PMT17-03193 City of Menifee Permit No.: PMT17-03193
29714 HALIN RD. Type: Mobile Home
�AACCELA—> MENIFEE,CA 92586
MENIFEE Date Issued:
0912812017
PERMIT
Site Address: 27755 JEFFERSON AVE, MENIFEE, CA Parcel Number: 329-202-006
92585 Construction Cost: $65,000.00
Existing Use: Proposed Use:
Description of INSTALL FOR REPLACEMENT OF MOBILE HOME 1026 SQ FT
Work: SERIAL#FLE220CA17-37546AlBINSIGNIA#PFS1191233/4
Owner Contractor
JOHN OPITZ .
27755 JEFFERSON AVE
MENIFEE,CA 92585
Applicant License Number:
JOHN OPITZ
27755 JEFFERSON AVE
MENIFEE, CA 92585
Phone:9099945828
Fee Description QY. Amount l$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,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_BId9 Permit_Template.ryt 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 contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and r I am exempt from Ilcensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. 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
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 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 fallowing website:
by Section 3700 of the Labor Code,for the performance of work for which ww le in o.ca. ov calaw.html.
this permit is issued.
Policy#
L- Date Ole
o I have and will maintain workers compensation insurance,as required by PRO E OWNER OR A ORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑B y 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.I have read this
numberare: 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 ente a 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
P PE OWNER OR AUIfHORRED AGENT
o I certify that in the performance of the work for which this permit Is issued, l
I shall not emolov 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 the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. WIII 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 an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o 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 TOONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant requires permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC construction
or modee ification
checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airllnes
Qua
CONSTRUCTION LENDING AGENCY oYes ❑No
I hereby affirm that under the penalty of perjury there is a construction WIII the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) D Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
theckmark(s)I have plated next to the applicable item hazardous material reporting.$)(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 itsPROPERTY 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 Ilcensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7032.5 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�Aeadead 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 D 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. ❑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
City of menifee
Building & Safeafety Dept.
DATE {�p(+p (/ PERMIT/PLAN CHECK NUMBER P I��D�I" 1�
TYPE: 3 COIUIGIET2WIALL • RESIDENTIAL O MULTI-FAMILY xD MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
�§ NEW O PLUMBIIN��G O RE-ROOF
APPLICATION NAME �wl�Gta o r*-
DESCRIPTION OF WORK Remove and Replace Mobile Home
PROJECT ADDRESS 27755 Jefferson Ave Romoland CA 92585
ASSESSOR'S PARCEL NUMBER 329-202-006 LOT TRACT
OWNER NAME John Opitz
ADDRESS PO Box 5513
PHONE 909 994 5828 EMAIL
APPLICANT NAME John Opitz
ADDRESS PO Box 5513
PHONE 909 994 5828 EMAIL johnopitz@hotmaii.com
CONTRACTOR'S NAME OWNER BUILDER? YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER /, LICENSE CLASSIFICATION
VALUATION$ �SlJ=»nj SOFT � Q2yi LSQFT
'T
APPLICANT'S SIGNATURE .� �� DATE 7
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION - CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE SMIP GREEN
INVOICE I
AMOUNT /� PAID AMOUNT OCASH OCHECK# OCREDRCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED S NO LICENSE NUMBER NOTARIZED LETTER YES =i NO
DOC#2017-0366634
RECORDING REQUESTED BY: 08/28/2017 03:25 PM Fees:$41.00
Corinhan Title Company Page 1 of 3
Recorded In Official Records
County of Riverside
WHEN RECORDED MAIL DOCUMENT AND TAX Peter Aldana
STATEMENT TO: Assessor-County Clerk-Recorder
John Opitz ••This document me electronically submitted
3370 Cutting Horse Road to the County of Riverside for reeording—
Norco,CA 92860.5103 Receipted by:TERESA#134
AFN: 329.202-00&2
TITLE ORDER NO.:7007720-DIA
ESCROW NO.:38%LH
7- ,�. 4O /O� n M THIS SPACE FOR RECORDEKS USE ONLY
7 �/f�j f�' /••Vf+ GRANT DAD
The undersigned Grantor(s)declare(s)that the DOCUMENTARY TRANSFER TAX IS:$ 80.30 County
M computed on the full value of the Uderest of property conveyed,or
_can ad on the full value less the value of llerts or encumbrances remaining thereon at the time of sale.
O is 0( FT from tax for the following reason:
1
d a da=1n1ng lax larrrt Name
FOR A VALUABLE CONSIDERATION, recelpt of which is hereby acknowledged, Jose Leonardo Nodega and Miguel
Martinez Norlega and Maria Elena Hernandez
HEREBY GRANT(S)to John Opltr, a Single Man
Ali that real properly situated In the City of Sun City,County of Riverside.State of Califomla,described as:
LEGAL DESCRIPTION Attached hereto and made apart hereof as Exhlbit"A
Commonly Known As:27755 Jefferson Avenue,Sun City,CA 92585
July 31,2017
se Leonardo Nodega
n&. ok.a
•. .dfAi 7 .
