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: