PMT17-03705 City of Menifee Permit No.: PMT17-03705
29714 HAUN RD. Type: Mobile Home
71CCELJ!? MENIFEE,CA92586
MENIFEE Date Issued: 10/13/2017
PERMIT
Site Address: 30102 PUERTO VALLARTA WAY, Parcel Number: 360-014-007
MENIFEE,CA 92584 Construction Cost: $2,975.00
Existing Use: Proposed Use:
Description of INSTALL PERMANENT FOUNDATION ON EXISTING MOBILE HOME,65'x 24'SERIAL#:
Work: A20620/1320620 HUD INSIGNIA MH273281/2
Owner Contractor
SUSAN SCHWER PERMA-BRACE CONSTRUCTION
30102 PUERTO VALLARTA WAY 21690 VINE ST
MENIFEE, CA 92584 WILDOMAR, CA 92595
Applicant Phone:9512459373
MENIFEE, CA License Number:636757
Phone:9512459373
Fee Description Qyt 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_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 eff/gctt}. �� the following reason:
License Class C 4 aII License No. V J 5-7 By my signature below I acknowledge that,exceptfor my personal residence
Expires " - — g Signature in which 1 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 K 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 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 application Is submitted or at the following website:
by Section 3700 of the Labor Cade,for the performance of work for which www.legirrfo.ca.gov/calaw.htmi,
this permit is issued.
Policy# Date
❑I 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 o By my signature below I 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: ( 1 application and the information I have provided Is correct.I agree to comply
Carrier �0.F-�V. with all applicable city and county ordinances and state laws relating to
t� building construction.I authorize representatives of this city or county to
Policy tl 4911 -J 'e� / Expires `— U enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑Icerlffy 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 4
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 foyyy��}tttJ1f�y�Yr'�th comply with a 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 ast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES rguidelines
CONSTRUCTION LENDING AGENCY Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within SD00 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
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 Ayes o /
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 p�OpERTY 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(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.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOG-424-LEAD(5323).
Code;The Contractor's 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 provingthat 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 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.
- enitee
DATE: PERMIT/PLAN CHECK NUMBER '1-0310
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY '3 MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL O MECHANICAL
O NEW C PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK n 4016/4 F (){/( A. 9 _ v/Pb
1 Imo_
PROJECTADDRESS 3o �� yec,- o VGA //(:qe,J,
�J AL(I ZIP ('(/
ASSESSOR'S PARCEL NUMBER 3 � 7Q- 0/ - 0? O -7 TRACT 7 7 3
OWNER NAME ff11SL,)S ci S Eck w eei _
ADDRESS C/ D 2, L)e&/- J Q /
PHONE Z136l EMAIL
APPLICANT NAME Ol n M o ylkS
ADDRESS :sr
PHONE EMAIL
CONTRACTOR'S NAME CZC'(-,, . 4 OWNER BUILDER? O YES4 NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATFLICNUMBER �LP 7$7 / LICENSE CLASSIFICATION
VALUATIONS �<' 2�! ?S - SQ FT f S Co d L SQ FT
/ APPLICANT'S SIGNATURE ' DATE O "
F USE ONLY
DEPARTMENT DISTRIBUTION CITY MENIFEE BUSINESS UCENSE NUMBER
D
BUILDING PLANNING ENGINEERING FIRE ACCEPTE BY:
PERMIT FEE ��,. SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE If NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 925B6951-W97i6nifee
www.cityofinenifee.us Building &Safety Dept,
OCT 13 2017
MAMEB sef, wp/e PHONE ) 93
JOB ADDRESS 3 0 j o ;2-
TRACUPARCELM" LOT 3-7
ASSESSORS PARCEL NO- 3 6 o 'V lq—oa�
REAR PROPERTY IMM
07 /
170
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CITY OF MENIFEE
BUILDING AND SAFETY DE RTME!INT
PLAN APPROVAL
REVIEWED BY WE
CgAS%;j,eA tn ho a permit fnr,Of 2n City offtenif G
approval of,any violation of any Provisions
regulations-and ordina.nces. This set of approved plans must he kept on the OCT 13 20LI
jobsite until completion, STREET
Received
STATE OF CALIFORNIH-BUSINESS.CONSUMER SERVICES,AND HOUSING EDMUND G BROWN JP.,GOVEPNOR
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
Title Search
Date Printed: Jul 7,2017
Decal#: LAX3136 Use Code: SFD
Manufacturer: SILVERCREST Original Price Code: AFJ
Tradename: SELVERCREST Rating Year.
Model: SIGNATURE MARK Tax Type: LPT
Manufactured Date: 01/01/1976 Last ILT Amount:
Registration Exp: Date ILT Fees Paid:
First Sold On: 03/01/1977 ILT Exemption: NONE
Serial Number HUD Label/Insignia Length Width
A20620 MH273281 65' IT .
B20620 M0273282 65' 12'
Record Conditions:
Voluntary Conversion to LPT Q�
Park Purchase Fee Exemption granted
Registered Owner:
roll*-
SUSAN s
30102 PUERTO ERTO VALLARTA
MENIFEE,CA 92594
Last Title Date: OS/20/1996
Last Reg Card: OS/10l1996
Sale/Transfer Info: Price$56,750.00 Transferred on 09/11/1995
Sites Address: 30102
MENI PUERTO VALLARTA
MENIFEE,CA 42584
Situs County. RIVERSIDE
Inactive Decal/DMV:
DECAL AAZ7682,DMV N11553,DMV NJ1554
Legal Owner:
EMPIRE AMERICAN REALTY CREDIT CORP
2300 E YATELLA AVE SUITE 450
ANABEDAv CA 92906-
Lien Perfected On: 12/29/95 12:00:00
***END OF TITLE SEARCH*** Page Number:l G�rw
RECORDING REOIESTM BY 299101
l'mr&Z Regimmend By WCERMFORRECORD
AM Ne1Ba RECCROED MAD.TO ATUDOMM
NAME r ,
STREET awn echmW IR
AID SEP 116%
ASS3MO2 Weata Vaileeta Shy Rati6ea, f1 92584 lk.egreWlthaerCITY
TATEZIP -ReaotlYr araa�'aa�
dew-om-o
�c THIS SPACE FOR RECDROERs use rnFl••
Gll/'11\1 CEO The undersigned Graetarn 60CWWS, that "DOWMENTARY
TRANSM TAX IS: i 62_7D Courny i C':V .
.Y'SFSSOR'S PARC'L•l. li0:qs7-2µ-007-0 XW=p~on the fell vowof the mMrest of prcavtV J 1•
Tam 054-M conveyed or
TITLE ORDER NO: 544552-5 eomp:tea an"a full wake ass the va+ue of :e"s o•
encumbra . r9eax" thereon at the 1L of Sate
f3C•RO%V \O: 416" OR transfer 6 a mpt from ax for the folto"r HMM
FOR A VAl LIAmE CONSDERATICU reCeryt Of which is hereby achmaxledgeO
Grarr lseow V. NDM. a taidor
hereby GRANTS,to
t Grantea/auyar SEM 9COM, an uWartied efottaa
1 all that real Mooerty situated in tha mijioorporaT,ed ales of R®ifce
hname of city or unrico.porated area•
Co my of Rivermi& Sate of Ca/.fc,,w xscncea as
�1 IOi 37 OF Ma NO. 4439, AS SH7lt m FIM Li WN 73, PAM 61, 62 AND 63 OF LAPS.
J` -gym OF RIVWMM TUINTlY, COSR7 M-
>b
1� n
7ated June 30, 1996 ✓�ii�.d
V. fl]YHi
STATE OF CAgWAl ass
COUNTY O
Onlwrefm e✓ .a�tl
personally
,
personally known 10 rrhe Wr proved to me On the
bass of satisfactory evdnncel to be the
persoNsl whose mnalsl hs4are subscribed to the
within wstnawx. and acknowledged to the tha;
helshert ey e. to same N hwherrthatr
authorized and diet by rlthehr
sgnahyefsl an hmatarhent the per I or the rA
entity upon F of which eh sr aced. Q c, olouw
executed the in am tooetuae D
WITNESS my ad ffict �al. u Mth,i4" ura Build nY Menifee
9 Safety Oept.
Signature IThis area fcr official notary Beall OCT 13
MAL TAX
STATEMENTS TOt IG®n gaimimr, 30102 Fuerta Vallerta My, misi£ee, CA 92584
NAME AODRE55 CITY. STATE a ZIP 'R e c lived
e d
..:___ •:n TICS FORM p.FMS ED COURTESY OF ORANGE COAST TITLE COMPAMES _
Branch:S06,User:4001 Comment: Station Id:AYM7
DOC#2015-0282466 Page 2 of 2
EXHIBIT A
Legal Description
The land hereinafter referred to is situated in the City of Menifee,County of Riverside,State of
California,and is described as follows:
Parcel 1,of Parcel Map 6450,County of Riverside,State of California,as per Map recorded in
Book 19,Page 21 of Maps,in the Office of the County recorder of said County.
APN: 360-220-001-2
City of Menifee
Building & Safety Dept.
OCT 13 61i
Received
RIVERSIDE,CA Page 2 of 2 Printed on 9/2920171:12:49 PM
- -- Document,DD2015 282466— --------- ------- -_ --_—-----
• p JOB ADDRtss OwNEN -
= - DEPARTMENT OF R 111LDWG AND SAFETY
COUNTY OF RIVERSIDE �+
°'� USF OF lFRMIE Y NO. bAT [WAIT NO. _
'' MOBILEHOME MOSILEHOME INSTALLATION — 100! 106634
_ INSTALLATION PERMIT cOMm DSF OFFICE
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a pESCtl PiION
FEE FILING S 10
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-- ' PERMIT FEE S � R a _
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ESCHSW CO ANS NCN Ofi1CF �[
TOTAL FEES » T eQ
CASH D CxECR MO.E3 N.C.❑ ^ wts CITY zip CODE
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City of Menifee
Building &Safety Dept.
OCT 13 Z0t1
Received
DEPARTMENT OF BUILDING AND 5AFEfY SOR ADDRESS `OV7NER-
000N:f OF RNER.SEOE __-.. - J ... •~~, _ ►
USE OF fromir V, Np DAT1jF PIPAIITNO.
M0$ILEHOME \` MOBILEHOME INSTALLATION f
wsTALLdi_lOK PEl2AttT cOMMo TT �� rj�- � asT -Fa
DESCD - '
nLlwDFIE
PFTLNFT SEE S #MO F -
FIN ^D T �( 'N OR
�f7EINSrCTgN SEE f -:
E W Aw IWANCH OFFICE
TOTAL•FEE
S _
CASH CHt.Cx .qmo-O - N.C. XDDUVSCw na• COof
CONVACTOR - - -_-
1 -.— 0
IMEE NiMEDF�,., n o+ -
tj{,_. 4 s
+3'..�'-. f0_r V ._. J- ' `r llkl000 - 1 l..t 7' •.tom
Cih" AF CT -ZIP COPE
SYr7DiEEE STRULT mFAX IF
LICENSE
310 C(;ro�f3
�DRAOW6 rmw R .
71115 FERMI SHAI .ffCOfAE VOID If WORK IS NOT C04wENCED WHHIN 'a DAYS.
CESSASIDN Of WM FOR VA OATS SHAL L ALSO CAUSE 1tg"l TO ktcomt VOID.
