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PMT17-03655 City of Menifee Permit No.: PMT17-03655 29714 HAUN RD. Type: Mobile Home <AACCEL/-> MENIFEE, CA 92586 MENIFEE Date Issued: 12/13/2017 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 INSTALL FOR MOBILE HOME 1782 SO FT Work: SERIAL#CAHK01271970D997509A/B, INSIGNIA#RAD1194177/8 Owner Contractor NANCYIBARRA , 258104TH STREET MENIFEE,CA 92585 Applicant License Number: NANCYIBARRA 258104TH STREET MENIFEE, CA 92585 Phone: 9512104659 Fee Description QtV Amount IE1 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_Permrt Tempiate.rpt Page 1 of 1 i i i 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 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 D 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 worker's 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this applii tion is su mitted or at the following website: by Section 3700 of the Labor Code,for the performance of work for which wwwl 'ihf o� tact t I. this permit is issued. Policy# A _ Date ❑1 have and will maintain worker's compensation insurance,as required by PRO E R OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work forwhich O By mysignature below 1 certify to each of the following:I am the property this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's 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 huild3thrk/ 'onTaOt arize representatives of this city or county to Policy# Expires enteid tified roperty for inspection purposes. (This section need not to be completed is the permit is for one / /J �� 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 to any manner so as to become subject to the CITY BUSINESS LICENSE# worker's compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's 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 D 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(SC lion or See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast Airlines Qua CONSTRUCTION LENDING AGENCY DYes ❑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) D 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 Contractor's 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 items)(Section 7031.5 hazardous material reporting. oYes ❑No Business and Professions Code).Any city or county that requires a permit to Date construct,after,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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING fRRP) 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 ❑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.ena.gov/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 Contractor's State License Law does not apply to an owner of a o 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 1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's 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. V city of Menif Building De OCT 12 20 Receiv 4 ' r �o�r�larla C � . s -- C�1 • T116 , 4 2 pF&ttj aa]Do [y I -04 jPo wer i I wq 2 5 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 LabeVlnsignia Number Weight Length Width Issued CAHKO127197OD997509A PAD1194177 30,000 66' 13'4" Oct 19,2017 CAHKO127197OD997509B RAD1194178 30,000 66' 13'4" Addressee NANCYIBARRA 25810 4TH ST ROMOLAND,CA 92583 Registered Owner(s) LC NANCYIBARRA 258104THST ROMOLAND,CA 92585371 r e A . Situs Address 25100 MALONE AVE ., s '1 'i ri 3 �• ROMOLAND,CA 92585 b �1, s lam, • Jf1 n,�..��i'� �' � City of Menl4e© '30ciiny & Satety Dept. OCT 2 ? 2017 iWIT 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 BUILDING • SAFETY PERMIT/PLAN Y • l APPLICATION Vienifee C DATE: I0 ll � T;Z RMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY .LKMOBILE HOME O POOL/SPA 0 SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL ONEW OpPLUMpB,ING 0RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK .{--1-"�Orllle Q 1 PROJECTADDRESS Mobne^- Ave, ZIP Qas�S ASSESSOR'S PARCEL NUMBER �Z I r 380 - O II_{'OT TRACT OWNER NAME an °U lb(2 C ,,, ADDRESS (( 5-sI 44f 1 J_1(_f-ect PHONE C151 Zfl/` CoA5 I EMAIL Q sriv-er -Cr-ee APPLICANT NAME ,p ` r ADDRESS ZI`50�10����//''4- q "�ee_� 1 /7 �yy� �^'� PHONE CQ! I(�--IL[,5 l EMAIL I cal l ! a ,j ( l.p\r/'-' yr --ee, 1'} CONTRACTOR'S NAME OWNER BUILDER? 4ES ONO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMB LICENSE CLASSIFICATION VALUATION$ ;f;,CM .C� / 5 LSO FT / /9 APPLICANT'S SIGNATUR DATE `` CffYSTAFF USE ONLY DEPARTMENT DISTRIBUTION A/ CIT"F MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY: PERMIT FEE SMIP GREEN PLAN CHECK FEE INVOICE TOTAL OWNER BUILDER VERIFIED 0 YES 0 NO DRIVERS LICENSE# NOTARIZED LETTER O YES 0 NO STATE OF CALIFORNIA -DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT CERTIFICATE OF TITLE Manufactured Home Decal: LBA6865 Manuracturer ID/Name Trade Name Model DOM DFS RY 90004 HALLMARK-SOUTHWEST CHARLESTON IV 27-1970D 07/16/1999 02/11/2000 CORP Serial Number Labellinsignia Number weight Length Width Issued CAHKO127197OD997509A RAD1194177 30,000 66' 13'4" Oct 19,2017 CAHKO127197OD997509B RAD 1194178 30,000 66' 13'4" Addressee NANCYIBARRA ~`! 25810 4TH ST ROMOLAND,CA 92585 Registered Owner(s) n ` { ) " ' m i� 1 NANCY IBARRA '"vy4 25810 4TH ST ROMOLAND,CA 92585 i a Situs Address ` 25100 MALONE AVE Jzz ROMOLAND,CA 92585 I o_� _t r- U � City of iwUW7ee 3viiainy 8: Safaty Dept. 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: 9887799 10192017-2 Recording Requested By DOC#2017-0339333 08/16/2017 01:53 PM Fees: $28.00 First Arrierican Title Company Page 1 of 2 RECORDING REQUESTED BY: Recorded In Official Records Madison Avenue Escrow County of Riverside Order No.5512911 Peter Aldana Escrow No.RV-7363 City Of Menifee Assessor-County Clerk-Recorder Parcel No.3273�800�-,011-3 Building Dept ✓-3 `�' ` dv---wN013 T "This document was electronically submitted AND WHEN RECORDED MAIL TO: OO 9 , q �Oa� to the County of Riverside for recording" NANCY IBARRA .L 1 Receipted by:MOLLY#056 ROMOLAND,CA 92585 e c e i ve d SPACE ABOVE THIS LINE FOR RECORDER'S USE GRANT DEED THE UNDERSIGNED GRANTOR(S)DECLARE(S)THAT DOCUMENTARY TRANSFER TAX IS$71.50 end CITY$ X computed on full value of property conveyed,or ❑ computed on full value less liens or en cum rances remaining at the time of sale. ❑ unincorporated area Menifee,and FOR A VALUABLE CONSIDERATION,receipt of which is hereby acknowledged Dennis L.Mac Milian and Maria S. Mae Milian,Trustees of The Mac Millan Family 1998 Trust U/T/A Dated July 16, 1998 hereby GRANT(S)to Nancy lbarra r a married woman the following described real property in the County of Riverside,State of California: Please see attached legal description More cnmmonly known as: APN N 327-380-011-3,Menifee,CA 92585 Date Aueust 7,2017 Dennis L.Mac Millan and Maria S.Mac Milian. Trustees of The Mac Millen Family 1998 Trust U/T/A Dated July 16, 1998 -N ✓/ �! By: ennis L. Mac Milian,Trustee By:Mffla S.Mac All rus A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document t0 which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. STATE OF COUNTY OF //'� }S.S. T� yn` n On 10 Alf f W�� before me- ' ""f� 1AA�YL(a�'�! ��yv Yivi t/ personally ap eared IvUIYAVi AM WAAAVLe- 1,1M#PkAj11AA who proved tome on the basis of satisfacto evidence to be the person(s)wh name(s)is/ilusubscribed to the within instrument and acknowledged to me that he/sh 'he executed the same in his/he ei authorized capacity(ies), and that by his/her/ i 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. LOPE TALAMANTES WITNESS my ha Notary Public-California QNli Orange County Signature (Seal) Commission l 2144387 Comm,fat Ives Fab 28,2020 Mail Tay Statement to:SAME AS ABOVE or Address Noted Below AC Engineering Group, Inc. 0910-8717-WO September 10, 2017 City of Menifee Nancy lbarra Building Dept 25810 4`h St. Romoland, CA 92585 OCT 12 2017 BMR# Received SUBJECT: GRADING EXEMPTION CERTIFICATION FOR THE LOCATED AT ONMALONE ST., MENIFEE, ASSESSOR'SPARCE NUMBER 327-380-011, RIVERSIDE COUNTY, CALIFORNIA. Dear Nancy Ibarra: Pursuant to your request, we have visited the above subject site. Based on our observation,please be informed of the following: 1- less than 50 cubic yard of cut orfill was moved in the past or will be moved in conjunction with this sites building area. 2- No more than one (])foot of fill was or will be placed in the building area. 3- This certificate is based on site visit and location of the structure marked by owner, showing on attached site plan only. If you have any questions or if we may be further assistance,please contact our office at your convenience. This opportunity to be of service to you is greatly appreciated. Respectfully submitted, AC Engineering Gr 9 FFS Si 4i 2 * 0.06 m N � 9�F C/VI By Moksudur Rahm oFCA FoaN�P Civil Engineer C692 750 S. Lincoln Ave. # 104-167, Corona, CA 92882 (951)272-8181, Fax (951)272-8794 ACE Group, 750 S.LINCOLN AVE.#104-16 CORONA,CA 92882 (951)272-8181,(951)272-8794 1 w QI 30' 25' 1 w 0 S LL O w In K O w W p IL K j z 2 m O azx 0 0 aN o O j J Q ~ cQ 0- G z — — — — — DRIVEWAY N 1587 �k,-ENGI �C. NFF� 3 c� •.1:�h",AJV \-�� z STATE OF CALIFORNIA DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT DIVISION OF CODES AND STANDARDtity cf Menifee e Building Dept OCT 12 20V Cash Receipt ^ o Customer: Date Received 4 0 7 NANCY IBARRA Media# 25810 4TH ST Reference ID LBA6865 ROMOLAND, CA 92585 Amount_ $116.00 Date DTN Amount Due 10/4/2017 9887789- R/O Transfer-Private Sale $116.00 Previously Paid: $0.00 Paid Today: $116.00 OTHER DTNS - C; .ODFS AND S:.: DTN - . CASAS 2 https://casas2prodwlext2.hc&ca.gov/casas/cas=Application/create... CASAS 2 Welcome, NANCY IBARRA • logout Codes & Standards Automated System Home Update Profile Update Password Formal Title Search Unit Search Identifier LBA6865 Search Select Unit Identifiers Manufacturer SITUS Address Decal No.: LBA6865 Manufactured Date: 823 W VALLEY BL, BLOOMINGTON, ! MCO No.: 8645621 07/16/1999 CA 92316 (SAN BERNARDINO Serial No.: Manufacturer: COUNTY)CAHK01271970 HALLMARK- SOUTHWEST CORP v CAHKO1271970D9975098 HUD Label: RAD1194177, Trade Name: RAD1194178 CHARLESTON IV Model: 27-1970D Unit Type: Manufactured Home Version 2.0.92 1 of 1 10/10/2017,2443 PM --;5-ME OF CALIFORNIA- DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT ' CERTIFICATE OF TITLE :. MRnu(6cturcd Fiumc Decal No: LBA6865 �— Manufacturer Wthlame Trade Mama Model DOM DFS RY Exp.Oa» B0004 HALLMARK-SOUTHWEST CORP CHARLESTONIV 27-19700 07116/1999 02/11/2000 Serial Number Labeelml9na Number Weight Length Width SPC SCC Exempt U16 Typo P CAHK61271979D997609A MD1194777 10,000 66' 10'4' 36 SFO LP7 CAHKO1271070DO976099 RAD11"t76 10,000 06' 13'4' Issued ,/otal Fee*Paltl F ' MW 4,2000. $67 00 Addressee C LL MESA MOBILE HOMES 105 S EL CAMINO REAL `?. SAN CLEMENTE, CA 92672 44— ' Registered Owner(s) MESA MOBILE HOMES f 105 S EL CAMINO REAL SAN CLEMENTE, CA 92672 a Situs Address 823 W VALLEY BL BLOOMINGTON, CA 92316 Z5 r,F OCj n � �n+'► � g g-7-� g 9 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, 7` i is .f Housing and Community Development - Codes and Standards en and Tilling Program .2111,Sacramento,CA 95812.2111 }9224 r(000)952.8356 hcd.". ov MULTI-PURPOSE TRANSFER FORM PLEASE COMPLETE ONLY THE SECTIONS THAT APPLY AND SIGN BOTTOM OF FORM UNIT DESCRIPTION -i I/-� m Decal(License)No.(s): e Serial No.(s):t"nTFC H KDIZ-1 t 2�0 T ►�9��� TOR AND ARRON MONOXibE CERTIFICATION INVe,the undersigned, hereby state that the manufactured home, mobilehome,or multifamily manufactured home described above is equipped with a properly working, operable smoke detector in accordance with California Health and Safety Code Section 18029.6 and a carbon monoxide detector in accordance to California Residential Code Section R315. IdYES ❑ NO PARK PURCHASE FE -EXEMPTION The registered owner of the above-described manufactured home/mobilehome that is located on private property owned by the registered owner is exempt from payment of the$5 Park Purchase Fund(PPF)fee(Health and Safety Code Section 18114.1). If you feel you quality for the exemption,complete the following questions: io • Do you(the registered owner)own your manufactured home/mobilehome? E YES ❑ NO Do you(the registered owner)own the land your manufactured home/mobilehome is located on? YES ❑ NO DESIGNATION OF CO-OWNER TERM _ We request the Department of Housing and Community Development to register our ownership interest in the unit described above with the following co-owner term: (READ CAREFULLY AND CHECK ONE BOX.) ❑ JTRS (Joint Tenants with Right of Survivorship): Upon the death of a joint tenant, the interest of the deceased party passes to the surviving joint tenant. The signature of each joint tenant is required to transfer or encumber the title ❑ TENCOM AND (Tenants in Common with the names joined by the word AND): Each tenant in common may transfer his or her individual interest without the signature of the other tenant(s)in common. The signature of each tenant in common is required to transfer full interest in the unit to a new registered owner or to encumberthe title ❑ TENCOM OR(Tenants in Common with the names joined by the word OR): Any one of the tenants in common may transfer full ownership interest in the unit to a new registered owner without the signature of the other tenent(s) in common. The signature of each tenant in common is required to encumber the title. ❑ COMPRO (Community Property): A unit may be registered as community property in the names of a husband and wife. The signature of each spouse is required to transfer full interest in the unit or encumber the title. ❑ COMPRORS (Community Property with Right of Survivorship): A unit may be registered as community property in the names of a husband and wife. At the death of one spouse, the decedent's community property interest passes to the surviving spouse without administration. The signature of each spouse is required to transfer full interest in the unit or encumber the title. INVe further agree to indemnify and save harmless the Director of the State of California, Department of Housing and Community Development, and subsequent purchasers of said unit, for any loss they may suffer resulting from registration of the above described unit in California,or from,issuance of a California Certificate of Title covering the same. INye certify r pe Ity of perjury under the laws f t e State of Qalif is that the foregeigg is true and correct. Executed on /at ✓f �1 A Oare City Sate s4naturs Signature Srgnattae Signature PHONE ��/ aia �59 E-0.1A1LAp0aE55: HCD RT 476.6G Side 1 (Rev.07116) Ci v o o3D r ` S TAX CLEARANCE CERTIFICATE �'n(O��6. m.amwn.�embrr 52889 m r. o © Mobile Home ,. El Floating Home County of San Bernardino Scnvl Numh.•r N.ufLYvmbcr lhwl7:umhr CF human CAHK0127l970D997509A/8 - LF3AG865 �r - i� -- ' o. t lzuhon rJlfwrr - - {uu w'tTvratLimhrr ;, "0 `�* 823 w VALLEY BLVD un, X 131,00INIY970NCA92316 Name MESA NIOBILE HOMES Name NANCN MARtxA Address 105 S.Et.CANUNO- r i! ---'�,%, Address 25100 MA LONE AVE --g? SAI\C[Ebl6\TECA16 M %r FiON7OLA1DCA9258S $�S h _ Rmvarag0� NANCY 1BARRA yyl� .•�f `''tt j v)„4 Fuf r l+oMlt Noma Lpcm, Year ems` f� ,�j� ROMOIJ.\D CA 92585 _ qi , . ,_ d - N I hereby certfyabaCEhtS f Uow-a een.psIP:t _.r.- me a f h� Dehnqu _ Propertyta15gablo- Ifie�oete .: fed thro'I�ttthe�fiscalygar:,to ,' r P. security,deposltfor payment,oJ'tile property taXe;tgi the(iscat ,e t6 i y - t t��:4,t,., F IF ,• o'taxes due orpayableaLthtsttme7NSll)FFI Nti. U7 3 ori -s-1w3 tg . z �^��9�. This certl Void onkl"id�a There may be a sup Sessrt>�ntpot co is a Certificate which may create an additional bill. untyTaa Collector te Z by R. Da (inuodfiY� - . .r