Maria Elena HannarMilk
A rrotary pubec or other aftw comple"Ids w0cate verifies only the Waft of ate InaMdual vdro sitmed the document to which tlda carafe is
eaedted OW not the trumAoss,acowraw or valift of that doamerm
STATE OF IA }
COUNTYOF Q
On IR qu s Z O/ I before me a Notary PtWc
personally paarod-TO5E jWUA ldd dtM.A ��SrnL LAAe L ua- NAQ� /y}4R•ALL IAIA �P/ Pew deL
wtioprovedto mean the badsof araelaryevidencetoba ppenm)"WwaemmntQLNe saibedmthe a trumentand
acimowtedged tome VW Bated the same in !fig(ff auul�lipptt1zzeedd capadtyiWand gtat by NeIAmAgfdsdlpnaw4dan
the Instrument the p the entity upon beheH at vMM iha pmsmttiyftttad,executed dta Instrument
I cmdfy under P/E}IIALTY OF PERJURY muter the laws of the State of Callamds that the finegotng paragraph Is true and carted
WITNESS yl doMtlal seal. _
(SEAL)
MAIL TAX STATEMENTS AS DIRECTED ABOVE
DOC#2017-0356534 Page 2 of 3
ACKCdOWIMOMi EWT
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
validity of that document.
State of Cal mia
County :of d—e S;A0 1
Onl jzv,1/sT 670/7 beforeme, 6', ,vehl /�'/ az> ra^'"�
/ insert name and title of the officer)
personally appearedrmeLpmsa �Q;ppU�L M aAJ�9rn NOli�9A,r AA90AEl�u.,Httuau�e�.
who proved to me on the basis of satisfactory eJidence to be the pefso ose nam IslaW
subscrib the within Instrument and acknowledged to meet he/ah� e4y executed the same In
his/her a authorized capacity({ ,g) and that by his/her/tf{ejy§tgnature on the Instrument the
pefso ,or the entity upon behalf of which the persop6 acted,executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of Callfomla that the foregoing
paragraph is tree and correct.
WITNESS my hand and official seal. P Bib
M*'I
Am= 19
Signature • (seal)
DOC#2017-0356534 Page 3 of 3
EXHIBIT "A"
LEGAL DESCRIPTION
The land referred to herein Is situated In the State of CALIFORNIA, County of RIVERSIDE, and described as
foRows:
LOT 95 OF ROMOLA FARMS, IN THE CITY OF MENIFEE, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA,AS SHOWN
BY MAP ON FILE IN BOOK 13 PAGE 8 OF MAPS, RECORDS OF RIVERSIDE COUNTY, RIVERSIDE COUNTY,
CALIFORNM"
Assessors Parcel Number. 329-202-006-2
I j
STATE OF CALIFORNIA NUBUSINESS,CONSUMER SERVIES AND HOUSING AGENCY MBLR:
DEPARTMENT OFHOUSING ANDDCOMMUNITY DEVELOPMENT t�
DIVISION OF CODES AND STANDARDS YL ?7
MANUFACTURED HOUSING PROGRAM
MANUFACTURER CERTIFICATE OF-ORIGIN
CHECK IF THIS IS A DUPLICATE MCO-ENTER ORIGINAL MCO NO.
MANUFACTURED HOME OR M LTIFAMILY MAN IFA Iwcn ur». NUMBER OF _
W SFD(SINGLE FAMILY DWELLING) ❑ MFMH(MULTIFAMILY MANUFACTURED HOME) TRANSPORTABLE SECTIONS.
COMMERCIAL MODULAR'
OCCUPANCY GROUP
MANUFACTURER NAME
MANUFACTURERLICENSE NUMBER;
Fleetwood HOmes,Inc. MF t200756
MANUFACTURER AODRES6: SUGGESTED RETAIL PRICE;
(9AW Jurupa Ave, (city) Riverside (state) CA MIP)92504
MANUFACTURER TRADE NAME: MODEL NAME AND10R NUMBER DATE OF MANUFACTURE:
Canyon Lake 220CL244430
NAME OF DEALER OR TRANSFEREE(OWNERSHIP TRANSFERRED TO); CAUFORNIq DEALER NUMBER OR DATE OF TRANSFER:•.
MAPLE RIDGg M mFc
TRANSFEREE DESIGNATION:
DEALER OR TRANSFEREE ADDRESS:
('4147 FOOTHILLS BLVD (�A VERNE (state) CA (zip) 91750
WOET RY CREDITOR NAME: _
INVENTORY CREOII'OR ADDRESS:
feet) (City) (State) (vP)
1: PLE220CA17-37546A P.F91191233 628 f 140 0
2 FLE220CA17-375468 PFS1191234 628 140 0
TRANSPORTER NAME
Tim Vick Transportation
�s a L'Domman
Corona CA 92882
(Stabi) Cim Sbla OUP)
DESTINATION FOR UNR DESCRIDEDABOVE
S ab
'I eerHfy antler penalty of Wuty under the laws Of Me Slele of C6111 mla thal the ebm facls ale true and CORDDL
EPaPNed al e, Riverside 4 Riverside CA
(BAG) tcoeay) (sbr>
SIONATUFMOFAUTHORQEDAGENr:
--711murm ORICINALW(PWI() FORWARD TOTHE IMMWORYCREMOR,UNLESS THERE IS NONE.THEN FORWARD TO THE PURCHASER(DEALER CFT TRANSFEREE).
COPYi(�I(YYVHITSI FORWARD TO THE DEPARTMENTAT PD,BOX len.SACRAMENTO,CA 9012-igMWITHIN FIVE(ODAY60F RELEASCOPY 2E.
OOPY3(DWDFUIROD) TO
BE RE TO THE
aY THE MANUFACTURER TO OMPANY'fHE UNITTO ITS DESTINATION.'
HOD 48&0-Slde 1(Rev.07)15)