YTILFTIEk PERMIT R v ! HLUIY ACRE(T"AT ALL WORK IN GOt•HECDON VAIN 11115 FERMIf WILL Y E DONE
## WMIFE-i!O. IN ACC:MDAHCE WY:H THE LAW:CFRNER COUNTY
51Df COY AND THE STATE Of
7[[LOW^AU011 CA11fOW1A I ALSO ACEEE 70 CAUT COMPfNSATICH INSLIUNCE UPON MY :C
7 EMPLOT(•S. COMFIIANCE VAIK 114E SAWS Of THE STATE OF CAUfO1HU COVOWC
01EDII-GINNIC CavTRACTOES O ALTO ISUARANTEEa -
ftlJK-gELD OFFICE 11[RERY C[SIIEY 11+A1 illL IN UAL VWO FAIPASED THE PLANE AND
f"CiFICATIONS HAS DDI.E SD vi ACCORDANCE WITH SIECI�D+I SSAS Of 114E
RPE-d FO-75 000F^HELD fUSVESS AND PMfLSS:ONS CODE Of Till STATE Of CAUSORNIA.
City of Menifee
Building & Safety Dept,
OCT 13 2012
Received
. .• _ INSPEC TarE necaxo REINSrEQgN A"ROVAL A ED
_ = BLDG PERMIT DATE 1 BISF'4CIlOR r: ;,{
AND:REQUIRED APPROVALS -
PLUMBING •_ - _ _TITLE,25
SYSTEM WAtER EDSTHj um -
.. - SOW w.
1._it'== -[RUUNAGE PIPING SYSTEM. tat E
6: ' FUEL GAS A1WG-
1'• ELECTRICAL
!f _i CONDUtYD0.1NSUlwAON .5m1G ".1-4
C--_ :4_...'YONQ'COFIDUCT�f.ON1WUtlY -
[`y�
.. :..:_ SUPPORT SYSTEM? FOOTINGS W -I - - •, ;I
to; "eGL-kJMN SUPPMTr"
�•.: cal
•<, ' lt�: CLEARANCE s,
RIVERSIDE COUNTY DEPARTMENT OF BUILDING AND SAFET`-`
CORRECTION NOTICE
ADDRESS: ��0 Y DATE: r
MOBILEHOME INSTALLATION INSPECTION
� Plumbing
1. Water distribution system t`ki
2. Drainage Piping system
Vie. Cr+%:ima Terns- v
f
4. Fuel gas piping
Electrical:
5. Conductor insulation
i—
6. Bond conductor continuity 7. Fixtwes and appliance banding rr
E
Support system:
— 8, Faosings � f
= 9. Jacks or piers
10. Coluonupport
.p
E
C
(inspector)
Correct the above circled items, then obtain a Mobilahtmtt Insto n .Rein E
spection Permit (as per-Title 25), then call for your reinspection_
--
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
MOBILEHOmE INSTALLATION APPLICATION
DISTRICT
TRAILER PARK. x
z.
INDIVIDUAL LOT I ,_
NAME OF PARK v _
ADDRESS IOC. P O /a��a/?�- TELEPHONE NO
Kill /-�'
OWNER/AGENT 1'�I� N tinr 5 .'.
SPACE NO
ADDRESS�30 P� r�fc) 1rr/a//l�0.fT�
MOBILEHOME INSTALLER
I Mbl7 M �lloil F?
?ELr^HONE un 77733�0
-- ADDRECC
n gSD3c�:?
LnSiHLLCriS wiiTtn�T^PIS LICENCE Nn c_
u` g � WIDTH �. LENGTH(LESS HITCH) dr`.
DATE OF MANUFACTURE OF MOBILE 6
_z i3rC.fP
NEW }C--kfWCAYE 11 mANUFHCTURER .S Y
MODEL N u *tLgTATE INSIGNIA: U-unit s j��� X-unit �3�_�
` SERIAL NUMBER
ROOF LIVE LOAD 2V WIND LOAD �� £
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- APPLICANT_ '^ >o 'a NPPL11 Hry 1 i
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PARK OWNER/MANAGER PARK OWNER/MANAGER
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(PRINT NAME) (SIGNATURE)
..� e � � +� � s ■ e +� s . eree +� seere er ♦ e +� ee +� • e • eereer +� * � * * � .;_
COMMUNITY AC ZONE CASE NO r
j LEGAL DESCRIP ION �eY 3 7 ..emuy3 �� 7'a 6
SETBACKS: FRONT o;L a SIDE -� ( S� REAR fJ ".
DATE - SIGNATURE OF LAND USE OFFICIAL
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