PMT16-01546 City of Menifee Permit No.: PMT16-01546
29714 HAUN RD.
<ACCEL/� MENIFEE,CA 9258E Type: Residential Plumbing
MENIFEE Date Issued: 0511812016
PERMIT
site Address: 23430 LA BERTHA LN, MENIFEE, CA Parcel Number: 350-184-014
92587 Construction Cost: $4,500.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING SEPTIC TANK
Work:
Owner Contractor
DENNIS ROMANO
30159 LONGHORN DRIVE
CANYON LAKE, CA 92587
Applicant License Number:
DENNIS ROMANO
30159 LONGHORN DRIVE '
CANYON LAKE, CA 92587
Phone:9099574009
Fee Description _qyt Amount(M
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$185.50
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 o I am exempt from licensure under the Contractor's 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
❑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 Code,forthe performance of work for which www.leginfo.ca.gov/calaw.htmi.
this permit Is issued.
Policy# Date
❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑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 polity 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 applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires Fit the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred 1, Date
dollars($100)or less ROPERTY OWNER OR AUTHORIZED AGENT
in I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any mannerso 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 ❑Yes ❑No
UNLAWFUL,AND SHALL SUBIECTAN 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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes o 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 ❑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 ezemptfrom the permitting checklist.I understand my requirements underthe State of
Contractors License Law for the reason(s)Indicated below by the California Health al 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 ❑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 forthe perm@to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIRAND PAINTING IRRP)
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-1970
and the basis forthe 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
o 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.epa.zov/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 ❑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 forthe 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.
i i SAFETY PERMIT/PLAN CHECK A. . •
Menifee
DATE fa l0 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O 56N of M nlfee
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHAN! .
ullding ty Dept.
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES MAy J 2016
DESCRIPTION OF WORK 0LU ,
Received
PROJECTADDRESS t 3 In1,y9 L� ] �,C 1 ,
ASSESSOR'S PARCEL NUMBER A A AJ Z6-6 _j 44?T TRACT
OWNER NAME � AAIP
ADDRESS/�� tJ te
PHONE ! O9 EMAIL AI .v
APPLICANT NAME A"A"
ADDRESS 0 ti.(/w yLI /eC
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 41ES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SQ FT L SO FT
APPLICANT'S SIGNATURE DATECITYSTAFFUSEONLY
- - '
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP X
INVOICE PAID AMOUNT AMOUNT O CASH O CHECK# -CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
COUNTY OF RIVERSIDE
jot%,DEPARTMENT OF ENVIRONMENTAL HEALTH
LAND USE APPLICATIQN3, Safety Dept.
OFFICE USE ONLY
3880 Lemon Street•Suite 200•Riverside•CA•92501 —(951)955-8980 MAY 18 2016 PE CODE: FEE:
❑47-950 Arabia Street•Suite A•Indio•CA 92201 —(760)863-7570 `L 7� 2
EHS ON R LMSar' ci 7 a/� APN:, I i
AAffid O L
TR/PM-q`?"z' LOT 9USE OF PERMIT.) n K
SECTION A
Na� ..riiL/S
OWNER: Address city UA/ p
Ph e / — Email .,v ,
Company Name Agent/Contractor
AGENT/
CONTRACTOR.: Mailing Address
Phone Email
Signature Date
PROPERTY INFO: Site Address' city
Water AgencyANell 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(C42) ❑Special Feasibility Boring Report Required
G WOCB Clearance Required ❑Detailed Contour Plot Plan Required(I to 5 foot intervals)
Q Soils Percolation Report Required
SITE EVALUATION INSPECTION REMARKS:
EHS INITIALS/DATE:
SECTION C
❑NEW 1 ❑ REPAIR!REPLACEMENT 1 6 EXISTING ❑PUrvIP ❑ATU 1 ❑CONNECT TO SEWER I FIXTURE UNITS.x.' BDRMS 9
Soils Percolalionmonng Report By: Date: Project-4
C42 Certification By. Date: License
Septic tank cap.: Soil Rate: Tested Depth: Max. trench depth:
Sq.FL Bottom Area: Total Linear Ft.: Une(s):
� Len the C7 feet - Each 3 feet wide
Sidewall Allowance: FL Rock/ Sq.ft.Running foot Rock below drain line: _in. or ❑Plastic Chambers
Leach Linesibad 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:
.Iuc2vn" A air v-- l
SECTION D
This Application is Approved O Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth in
Section C above.No construction Is permitted In the required reserved 100%Expansion area.
EHS Signature: '" Date /�
s r:
ID
_• _ ,:City of�vlenifee - ;:,
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEMuilding & Safety Dept.
Land Use&Water Resources MAY 18 2016
Western Riverside County Eastern Riverside County �,
3880 Lemon Street•Suite 200•Riverside•CA•92502 47-950 Arabia Street•Suite A•Rilece ive d
Phone:(951)955-8980•Fax: (951)955-8988 Phone: (760)863-7570•Fax (760)863-7013
Property Information: APN: 350-184-014 Date of Inspection: 05/04/2016
1. Owner Dennis Romano Address: 23430 La Bertha Lane City: Quail valley
FAILURE TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT OWNER FROM OBTAINING
ENVIRONMENTAL HEALTH APPROVAL
2. Show design and location on a scale of 1:20 or 1:40 of the sewage disposal system and 100%expansion area in relation to
attached dwellings,structures,wells, rocks,watercourses,eta
3. a. I examined existing subsurface sewage disposal system at the above location on 5I4/16 and determined that
the tank capacity is 1,000 gallons and that there is sq.fL of leach line bottom area. There are
— bedrooms in the dwelling and there are fixture units.
b. There are 1 leach line(s), each 60 ft.long. I]Rock ❑Plastic Chamber
d. There are Seepage pit(s), each in.diameter,and ft.TD. ft. BI
e. The leach bed is ft.by ft.,total sq. it. of leached area.
4. a. Construction of septic tank(Please check one of the following):
❑Concrete ❑ Fiberglass El Steel ❑Other.
b. Internal dimensions of septic: Length 4.8 ft. Width 8 ft. Depth 5 ft
c. Condition of tank(please check yes or no for each question): Inlet Tee present? ❑Yes ❑No
Tank Structure deteriorated? Yes ❑ No Outlet Tee present? ❑Yes ❑No
Effluent Filter Present? ❑ Yes ❑ No Two compartments? ❑Yes ❑No
d. Condition of D-Box: Level? ❑Yes ❑ No Replaced? ❑Yes ❑No Septic Effluent? ❑Yes ❑No
5. a. While pumping the tank,did effluent flow back into tank from absorption system? ❑Yes 9 No
b. Prior to pumping, was the liquid level in the tank above the outlet tee? ❑Yes KNo
c. Was the area around the lids oxidized? El Yes ❑No f
d. Is design of system gravity feed? El Yes ❑ No
e. Were well(s)observed on this or adjacent property? ❑Yes I]No
If yes, indicate distance of well from: Septic tank ft. Leach lines Seepage Pits ft.
f. Distance from springs, lakes, and natural water courses(check all that apply)
❑ Septic Tank ft. 0 Leach lines 38 ft. ❑ Seepage Pits ft.
g. Is sewer is within 200 ft.of system and abuts property line? ❑Yes 21 No
Additional Comments: Leach line appears to be operating okay.
h. How long has dwelling been vacant?(a applicabte) months 4 weeks ❑ N/A
6. a. ❑ It is my opinion that the system appears to be in good working order and can be expected to function properly with
proper maintenance. No repairs are necessary at this time.
b. O It is my opinion that the system is not in good working order and will not function properly without the following
repairs: Tank is 7.6 deep,shows deteriorat' nand nosion.Did not pump lank due to safely reasons. Tank may collapse without liquid
Ice f p ' ry th t o fo I act.
Signature: Print Name: ROBERT M HARDING
Contractor License No.: C42891951 Expiration Date: July 2017
Pumper Co.: Rightway Phone Number. 951-674-8608
Address: 653 W Minthom City: Lake Elsinore Zip: 92530
Rev.10/12
city of Menifee
Building & Safety Dept.
18 2016
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"SIDE
DEPART vi _r. NV11 .,,A I NTAL HEALTH"" {
ONSITE VAS T -h.' MENT SYSTEM °-
Dwelling Irpoo p SephcTank
Commercial W,_ 1' il. of Leach Line
j Seepage Pits vu.D,.,_BI_TD^MD_
_ Conned to Sewer _ c .nnrete Pump Chamber
�. Connect-to Existing
• Installation of leach lines arp not to e.ceed ft.in depth
• Install risers to grade.leaving lids acu:ss,t;e for cleaning.
Note: Larger tanks (2000 galleas or greater) require 2 risers to access prnnary
chamber.
• Approved cleanable effluent filters must he installed to facilitate servicing;
• No on-site water softening devices shad be discharged into the septic system without
clearance from the California Rprjional Water Quality Control Board.
• Installation shall conform to the current UPC
• Any grading in the area of proposed drip lines shall require new approval by Iles
[)apartment. _ /n
Date: S—f
'p f A(6'-(I
-D (AIL Z
A! Y OF MENIFEE
D5tHMING AN SAFE ; DEPARTP41ENT
REVIEWED BY
-- --- DATE
'.Approval of these plaris;
approval of,any violation of auq p r r:tie iedenl,state or city
regi,lations and ordinances. This set,it appraed pians must be kept on the
jobsite until completion.