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PMT14-01369 City of Menifee Permit ND.: PMT14-01369 29714 HAUN RD. Type: Residential Plumbing riCCE-A MENIFEE, CA 92586 MENIFEE Date Issued: 05/29/2014 PERMIT Site Address: 31755 COUNTRY HAVEN LN, MENIFEE, Parcel Number: 357-110-049 CA 92584 Construction Cost: $6,793.10 Existing Use: Proposed Use: Description of REPLACEMENT OF LEACH LINES Work: Owner Contractor DAVID HUNT LE PEW INDUSTRIAL INC 31755 COUNTRY HAVEN LANE 41735 ELM STREET#303 MENIFEE, CA 92584 MURRIETA, CA 92562 Applicant Phone: 8889615971 ' LE PEW INDUSTRIAL INC License Number: 988020 41735 ELM STREET#303 MURRIETA, CA 92562 Fee Description City Amount l$1 Sewer 1 150.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 $178.00 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 building 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 I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions Professions Code and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class e y License No. 00 O who builds or improves thereon, and who contracts for the projects with a Expires/4 Signature I il 104 4 licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for the ❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason: I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have permit is issued. # built as an owner-building if it has not been constructed in its entirety by licensed Policy contractors. I understand that a copy of the applicable law, Section 7044 of the ❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Cade,is available upon request when this application is section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htti),//www.loginfo.ca.gov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier Property Owner or Authorized Agent Date Expires Policy# ❑ By my Signature below, I certify to each of the following: I am the property Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this (This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to enter the above- 1 certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes. shall not employ any persons in any manner s as to become subject to the workers' compensation laws of California, an a ree that if I should become subject to the workers'compensation provisi s f Se on 3700 o e Labor Property Owner or Authorized Agent Date Code, I shall forthwith comply with those rov io s. 1 City Business License# Date;�T� Applicant; WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES El NO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE? agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE 3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME: License Law for the reason(s)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A Any city or county that requires a permit to construct, alter, improve, demolish, D NO SCHOOL? or repair any structure, prior to its 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 License Law(Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING El 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I EPORI'ING. compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's Slate License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). CITY OF _"_IL' NI EE PLCK No: Permit No: 29714 Haun Road Building of Safety Dept. Date: Date: Menifee, CA 92586 Phone: (951)672-6777 MAY 2 9 2014 Amount: Amount: Fax:(951)679-3843 Ck#: Ck#: Received Building Combination Permit To Be Completed By Applicant Legal Description: Planning Case: F: L: Rt: R: Property Address: „A Assessor's Parcel Number: .3 71�� �oa./a /laYtii 2.v. !�[w/ifs� - //O - a� Project/Tenant Nam e:,/U� Unit#: Floor#: y( 14 T Fjgr� N Name:.U/9(///J �Ui✓� P7Se/•o ss/—� / Fax No. Property Ad-dress: Owner 7S S' O u.✓T�t y4f y Ls✓, Unit Number I Zip tnZFe G f� Email Address: Name:^ T D / /� Phone No. �� /�.a-w1N ✓SY'✓i.c/ nc. �'y'�/•.59�/ Fa� 'ora�603 Applicant A ress: E� s 9O Unit Nu r Zip Gpde J 3 7z�sG� Email Address: /Nfo Q Le �✓z�d�s��•v/. Co � Name: Phone No. Fac. , x N_e rev+ + S,r�p✓S�I�tL Contractor Address: ` A City State Zip Code Contractor's City Business License No. Conlra5t�r�s Cily State of California License No. Classification: (i Number of Squares: Square Footage Descripti of Work: e-n O Ap ica is Si lure Gl�! Dale: To Be Completed By City Staff Only. Indicate As R-Received or N/A-Not Applicable 5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gan,Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11) ElFoundation Plan ❑ Cross Section ❑ Plumbing Plan El Structural Calculations ❑ Single Line diagram for elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan I ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration' Addition" Means/Methods Work Type: Repair" Retroflt* Revision to Existing Perni Required? YES NO Proposed Building Use(s): Existing Building Use(s): #Buildings: #Units: it Stories: Will the Building Have a Basement? V of N Bldg. Code Occupancy Group Indicate Indicate if Indicate all ea-tech.Haz.Zone Al Project Sprinklin d YES or NO Completion: Construction that apply: Coastal Zone Type(s): C Of O YES or NO Noise Zone Required? Listed on Historic Resources Inventory CITY PLANNING STAFF ONLY APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit Special Good.Bldg. Offcr.iAplp,.vM Expedite Project(s): Child Care City Project Green Building Landmarki I Affordable Housing For Staff Use Only Buildingl5afety Permit Specialist Cily Planning I Civil Engineering EPWM-Admin ITransporlalion Mgmt. Rent Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY City of Menifee Building & Safety Dept. MAY 2 9 2014 Received Ly, COUNTY OF RIVERSIDE ENVIRONMENTAL DEPARTMENT OF ENVIRONMENTAL HEALTH OWTS INSPECTION CARD FAPN: 35 7- 1 (0 —D4--q ON No.: EHS No.: Site Address: i 7 S S in t o (,a n 0 cn l�Q—� l To Schedule an Inspection Please Call (951) 955-8980 OWTS Components Date Re-Inspection Inspector of Ins ection Date Initials Se tic Tank e ch Line ged— See age Pits Se tic Tank Abandonment er Lateral D-Box Risers Effluent 1 ers Flna Inspection TO BE POSTED A T JOB Sl TE IN PLA IN VIEW Please Note: ❑ If this box is checked, upon approval of your OWTS installation, please call the Department of Environmental Health at (951) 955-8980 and ask for the Accounting office to reconcile fees prior to calling the Riverside county, Building and Safety Department for final inspection. Please give the ON number above when you call. Rev.Mar.20141s QMTIy- 0130q m 5 't L O � •c { m m o ro o F \ i vcmo ¢ o ^ m gv3ro rn ro a) 3 _ I m $^ `� on N N a) V 6 3, � a v � � o -a' m 5, 0 xI d - . L ,' .. gyp• �' d a m > Cp CD CD v !D m (P v m ON J r dm� fIj O CI OF MENIFEE 6 ILDING AND SAFETY DEPARTMENT P AN APPROVAL y VIEWED BY �� �� CD 3 �7 DATE 0 (D N 900 �.. CO m CD *Approval of these plans shall not be construed to be a permit for,or anCID < �, approval of,any violation of any provisions of the federal,state or city QCD o v o regulations and ordinances, This set of approved plans must be kept on the a jobsite until completion. COUNTY OF RIVERSIDE I L� DEPARTMENT OF ENVIRONMENTAL HEALTH SW M Lot No. APN:ASSESSOR'S PARCEL NUMBER 6L ND USE APPLICATION 3I S 7 - 110 - d ON# IN# H LMS# c k EHS#� SECTION A AGENT,CONTRACTOR ADDRESS CITY TELEPHONE# OWNER ADDRESS CITY TELEPHONE# JOB PROPERTY ADDRESS CITY Thomas Brothers©Map# .j LOT SIZE WATER AGEN�LUSE OF PERMIT t j SECTION B *FINANCIAL RESPONSIBILITY NOTE:Pertaining to Deposit-Based fee Payments-Fees placed on deposit are intended to pay for System review including approval and installation.The project owner or j applicant named in Section B will be subject to billing requests for additional monies should fees deposited to that point be insufficient. At final approval,the project owner or -� applicant named will receive a final statement and notice of any final fees due or refunds due(as applicable). ROP Fees:For Alternate Systems,renewable operating permit(ROP)fees will be due upon finalization of the project. ROP fees will be issued to the project owner or applicant named in Section B. -i SEND ALL BILLING MATTERS TO THE CLIENT OR ENTITY LISTED BELOW: RESPONSIBLE CLIENT/ENTITY NAME MAILING ADDRESS y CITY/STATE ZIPP,J/1A1, TELEPHONE# j.. 00,f Applicant Signature: /" Date: .j Below-For Office Use Onlyj SECTION C CHECK BOX IF REQUIRED If any box is checked,this application shall be considered rejected until the information is provided and the fees paid. Re-submittals later than 90 days after date noted below may require repayment of fees. -{ ❑ Holding Tank Agreements Required ❑ Floor Plan and/or Plumbing Layout Required ❑ Certificate of Existing OWTS Required ❑ Special Feasibility Boring Report Required -q ❑WQCB Clearance Required ❑ Detailed Contour Plot Plan Required(1 to 5 foot intervals) { ❑ Soils Percolation Report Required PRE SITE INSPECTION REMARKS INITIALS&DATES Q.Y�1 f j SECTION D Soils Percolation/Boring report by Project# Date Type of System: ❑Ne ❑ Replacement ❑ Existing #Fixture units Septic tank Cap. Soil Rate ++ ❑ Pump ddition ❑ATU ❑ Connect to Sewer # Bdrms 1200 S !5'(1 Sq. Ft. Bottom Area Total Linear Ft. Sidewall allowance_ft Rock/ actft running foot. { 5co /6b Tested Depth Maximum Trench Depth 1 Install Lines Z ft long 3 ft wide with min. below Arm..-, 0 lastic Chambers Leach Lines/bed s ecial deal n for slope Applicable ❑ N/A ❑ Overburden Factor: { Pit Diameter No. Pits Pit below Inlet(BI) Pit Total Depth Max Allowable Depth Well Review Approved by: (Signature) 777f111JI CONSTRUCTION/INSTALLATION INITIALS&DATES 1 3 SECTION E + This Application is pproved ❑ Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth - in Section D above.A building permit is necessary for the construction of the above designed system. No construction is permitted in the required reserved 100%Expansion area. (1) Septic tank must be 100'minimum from any wells. (2) Leach lines must be 100'minimum from any wells including expansion area. (3) Sewer lines must be 50'minimum from any wells. (4) Seepage pits must be 150'minimum from any wells including expansion areas. EHS ature: Date: t' T Environmental Resources Ma ement Office Locations Environmental Health-ERM Division Environmental Health-ERM Division Riverside Permit Assistance Center Indio Permit Assistance Center 3880 Lemon Street,Suite 200 47-950 Arabia Street,Suite A Riverside,CA 92501 -- Indio,CA 92201 RIVERSIDE 951 955.8980 INDIO f7601863-7570 DEH-sAN-122 Rev:10112 Distribution:WHITE'-Off.File;YELLOW—Applicant',PINK—Bldg.Dept,;GOLDENROD—PlanslRecords �'.