PMT15-00952 i
I,
City of Menifee Permit No.: PMT16-00952
_� '�^.�,� 29714 HAUN RD.
LfY' MENIFEE, CA 92586 Type: Residential Plumbing
sw s:nM MENIFEE Date Issued: 04/16/2016
PERMIT
Site Address: 29475 WATSON RD, MENIFEE, CA 92585 Parcel Number: 327-300-058
Construction Cost: $2,900.00 _
Existing Use: Proposed Use:
Description of LEACH LINE ADDITION
Work:
Owner Contractor
WILLIE MOSLEY LANK ENTERPRISES INC
29475 WATSON ROAD P 0 BOX 891416
MENIFEE, CA 92585 TEMECULA, CA 92589
Applicant Phone: 9516767114
CARLY ROZZO License Number:458947
LANK ENTERPRISES INC
P 0 BOX 891416
TEMECULA, CA 92589
Fee Description ON Amount f$1
Building Permit Issuance 1 27.00
- '� � r'1
m
'.�0.m1
$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 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 BIdg_Permit Template.rpl Page 1 of 1
i
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 Clas Licen No. q—) who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'Slate 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, 1 cannot legally sell a structure that I have
permit is issued.
Policy# built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
have and will maintain workers' compensation insurance, as required by Business and Professions Code,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:http//www lepinfo oa gov/calaw html.
permit is issued.M workers'compensation insurance carrier and policy number are:
Carrier �:.r Property Owner or Authorized Agent Date
Expires l a 3 1 l Policy# O
❑ 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-
0 1 certify that in the performance of the work for which this permit is issued,I ident'ild prop for the i ection purposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of California, and agree that if I should become v K_
subject to the workers'compensation provisions of Section 700 of the Labor Code,I shall forthwith co ply with those p ision property Owner or thorized Age Date
. 2 / �'1 Da
/\I City Business License# ® J LP�( ,o /
Date; Applicant;
I WARNING: FAILURE TO SE RE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
P 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, OYES 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 ❑N0. 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
OWNER BUILDER DECLARATIONS GUIDE LINES
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 OYES 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, ❑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 (Chapter9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES 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
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL FfEPORYIN
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY/"WNER AUTH ED AGE
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State 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).
& SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: C,COMMERCIAL )(RESIDENTIAL 0 MULTI-FAMILY - MOBILE HOME C:% POOL/SPA O SIGN
SUBTYPE: <%ADDITION O ALTERATION O DEMOLITION C% ELECTRICAL O MECHANICAL
CJNEW YPLUMBING C., RE-ROOF-NUMBER OF SQUARES
�I I enite
DESCRIPTION OF WORK C ( \ ✓�Q (,Z ,\ BUlldin 9 & Safety ept.
APR 1
PROJECTADDRESS
nucelved
ASSESSOR'S PARCEL NUMBER 3 LOT TRACT
OWNER NAME a5
�p
ADDRESS l nc�:> Loa. -S VN %, .0 I V�L•`1
PHONE q65--`130 -Q 3')- EMAIL
APPLICANT NAME
ADDRESS D U Sc e4/o ci.,L�
PHONE ���— (p-) (p� l t� EMAIL c ►� n (11(✓,
CONTRACTOR'S NAME L. V-C WNER BUILDER? YES NO
BUSINESS NAME
ADDRESS
PHONE �� I (p EMAIL t KS C r
CONTRACTOR'S STATE LIC NUMBER LICENSE LICENSE CLASSIFICATION cl O
VALUATION $ '_g66) SQFT LSQFT
APPLICANT'S SIGNATURE ATE l
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT "CASH t7%CHECK# `>CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# •'JCREDIT CARD VISA/MC
OWNER BUILDER VERIFIED G?YES O NO DL NUMBER NOTARIZED LETTER ^ YES L11 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menefee, CA 92586 951-672-6777
www.cityofineni(ee.Lis Inspection Request Line 951-246-6213
_on'.
city of Menifee
Building & Safety Dept.
