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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 !/ MOVA1TAFn7 UlGlu 1 Enz z N 0-3 m000 0 > L v y0 - _ r I III pm it �y�+cm 8 fn to cT� zr 9 tntn tic� O Z m os^ COz G pq o S , ' Cf D C7 y' ? 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