PMT17-03654 City of Menifee Permit No.: PMT17-03654
29714 HAUN RD.
<-ICCELAk? MENIFEE, CA 92586 Type: Mobile Home
MENIFEE Date Issued:
12/1312017
PERMIT
Site Address: 25120 MALONE AVE, MENIFEE,CA Parcel Number: 327-380-011
92585 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of PERMANENT FOUNDATION FOR MOBILE HOME 1782 SO FT
Work: SERIAL#CAHK01271970D997509A/B, INSIGNIA#RAD119417718
Owner Contractor
NANCYIBARRA
258104TH STREET
MENIFEE, CA 92585
Applicant License Number:
NANCYIBARRA
258104TH STREET
MENIFEE, CA 92585
Phone:9512104659
Fee Description ON Amount($1
Manufactured Permanent Foundation 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_Pernil_Templale.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 D 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 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
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legallysell 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 appli tion is su mitted or at the following website:
/
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.l i f ov a a t I.
Policy# Date /5
D I have and will maintain worker PROE ROR AUTHORIZED AGENTs compensation insurance,as required by "
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below l 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
number are: application and the information I have provided is correct.I agree to comply
Carrier with all apoicable city and county ordinances and state laws relating to
building stru 'onTOt orize representatives of this city or county to
Policy# Expires enter the b id itiffed droperty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
/r
dollars($100)or less Date
PROP WNER 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 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. 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 15 ❑Yes O No
UNLAWFUL,AND SHALL SUBJECTAN 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(SCAQMDr7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines
Qua
CONSTRUCTION LENDING AGENCY oYes ❑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 D 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 Lawforthe reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable items)(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(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 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 ❑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:
❑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 role please fill out the RRP
Acknowledgement.
r
BUILDING
& SAFETY PERM IT/PLAN CHECK APPLICATION
lMenifee
DATE: I O I ( � RMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY .MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW OPLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK MOFj I e jQ
wrorl-r
PROJECTADDRESS Ma to n�le Ave, 1 ZIP
ASSESSOR'S PARCEL NUMBER w y1- 3C7b'"Q ��-%T TRACT
OWNER NAME 0 C(n('U I
� Q ._(_,,,
ADDRESS 57gj "T ' 1 1 S I f eet pp
PHONE 951 2,104(P561 EMAIL
APPLICANT NAME �
ADDRESS /�2�8 10 L p-)
PHONE Cam-(,ak(D-�J 5 ( EMAIL
CONTRACTOR'S NAME OWNER BUILDER? XYES NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE L(IIC NUMB LICENSE CLASSIFICATION
VALUATION$ 1'bCC1: 'CC SQ,FT LSO FT
APPLICANT'S SIGNATURE DATE
v
CITY STAFF USE ONLY {
DEPARTMENT DISTRIBUTION /ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
�'✓J✓yJ.I;liy0�1%7?:11;:=3'.ii;
U
City of Menifee
Building Dept ��}} --k
OCT 12 2017 "
Received
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BIl1LDING AND SAFETY DEPARTMENT C�
PLAN APPROVAL
I � 1 2017
REVIEW o4 - 1
OC 'Approval of these plans shall not be cgnstrued to he a permit for,or an
S� approval of,any violation of any provisions of the federal,state or city .
Tq n r regulations and ordinances. This set of approved plans must be kept on the
I�J jobsite until completion.
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STATE OF CALIFORNIA-DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
_ CERTIFICATE OF TITLE
Manufactured Home Decal: LBA6865
Manufacturer ID/Name Trade Name Model DOM DFS RY
90004 HALLMARK-SOUTHWEST CHARLESTON IV 27-1970D 07/16/1999 02/11/2000
CORP
Serial Number Label/Insignia Number Weight Length width Issued
CAHKO127197OD997509A RADI 194177 30,000 66' 13'4" Oct 19,2017
CAHKO127197OD997509B RAD1194178 30,000 66' IT 4"
Addressee
NANCYIBARRA
25810 4TH ST
ROMOLAND,CA 92585
VT
Registered Owner(s) g ri
NANCYIBARRA l {
25810 4TH ST
ROMOLAND,CA 92585 ti i' xtnV' t
Situs Address �' , � �✓ .'." -A �., ,
25100 MALONE AVE ,�� a
ROMOLAND,CA 92585
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City of M4l ir;':>o '
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6 Sais? • : . .,
OCT
IMPORTANT
THE OWNER INFORMATION SHOWN ABOVE MAY NOT REFLECT ALL LIENS RECORDED WITH THE
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT AGAINST THE DESCRIBED UNIT. THE
CURRENT TITLE STATUS OF THE UNIT MAY BE CONFIRMED THROUGH THE DEPARTMENT.
DTN: 9887789 10192017-2