PMT16-01876 City of Menifee Permit No. PMT16-01876
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued:
0 611 4/2 01 6
PERMIT
Site Address: 23806 NEWPORT RD, MENIFEE, CA Parcel Number: 350-253-019
92587 Construction Cost: $7,500.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING SEPTIC SYSTEM
Work:
Owner Contractor
DESTRY JOHNSON LANK ENTERPRISES INC
23806 NEWPORT ROAD P O BOX 891416
MENIFEE, CA 92587 TEMECULA,CA 92589
Applicant Phone:9516767114
CARLY ROZZO License Number:458947
LANK ENTERPRISES INC
P 0 BOX 891416
TEMECULA, CA 92589
Fee Description Qty Amount f$1
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$185.60
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_Templatexpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and a 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 Classc H PL-4—A License N `fS�—L `l By my signature below I acknowledge that,except formy personal residence
Expires Q��� Signature a 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 wehsite:
by Section 3700 of the Labor Code,for the performance of work for which www.leeinfo.ca.gov/calaw.html.
this permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
D I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which D.By my signature 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 an the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
/t7O l with all applicable city and county ordinances and state laws relating to
Carrier TJ C9 Lr building construction.I authorize representatives of this city or county to
Policy# w�-C-G— l Expires �� �� 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
D I certify 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 became 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 rker' compensation provisions of Section 3700 of the Labor
Code,I shall rth it omply Ith those provisions. A I ( Will the applicant orfuture building occupant handle hazardous material or a
i `1 � („ mixture containing a hazardous material equal to orgreaterthat the
Applicant Date Y� amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO Q6RE WO + R' MPENSATION COVERAGE IS o 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(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
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 o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repair anystructure,prior to its PROPERTYOWNER 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 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-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
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.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 notapply to an owner of a D An EPA Lead-Safe Certified Renovator will be responsible forthis 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. o No EPA Lead-Safe Certified Firm is required for this project because:
o 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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE LAWAiLo PERMIT/PLAN CHECK NUMBER -
TYPE: O COMMERCIAL VIRESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA C SIGN
SUBTYPE: O ADDITIO�N"�O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW $'PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK C- Ce.lf_ -
PROJECTADDRESS 01� V(0 oelAJ
ASSESSOR'S PARCEL NUMBER � - ZS_� L I LOT TRACT BUilding & Safety Dept
OWNER NAME UN 14 2016
ADDRESS
PHONE �� EMAIL eC
APPLICANT NAME ''\\ GZZu
ADDRESS V D < < `(//-�/l ��r v \ y "i�4
PHONE (jn `e EMAIL l.�✓ ht� F.-SQ C . (-Gn-
CONTRACTOR'S NAME OWNERBUILDER? OYES NO
BUSINESS NAME
ADDRESS r ,, b —7 Ci lU (� �� ✓''
PHONE �(/� �(J L ��EMppAIL
CONTRACTOR'S STATE LIC NUMBER I� � `-C9_ LICENSE CLASSIFICATION C
VALUATION$ SQ FT L SO FT (� lam,
APPLICANT'S SIGNATURE DATE 6r( ` T"
CITY STAFF USE ONLY %
DEPARTMENT DISTRIBUTION CITY OF MEN IFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT ` 5 •✓� O
AMOUNT OCASH 0CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO OIL NUMBER NOTARIZED LETTER C) YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
County of Riverside
t}`= DEPARTMENT OF ENVIRONMENTAL HEALTH
OF
c� OWTS INSPECTION CARD
APN: —ON No.: [? EHSNo/.:
/�
Site Address: (;M�G�7 P�� n;' /<y � � ��
To Schedule an Inspection Please Call (951) 955-8980
OWTS Components Date Re-Inspection Inspector
of Inspection Date Initials
Septic Tank S—O ex i'sf;
Leach Lines/ Bed -3 ,? Z 10 K.x
Seepage Pits
Septic Tank Abandonment -
Sewer Lateral
D-Box
Risers
Effluent Filters
Final Inspection
TO BE POSTED ATJOB SITEIN PLAIN VIEW
City of Menifee
Building & Safety Dept.
JUN 14 2016
Received
COUNTY OF RIVERSIDE
DEPARTMENT OF ENVIRONMENTAL 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 Or 7Y'?i 1 473.29
EHS# ON# LMS# APN:
350 - s3 Vi9.
TR/PM LOT# USE OF PERMIT: e
(J 1N`j-S C[ / y Building & Sate Dept
SECTION A C
23
Name �S () nS�I JUN 16
OWNER: Address 0 ✓ G Iv Gl city
d
Phone Email
[p (�
Company Name i /}{�pl,4e 1� SSA lontractor n ,
AGENT/ �U 1S / / plwne 9a
CONTRACTOR: Mailin Address G�
// /
Phone 1p � L7 ! Email V-L J / L
Si nature �j Date - (o
PROPERTY INFO: Site Address City .en
Water Agency/Well Lot Size A
SECTION B Below—For Office Use Only ✓y
CHECK BOX IF REQUIRED r
If any box is checked.this application shall be considered denied unlit 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
❑WQCB Clearance Required ❑ Detailed Contour Plot Plan Required(1 to 5 foot intervals)
❑Soils Percolation Report Required 000
SITE EVALUATION INSPECTION REMARKS: a
EHS INITIALS/DATE: 7-- / / Q
SECTION C b /� J
❑NEW I &VREPAIR/REPLACEMENT 1 ❑ EXISTING ❑PUMP ❑ATU ❑CONNECT TO SEWER I FIXTURE UNITS# BDRMS#
Soils Percolation/Boring Report By: - Date: Project#
C42 Certification By: + Dale: License#
L,Z.I:K syf 5 6 An KTr 2 oib q
Septic tank cap.: `0 Soil Rate: S� Tested Depth: Max. trench depth:
Sq.Ft.Bottom Area: S Total Linear FL: 7S Line(s):
3``��/pp�- Length: 3� feel - Each 3 feet wide
Sidewall Allowance: . r ,r Ft.Rock/ Sq.ft.Running foot Rock below drain line: 'I--1 Ll in. or ❑Plastic Chambers
Leach Lines/bed special design for slope: ❑WA ❑Overburden Factor.
Pit Diameter. Nt No.pits: Depth below Inlet(bi): Pit Total Depth: Max.allowable depth:
CONSTRUCTION/INSTALLATION REMARKS:
SECTION D
This Application is r ad Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth in
Section C above.No r i is permitted in the required reserved 100%Expansion area.
EHS Signature: D>�e:J�nz e�UJ�
DEH-SAN-122 Rev:10114 Distribution:WHITE—Otte Fie.YELLOW—Bldg.Dept.PINK—App!l"nl