproperty for inspection purposes. (This section need not to be completed is the permit is for one-hundred G"� C )C✓ Date 0 3D// 7 dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT I certify that in the performance of the work for which this permit Is Issued, I shall not emolov any persons in any manner sous to become subject to the CITY BUSINESS LICENSE g workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. 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:FAILURE 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($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?5ee permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY ❑Yes o No I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(Section 7031.5 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(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 _ ❑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 property who,through employees'or personal effort,builds or improves the D An EPA Lead-Safe Certified Renovator will be responsible for this project 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. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑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. APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK Menit e DATE PERMIT/PLAN CHECK NUMBER 1 — Q TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY AP MOBILE HOME O POOL/SPA ' e SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHARWkIng & Safety Dept. G NEW jO PLLUUMBINJG/ O RE-ROOF-NUMBER OF SQUARES j DESCRIPTION OF WORK ) /"S LAG ReceiVEd PROJECTADDRESS Of LSO�O LCJ��G n�Y G ��( , UGl L v G )C CA`/z&Y4 ASSESSOR'S PARCEL NUMBER - a li-oy3 LOT TRACT OWNER NAMEc� J J�/Y �' (� IC �S�7 q ADDRESS o1,T�0� C=,�Clnlil1L U�1 CA l PHONE gsc- 3s�91 �3 EMAIL APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? 3 YES O NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION $ S-C r�2O� Q/ SO FT L SO FT APPLICANT'S SIGNATURE -d/,c '12,& DATE _�--2 DEPARTMENT DISTRIBUTION CITY OF MEN IFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN i SMIP INVOICE PAID AMOUNT , AMOUNT au-i��a ,• 'J� OCASH OCHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED 0 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.cityofinenifeaus Inspection Request Line 951-246-6213 DOC # 2017-0232067 06/09/2017 01:13 PM Fees: $24.00 Page 1 of 4 Recorded in Official Records County of Riverside Peter Aldana RECORDING REQUESTED BY Assessor-County Clerk-Recorder Chicago Title Company MAIL TAX STATEMENT "This document was electroniSag! su ted. AND WHEN RECORDED MAIL DOCUMENT TO: o the County of RiversideBfufl n iq* Safety ee Gilberto Rios Receipted by:LISA t580 9 & Safety Dept. 28867 Escalante Road JUL 2 7:2017 Menife�,CA 92587 Space Above This Line for Recorder's Use only "q c l@ 1` G O A.P.N.: 350-231-043 File No.: 203-044709 (CH) to ' 507/ Title Order No.: 7101708026 1�)b GRANT D''//E11ED The Undersigned Grantor(s)Dedare(s):DOCUMENTARY TRANSFER TAY aq-.Ov ITY TRANSFER TAX$0.00; X computed on the consideration or full value of property conveyed,OR computed on the consideration or full value less value of liens and/or encumbrances remaining at time of sale, unincorporated area; [X (.NYI.f FOR A VALUABLE CONSIDERATION,receipt of which is hereby acknowledged, Ignacio Sierra and Hilda Sierra, husband and wife as joint tenants C. hereby GRANTS to Gilberto/Rios, and Mercedes N. Rios, Husband and wife as joint tenants the following described property in the r ,County of Riverside,State of California: See Exhibit "A" attached hereto and made a part hereof. O Dated: M 2017 r_ Hilda Sierra 25�o�to s;err� Mail Tax Statements To: SAME AS ABOVE -------------------------------------------------------------------------------------------------------------------------------- I RECORDING REQUESTED BY Chicago Title Company MAIL TAX STATEMENT AND WHEN RECORDED MAIL DOCUMENT TO: Gilberto Rios 28867 Escalante Road Menif4,CA 92587 Space Above This Line for Recorder's Use Only A.P.N.: 350-231-043 File No.: 203-044709 (CH) 10DC Title Order No.: 7101708026 1 GRANT DEED The Undersigned Grantor(s)Dedare(s):DOCUMENTARY TRANSFER TAY,,aq-•o(em' TRANSFER TAX$0.00; X computed on the consideration or full value of property conveyed,OR computed on the consideration or full value less value of liens and/or encumbrances remaining at time of sale, unincorporated area; [X `,�„", � p�; FOR A VALUABLE CONSIDERATION, receipt of which is -r'e_b�yoaackknoowledged, Ignacio Sierra and Hilda Sierra, husband and wife as joint tenants C. hereby GRANTS to Gilberto/Rias, and Mercedes N. Rios, Husband and wife as joint tenants the following described property in the i County of Riverside, State of California: See Exhibit "A" attached hereto and made a part hereof. Dated: M �2` 2017 Igng'io5ierra Hilda Sierra TJ,c tnoito 5 iP,fra Mail Tax Statements To: SAME AS ABOVE Stale of Calif.mia aesxa,r Business,Transportation and Housing Agency 'se ��. DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT o 4.0 Divklon of Codes and Standards is ,, y. HCD 415 APPLICATION FOR 3L�rvxxsQ y� ❑Alteration ❑ Addition or Conversion ❑ Alternate Approval ❑ Technical Services ❑ Inspection To Obtain Insignia CONTRACTOR/OWNER-BUILDER DECLARATIONS SECTION 1-UNIT INFORMATION Not required for Special Purpose Commercial Modular I.LICENSED CONTRACTORS DECLARATION 1/We are requesting services for the fallowing unit(s): /'•.l ('^ (Check Appropriate Box) \.ry �� I hereby affirmmme under penalty of perjury that I am f the B tl under provisions of DTN/Per nit N0. Chapter d(commencing with Seaton effect. of Division 3 of the Business and Professions ❑ Manufactured Hom turgid Home Code and my license B in full force and gilled. O Multifamily Manufactured Home s xoLA ❑ Commercial Modular(Occupancy Group I Fee 3"f 9-• License Class Lic.No. Exp.Data ❑ Special Purpose yCommercial Modulw/\^�' (1 Contractor Date Decal Number �.S J\\ `i Date 2.OWNER-BUILDER DECLARATION Sepal Numbers)/VIN Number J l 1 d AA NO- I hereby offinn under penalty of penury that I am exempt from the Contractors' the License Law for the following reason: SSec.7031.5.Business and Professions Code: Any city or county which requires a permit RT TO o construct alter,improve,demolish,or repair any structure,pdw to its Issuance,also Manufacturer Name/Model Name requires the applicant for such permit to file a signed statement that he or she is /k,- i�b i/Q v„L t5, FIT BY licensed pursuant to the provisions of the Contractors' License Low Chapter 9 - C7 (commencing with Section 7000 of Division 3 of the Business and Professions Code)or L/ that he or she is exempt there from and The basis for the alleged exemption. Any `T violation of Section 7031.5 by any applicant for o permit subjects the applicant to a civil year of Manufacture penalty of not mare than five hundred dollors($500)J Insignia/HUD Label Numbegs) I, as owner of the properly, or my employees with wages as their sole ompensatlon.will do the work.and the structure is not blended plot fered for sale. SECTION 2-OWNER/APPLICANT INFORMATION (Sec. 7044, Business and Professions Code: me Contractors' License Law does nos C L t b-y t1 Y- s.95 appy to an owner of property.who builds or improves thereon,and who does such Owner work himself or herself or Through his or her own employees, providbd that such �13 S fa O R,5,4 A(T� V} improvements are not intended or offered for sole. 11. however, the bui� ress ng or Add O improvement is sold within one year of completion, the owner-builder will have the burden ofproving that he orshe did not build orimpm for the purpose ofsole.). City QyIR6 ✓Atelcounty t,Q/� '-t~54 LL"+r yIp�S9J [ 1 I, as owner of the property, am exclusively contracting with licensed Location Address s b O ASS rc'^ c�p Ji7rt- controdws to construct the project � (Sec.7044.Business and Professions Cade:The Contractors'license Low does not apply Park Name fit Applicable) Park IDX to an owner at property who builds or Improves thereon,and who contracts for such I1�, ✓ 1 S Blaxxxi projects with a confroclor(s)licensed pursuant to the Contractors'license Laxi Applicant C-•,V" TKO 1-0 I I I am exempt under Sec. ,B.&P.C.fur Thu reason: Address -2 FT6 �y C- SC A I h t 1 1 n / / s;Owner G`f ., �-l.eS Dale CcityEY✓/I¢` 6 as 3.WORKERS'COMPENSATION DECLARATION Telephone-Applicant CfSt—3 7 Homeowner Of ill Oiffe n Ap�can 1 hereby affirm under penalty of perjury one of the following declarations: SECTION 9-CONTRACTOR,ARCHITECT OR ENGINEE DRb1A%gnifee [ I I have and wR maintain o certificate of consent to self-Insure for workers Building UU�I IIVV�I ee compensation, as provided fur by Section 3700 of the Labor Code, for the Conhaclor'S Name 0 Safety I�CrYr..,, Performance of the work for which this permit Is Issued. a I I I have and will maintain workers compensation insurance. as requited by AdamsS- y Section 3700 of the Labor Code.for the perfonnori of M�' ft, rJi)utgltsi�(rerr�Rp Issued. My workers'compensation insurance tamer an lio cYnu betk}ai 7 t r L C Architect/Engineer Name Corder , ' ' r^ -{ Sitp)i� +:� r; U SA uC ARTMEI��iecejye Policy Number svpFn�FI�' �� \��P �t� Address [ I certify that in the performance of the f 1 �csl°ISKU+I shall not employ any person In any manner so as o become su I� s' SECTION 4-DESCRIPTION OF WORK/ACTIVITY AND VALUATION compensation laws of California,and agree that X 1 should became subject to workers' compensation provisom of Section 3700 al the Labor Code,I shall forthwith comply Describe the proposed work/activity in detail. Attach additional pages if necessary. Where with those provisions. structural alterations or coalitions are proposed. complete plans. specifications. details, and P as are required to be attached to this farm. Provide the make and model of any Applicant f VIEWED Ry a e to be Installed ovi complete electrical calculations for any electrical WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAG AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlN �f{s YjhyJ f�y �-c. �a•+"� L 4.�+ (�t HUNDRED THOUSAND DOLLARS (y100,000I, IN ADDITION TO THE��B��.,pp r COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE L.iAbRL2tlUl ,� m ...t In,C. k4go y- o� INTEREST,AND ATTORNEY'S FEES. "Approval Of these t •s P''�-VUeni - 1 4.CONSTRUCTION LENDING AGENCY 'I ` CI✓ 3fH (&Jr Ks'(C, NU approval of,any violation of and p sits �h � �p�RR}}�� pp��((yyrr w`•a r_ 11 �•v i-V w e I hereby offirmvnder penalty of perjury that there i{{__a consiruchon lentlng agent Pdicdte t e To a osf E1Y�E Won! t be Performed S•�d� 6 for the performance of the work for which thisr6�4M1BtI0n$Br1dlp�j♦jbyT; �� Or xpt� s9��n rr—sir Code). SECTION 5-SiGTOR� IHRi�Q Lender's Name fobsite Until co)npletl0n. I/We hereby make applicolbn for the services designated above. Lenders Address 5.CERTIFICATION Signature 4//a O 6. �/c-(fiJs Date I certify that I have read this application and stole that the above information is correct. I agree to comply with all city and county ordinances and stole laws relating "DEPARTMENT USE ONLY" to budding aonshuction,and hereby authorize representatives of this county to enter { upon the above-mentioned property for Inspection purposes. Permll Expiration Date fl Z• � L^"- ❑-APPROVED ❑ CONDITIONS(see reverse side) ❑ DISAPPROVED(see reverseslde) Cf l6-:4V S�aYlr7 k Issued By: 'S •'\'�, Date: 1�-�lif It'I C— �r•� Signature of Applicant or Agent Date Closed/Signature of District Representative Date HCD 415(Rev.07/2013) DISTRIBUTION: YELLOW-DEPARTMENT WHITE-AREA OFFICE PINK-OWNER/APPVCANT