PMT16-02283 Ginty of Menifee Permit No.: PMT116-02283
29714 HAUN RD. Type: Residential Plumbing
<IkCCE!6� MENIFEE, CA 92586
MENIFEE Date Issued: 07/15/2016
PERMIT
Site Address: 23551 CASSANDRA DR,MENIFEE, CA Parcel Number: 350-232-012
92587 Construction Cost: $12,000.00
Existing Use: Proposed Use:
Description of REPLACE LEACH LINES TO EXISTING SEPTIC SYSTEM
Work:
Owner Contractor
RALPH DEPUCCHIO RIGHTWAY SITE SERVICES INC
23551 CASSANDRA DR 653 WEST MINTHORN
MENIFEE, CA 92587 LAKE ELSINORE,CA 92530
Applicant Phone:9516748608
JANICE CURTIS License Number.891951
RIGHTWAY SITE SERVICES INC
653 WEST MINTHORN
LAKE ELSINORE,CA 92530
Fee Description Oft Amount t$)
1 150,00
Building Permit Issuance 1 27.00
_ Eid 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_Permil_Template.rpt 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).
1 hereby affirm under penalty of perjury that 1 am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
/
License Class 1 -/D r(i 'tense No. C;6 Ig51 By my signature below I acknowledge that,except for my personal residence
Expires `�-�1,I'I 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 that I
WORKER'S COMPENSATION DECIARAT N 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 ,www.leeinfc.ca.eov/calaw.htmL
this permit is issued. 7
Polity# t2 IBC_ �I n�� / Date
o I have and will maintain workers 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 workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: r application and the information I have provided is correct.I agree to comply
L` k- '�L', yC �LCL-� With all applicable city and county ordinances and state laws relating to
Cartier f1 building construction.I authorize representatives of this city or county to
RPolicy# ,ry�.'�1 �(0"�$2)Expires - L ^enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred \ ) ,VlYW Q .( 1 n 4A-.O Date �� S
dollars($100)or less PRUP.ERTY OWNER OR AUTHORIZED AGENT
D I certify that in the performance of the work for which this permit is issued, V
I shall not emelov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# l
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers 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�sp��ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes RN
UNLAWFUL,AND SHALL SUBIECT AN EMPLOYERTO CRIMINAL PENALTIES Willthe intended use of the buildingbythe applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),IN occupant require a permitforthe 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 D Yes -rrNo
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) D Yes - 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
Contractors License Law for the reason(s)indicated below by the hazardous material re arting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Yes N I c ,r
Business and Professions Code).Any city or countythat requires a permit to �, tO Date l J-' (P
construct,alter,improve,demolish or repair any structure,priorto its PRO RTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING fRRP)
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.eoa.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 Contractors 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 for the purpose of sale. ❑No EPA Lead-Safe Certified Firm Is required for this project because:
01,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 JIJ :v-,
Menifee
DATE PERMIT/PLAN CHECK NUMBER (o Q10L
TYPE: 0 COMMERCIAL jO RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME C POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW PYPLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS SI CAS C-
ASSESSOR'S PARCEL NUMBERT. LOT TRACT
OWNER NAME
ADDRESS a SPAA
PHONE EMAIL
APPLICANT NAME
ADDRESS G °►�5��
PHONE ��-��Qw� �l 015p EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES ENO
BUSINESSNAME ti Q,t t
ADDRESS
PHONE r� EMAIL
CONTRACTOR'S STATE LIC NUMBER �'l l R5( LICENSE CLASSIFICATION C—
VALUATION$ SO FT L SQ FT I -
APPLICANT'SSIGNATUR DATE �� S- I
CITY STAFF USE ONLY —r-7
DEPARTMENT DISTRIBUTION N CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT
AMOUNT 0 CASH O'CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH OCHECK# 0CREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER O YES C NO
City of Menifee Building&Safety Department 29714 Houn Rd, Menefee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
All
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: J
El47-950 Arabia Street•Suite A-Indio•CA 92201-(760)863-7570 C't U-� r Vz r1 1`44.1� �� � t�� ���a
EHS# 3 IZ ON# LMS# rn U �ae3
TR/PM LOT# I r� U OF ERMOIT: C t�
I o� JI
SECTION A
Name
OWNER: Address 3 - 4 a CA CrAza
Phone Email
.Company Name�. ; r: .� Agent/Contractor C4L_ LL(-�i
AGENT/ LAl p^
CONTRACTOR: Mailin �Alddress �C k A GN12- lJ�
Phone 1. Email
Si nat Date
�I f
Site Addresc (. ./.t t L{, `E
PROPERTY INFO:
WaterAgencyMell 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. CV-1 Of Men(fee
❑Holding Tank Agreements Required ❑Floor Plan and/or Plumbing Layout Regifit9 -tng atety Dept.
❑Certificate of Existing OWTS Required(C-42) ❑Special Feasibility Boring Report Required
❑WQCB Clearance Required ❑Detailed Contour Plot Plan Required(1 to 5 fo�dter�gl6'r 2U16❑Soils Percolation Report Required L II ::ll U
SITE EVALUATION INSPECTION REMARKS:
ceJVe
EHS INITIALS/DATE:
SECTION C
❑NEW EPAIR/REPLACEMENT 1 ❑ EXISTING ❑PUMP ❑ATU 1 ❑CONNECT TO SEWER I FIXTURE UNITS# BDRMS#
Soils Percolation[Boring Report By: Date: Project#
-42 Certification By. Date: License#
CA:S l�l
Sep(�altank cap.: )� I S Soil Rate: Tested Depth: ax. trench depth:
Sq.FL Bottom Are§:,�� Total Linear FL: (� U Line(s):
�I / Length: U feet - Each 3 feet wide
Sidewall Allowance: 3 Ft.Rack/ Sq.ft.Running foot Rock below drain line: 5 m in. or ❑Plastic Chambers
Leach Lines/bed special design for slo ❑WA ❑Overburden Factor.
Pit Diameter. .pits: Depth below Inlet(bi): Pit Total Depth: Max.allowable depth:
CONSTRUCTION/INSTALLATION REMARKS:
SECTION D
This Application is IrApproved 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: /�
DEHSAN-122 (aev.11n4) _ Disbib.Uon:WHITE—Office Fle:YELLOW—BIGg.Dept.PINK—Applicant !/
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