I APR 15 2015
N STALL
Received
COUNTY F RI\/ERSIDE
D_PARTINAS-AT OF ENVIRONMENTAL HEALTH
SGwac a Disposal
t ,•1 ng ) d Gal. Septic Tank �IY4, o /
CwFuncrcial '1 Sq. Ft.of Leach Line ' rr 1 a P-C
,� n o-exo Pits No.D!@_BI._TD_MD_
Gonnact to ss'.ler connect to Existing System
e InSt.'.il<7i'rOn r,r-.� •.O n`t J_ft. Y
e I^�i�ri riSe,S ti r,;'7,'�'cJ, l5.;'di ,•roc-�� u
` �, ) �= � fer cleaning. Approved
deanabIo Efluent -Y. muziI ,- nsta _ �0 !_c lit�tt;uo N 'ir,g. J
® No on-sit 3rr iso Ien h I be discharged Into the septic
system without J mice ii ihI CF ..O nla Reg:o:ial Water Guc!'ly G'OGtrol
Board.
a Ail sewag8 dlopc`:ia!Iostall-'t On s!ail M"corm t0 the current UPC H 1
• Any grading in the arao N C-to Rroposed tach lines shall requiro rrew
appioval by ih.'s dop:n t.T,=:lt. t v r
Date:-
A E,,.,.: i
0
MENT
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i nust be kept on the
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City of Menifee
Building & Safety Dept.
L ` COUNTY OF RIVERSIDE APK
DEPARTMENT OF ENVIRONMENTAL HEALTH
OWTS INSPECTION CARD Received
APN: _S�ON No.: EHS No.:
Site Address: �� '� �1 fflyi��'�d
To Schedule an Inspection Please Call (951) 955-8980
OWTS Components Date Re-Inspection Inspector
of Ins ection Date Initials
S
Leach Lines Bed Inn
e Pits ~
Septic Tank Abandonment —
Sewer Lateral —
D-Box
Risers —
Effluent Filters —
Final Inspection
TO BE POSTED ATJOB SITE IN PLAIN 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.2014 Is
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTI
PLAN APPROVAL
REVIEWED BY
'Approval of these Bans shall not be construed to be a
approval of,any violation of any provisions of the feder,
regulations and ordinances. This set of approved plans i
jobsite until completion.
COUNTY OF RIVERSI➢F�of Menifee
DEPARTMENT OF ENV1R PVFA_L HEALTH
LAND USE APPLICATION
OFFICE USE ONLY
❑3880 Lemon Street•Suite 200•Riverside•CA•92501 —(951)955-8980 PE CODE: FEE:
❑47-950 Arabia Street•Suite A•Indio•CA 92201 —(760)863-7570 Received + T I !
EHS# ON# I LM6?#a ,;) --1 APN:
e .i
I 1
TRIr I, , i LOT# rj USE OF PERMIT: .
t. ' f
SECTION A
Name i I � IV
OWNER: Address P,7f t._ > i-��.�I CL Sn_ F.'�_ r^( ?.t��r j 1';(,.6'—if L� l^..X
Phone (r / �/U -�`r<-�ry iEmail
Com an Name A enUContractor t
AGENT/
CONTRACTOR: Mailing Address --t \-q t \ 9 Z'J�Dci
Phone p1 ILI Email
Signature Date li
Site Address Oi-cxL..( -'1 4Fi'' E� ��f✓ Qx7-C-'- L-
PROPERTY INFO: l
ater Ac NOell Lot Size /'
SECTION B Below—For Office Use Only
CHECK BOX IF REQUIRED
If any box is checked,this application shall be considered denied until the information is provided.
❑Holding Tank Agreements Required ❑ Floor Plan and/or Plumbing Layout Required
❑Certificate of Existing OWTS Required(C-42) ❑Special Feasibility Boring Report Required -
❑WOCB Clearance Required ❑ Detailed Contour Plot Plan Requifed;(1 to 5 foot intervals)
❑Soils Percolation Report Required
SITE EVALUATION INSPECTION REMARKS:
7
.Il r
EHS INITIALS/DATE:
Iit 'f
SECTION C
❑ NEW REPAIR/REPLACEMENT ❑EXISTING ❑ PUMP ❑A ❑CONNECT TO SEWER FIXTURE UNITS# BDRMS#
Soils Percolation/Boring Report By: Date: Project#
C-42 Certification By Date: License#
Septic tank cap.: Soil Rate: Tested Depth: Max. trench depth:
Sq. Ft.Bottom Area: Total Linear FL: Line(s):
Len the feet - Each 3 feet wide
Sidewall Allowance: Ft.Rock/ Sq.ft.Running foot Rock below drain line: _in. or ❑Plastic Chambers
Leach Lines/bed special design for slope: ❑N/A ❑Overburden Factor:
Pit Diameter: No.pits: Depth below Inlet(bi): Pit Total Depth: Max.allowable depth:
CONSTRUCTION/INSTALLATION REMARKS:
SECTION D
This Application is @ Approved 0 Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth in
Section C above.No cpnstruction is permitted in the required reserved 100%Expansion area.
EHS Signature: it
Date:
1 `
DEHSAN-122 Rev:10114 Distribution:WHITE—OHim File;YELLOW—Bldg.Dept PINK—Applicant