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PMT16-02103 City of Menifee Permit No.: PMT16-02103 29714 HAUN RD. Type: Residential Plumbing <ACCELA? MENIFEE, CA 92586 MENIFEE Date Issued: 07/06/2016 PERMIT Site Address: 28823 LORETTA AVE, MENIFEE, CA Parcel Number: 372-120-012 92584 Construction Cost: $6,000.00 Existing Use: Proposed Use: Description of ADDING 2 ADDITIONAL LEACH LINES TO EXISTING SEPTIC SYSTEM Work: Owner Contractor MICHAEL HOLMES LANK ENTERPRISES INC 28823 LORETTA AVE P 0 BOX 891416 MENIFEE, CA 92584 TEMECULA, CA 92589 Applicant Phone: 9516767114 CARLY ROZZO License Number:458947 LANIK ENTERPRISES INC P0 BOX 891416 TEMECULA,CA 92589 Fee Description r3yt Amount f3l 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 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_Templatesiat Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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 D 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 Claa/s l Class. t . (-J7 ITT e r License No 4 By my signature below 1 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 legallysell a structure tbat 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 workers. 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,for the performance of work for which w„ww.leeinfo.ca.eov/calaw.html. this permit is issued. Policy# Date ,Rfl rave 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 policy owner or authorized to act on the property owner's behalf.I have read this numberare:Q //�� ^ (/�' application and the information I have provided is correct.I agree to comply Carrier s—�xA/�qag l � ` /bu with all applicable city and county ordinances and state laws relatingto _ building construction.I authorize representatives of this city or county to Policy# t/'c--C- ` Expires 1 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, �t I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 0�ba- workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the�Ilthp e splion provisions of Section 3700 of the Labor Code,I shall foy v'kh those provisions. Will the applicant or future building occupant handle hazardous material or Applicant Date 7 c mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SE RE WORK US COMPENSATION COVERAGE IS D Yes p 6 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 forguidelines CONSTRUCTION LENDING AGENCY D Yes XNo 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 bou n0a ry of a school? (Section 3097 Civil Code) Dyes o OWNER BUILDER DECLARATIONS 1 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 perjurythat I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the hazardouymaterial rep rtin . checkmark(s)I have placed next to the applicable items)(Section 7031.5 Dyes�No / Business and Professions Code).Any city or county that requires a permit to Date ''7—6 rl construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER ORWHOR17LW AdnT 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 Contractors 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 Iicensure 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 D 1,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.eav/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 Contractors State License Law does not apply to an owner of o 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 for the purpose of sale. D No EPA Lead-Safe Certified Firm is required for this project because: D 1,as owner of the property am exclusively contracting with licensed contractors to Construct the project(Section 7044,Business and Professions Code:The Contractors 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 — PERMIT/PLAN CHECK NUMBER PI�� Uc3�O TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME C POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW P.KUMBING O RE-ROOF-NUMBER OF SQUARES n,, - DESCRIPTION OF WORK C y' PROJECTADDRESS ASSESSOR'S PARCEL NUMBER Z'd l 6 Z LOT _� TRACT OWNER NAME M \ ADDRESS PHONE EMAIIL�.�-�/� APPLICANT NAME � Lt/I( Ii(0 ADDRESS o PHONE �� I `Q ) -� [ l 1 EMAIL ll CONTRACTOR'S NAME G OWNE(RBUILDER? O YES NO /� BUSINESS NAME L/l,v�L+ ADDRESS �V 7� 01 PHONE �- l /EMAIL CONTRACTOR'S STATE LIC NUMBER O -/ `�� LICENSE CLASSIFICATION VALUATION$ Q(/ v SOFT L SQ FT / APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF ME E BUSS�IC�[JSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAIDAMOUNT O AMOUNT �� CASH 0 CHECK 4 OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH OCHECK# OCREDITCARD VISA/MC OWNER BU LLDER VERIFIED O YES O NO OIL NUMBER NOTARIZED LETTER O YES 0 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 ✓ : ►751 COUNTY OF RIVERSIDE DEPARTMENT OF ENVIRONMENTAL HEALTH LAND USE APPLICATION Z Z City of Menifee OFFICE USE ONLY ❑ 3880 Lemon Street•Suite 200•Riverside•CA•92501—(951)955-8980 Bu Ilding $ Safety Dept, P°°��E CODE:/ FEE: 1I ❑47-950 Arabia Street•Suite A•Indio•CA 92201—(760)863-7570 /yi✓/ 2 �`/ � y� EHS# A e1 33 S ON# LMS Ll D ` APN: — be `O TR/PM - /) LOT# USE OF PER IT:/ n.% _ / I •�A_ SECTION A- Name OWNER: Address o, F Phone Email Com any Name ��� I A ent/Con actor A- AGENT/ l . CONTRACTOR: MailingAddressO (0 j / [l 7 Phone L t./� I Email Signature � Date p PROPERTY INFO: Site Address Z 0 nj WaterAgencypLot 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 ❑WQCB Clearance Required ❑ Detailed Contour Plot Plan Required(1 to 5 foot intervals) ❑Soils Percolation Report Required SITE EVALUATION INSPECTION REMARKS: EHB INITIALS/DATE: V SECTION C ❑ NEW I KREPAIR I REPLACEMENT 1 ❑EXISTING ❑PUMP ❑ATU ❑CONNECT TO SEWER I FIXTURE UNITS# BDRMS# Soils Percolation/Boring Report By: Date: Project# C42 Certification By: Dale: License# O Septic tank cap., 1 XLJ Soil Rate: Tested Depth: Max. trench depth: Sq.Ft.Bottom Area: a Total Sa Linear Ft.: , , Line(s):� C � Length, o !/ eel - Each 3 feet wide Sidewall Allowance: Ft.Rock/ Sq.ft.Running foot Rock beJI4w drain line: _in. or Plastic Chambers Leach Lines/bed special design for slo ❑ WA D Overburden Factor: Pit Diameter. No. Its: Depth below Inlet(bi): Pit Total Depth: Max.allowable depth: CONSTRUCTION/INSTALLATION REMARKS: SECTION D This Application is a1CppFoVe_d_GZMwkd regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth in Section C above.No garnstruction is pe ifted in the required reserved 100%Expansion area. EHS Signature: Date: 7 DEH-SM-122 (Rev-11114) Distribution:WHITE—Office Fla;YELLOW—Bldg.Dept.PINK—Appricanl ILNIPORARN BEN(HNI %RK • '�. !�. i!. ii' �l lip , . . .. 3 7 A - Id- - of a s Gr9-Ce COUNTY OF RIVE: rA ahael I tol.v-1 s DEPARTMENT OF ENVIROW"WH 12yp-O i2 ONSITE WASTEWATER TR TVN Z3 o ( 2(� T v 4' /Uuv Gal.Septic Tankcommercial 5; Sq.Ft.of Leach Line —'SeeMwip"is — - - --N0 0: �-- D - - —I City of Menifee CgnJ�toSewer CwWOWPuMCframber Building & Safety Dept. Coiirrxt to Existing • InstaAetion of leach Fines are norto exceed R in d@A I J U L 0 6 2ll I • Intel deers to grade,leaving lids accessible roman g. Note.,Larger tanks (2000 gallons or greater) require 2 deers to accost primary ,�it chamber. e c e i v e d • Approved deanable effluent filters must be installed to facilitate servicing. • No on-ske wilier softening devices shall txs discharged into the Septic system without clearance from the California Regional Water Quality Cor{troi Board, i 1/ • Installation shall conform to the current UPC: • Any grading in the area of proposed drip ' es shall require new approval by this I �✓ Department. Date: 7 C �� EHS: ( a `1 1 _ � crosv ti � 171 Vei✓Y�' r -. 1p OF CPL�FD e R CITY OF MENIFEE V � BUILDING AND SAFETY DA TMENT PLAN APPROVAL 3 0 fin" REVIEWED-Bf� N �Ilr� +� Ty5, 1 ... DATE 'Appl.val of these plans shall t on,,truecl to be a.permit for,or an r approval of,any violation of any prov:,ions of the federal,state or city regulations and ordipances. This set of approved plans must be kept on the' - jobsite until completion. r+iRr'f c+,�Tr: