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PMT16-02629 City of Menifee Permit No.: PMT16-02629 29714 HAUN RD. Type: Residential Plumbing <ACCELA? MENIFEE, CA 92586 MENIFEE Date Issued: 0911412016 PERMIT Site Address: 26072 OKUMA RD, MENIFEE, CA 92584 Parcel Number: 360-290-003 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of NEW SEPTIC SYSTEM FOR FUTURE MOBILE HOME INSTALLATION Work: Owner Contractor VICTORIA FONG , 31630 RAILROOD CANYON RD#19 CANYON LAKE, CA 92587 Applicant License Number: VICTORIA FONG 31630 RAILROOD CANYON RD#19 CANYON LAKE, CA 92587 Phone:7757625600 Fee Description Qtv Amount fbl 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 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_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjurythat 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 ❑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 License No. By my signature below I 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 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 o 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 )my plication is submitted r at the following website: by Section 3700 of the labor Code,for the performance of work for which this permit is issued. in w.html. Policy II Date RTY OWNER OR AUTHORIZED AGENT o I have and will maintain workers compensation insurance,as required bysection 3700 of the Labor Code,for the performance of the work for which signature below I certify to each of the following:I am the property this permit is issued.My workers compensation Insurance carrier and policyor authorized to act on the property owners behalf.I have read this numher are: tion and the information I have provided is correct.I agree to comply applicable city and county ordinances and state laws relating to Carrier building construction.I aut orize representatives of this city or county to Policy H Expires ent a ab en property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date — / dollars($100)or less WNER AUTHORIZED AGENT o I certify that in the performance of the work for which this permit is issued, 1 shall not employ any persons in any manner so as to become subject to the Cl BUSINESS LICENSE If workers compensation laws of California,and agree that if I should become RDOUS 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 specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes r,, . 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)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidef es CONSTRUCTION LENDING AGENCY ❑Yes 7No 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 bound ryofa school? (Section 3097 Civil Code) o Yes u7 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 Calif ' Health&Safety Code,Section 25505 and 25534 concerning Contractor's License Law for the reason(s)indicated below by the Inrdous ateria checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 es oy/ / Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,prior to its PR ER NER R A THORIZED 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 Contractors State PA BEN VATION REPAIR AND PAINTING RRP License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The A Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure r iving 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 esidence 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.aov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-BOG-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a 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. o No EPA Lead-Safe Certified Firm is required for this project because; ❑I,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 TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK � PROJECTADDRESS r 2_& l W L . ASSESSOR'S PARCEL NUMBER y-2,, Un -' LOT ? TRACT OWNERNAME �J��jM�" �Y \U%.,1 �//� ADDRESS �v ��""r f\\Wt lON Y'V PHONE 1�1�� 1W2' An EMAIL APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? O YES ONO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION GO VALUATION$ SO FT L SO FT G APPLICANT'S SIGNATURE ` DATE -r- DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE I I Cp PVDAMOUNT AMOUNT -V_ 1 0CASH 0 CHECK 4 OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT --CASH C;CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 FONG PROPERTY LA CRES'CA GEOTECHNICAL LEGEND APN NO, 360-290-003 Approximate Location of Percolation Test T-I Approximate Location of Exploratory Trench QAL ........... Alluvium Soil City of tetfee Z— o N Building & Safety Dept. 3 � \IJ\ S EP 142016 frill Will Received $ � FUTURE HOUSE SEPTIC SYSTEM its a ; 3$Z n O m IN THE AREA OF PERC TEST P-1 THROUG*-d 2 rB� � �d o OZ INSTALL A MINIMUM OF 20 d ° g x > rtl SQ/FT OF LEACH FIELD. PER � :O--= Q X y I I I fn Z p 3 100 GALLONS OF SEPTIC P m a �. n Z Cl) ; -n TANK CAPACITY. UTILIZING A I500 = O� ^ s o 0 � O - GALLON SEPTIC TANK,INSTALL A H "_' a te-, m o 6- m � Z m MINIMUM OF 300-SQ/FT OF LEACH LINE _s CITY 01 MENIFILIZING INFILTRATOR CHAMBERS INS ALL > > n ° I ° — =1Z }LEACH L a 6UILDJG ANDG=M=5qE -j(so ) LONG LIN S 6N` s='.AN" PPROVAL GPI L�t )s --- DIU -- C;' L C Q a le d for, 'J i:.1 any vra a w.o o: D' fed,-ral „ate or, ris,ijoe iow and ordinances. I his .el i! vprij 1"01.In5 Must al v 1 ChAMbS r.c al;5lte u0t cor' 0. Q A f� L z x u �5 !p- �` MARK A. SWEENEY ^ No. � c�ar�irn /,I ENG{NE'ERlNGGEOLOOST ��OfiCFlL1FO 1 W Y GEOLOGIC MAI FIGURE II DEPARTMENT OF ENVIRONMENTAL HEALTH 1 l` www.rivcoeh.org o LAND USE APPLICATION OFFICE USE ONLY �1-03880 Lemon Street•Suite 200•Riverside•CA•92501-(951)955-8980 pp PE CODE: /� FEES: ry 'Cl 47-950 Arabia Street•Suite A•Indio•CA 92201 -(760)863-7570 04L -P l en/1' a1`f� -7,GO.2? EHS# '/ _D r!4 2 O LMS# APN: l/J 7 [� S' PM� & - D2636 36a-2�a -oo3 - TR/PM LOT# 3 USE P�tE�R/MIT: 1 -isZ SECTION A nn . 11II b Name l �V N ^ ,, /� p �} OWNER: Address 1 IAAZ 3 (5N Ci 4ejwf LAZE Zip /Zfo Phone Email GENT/ Compan Name �� (/✓ G.J'U an ontractor CO TOR: Mailin Add+r�ess �AV LW P 1110I 7%/ lle?49 Ci COSj���L���✓ - Zi �Zl /� Phone 1 J" Email i '1/r'✓hlro / GAO-ic. PROPERTY INFO: Site Address © IEIflAA ,�- T-OA-4 City M-111/F-4-i, rf zip9Z5-Q1 Water Afe-n'g>Aqell CAS744/ Mtl&lr Lot Size APPLICANPs SIGNATURE: DATE: SECTION B Below—For Office Use Only CHECK BOX IF REQUIR If any box is checked,thl applioduon shall be considered denied unfit the Information is provided. ❑Holding Tank Agreem n R equired ❑ Floor Plan and/or Plumbing Layout Required ❑Certificate of Existing OWTS Required(C-42) ❑Special Feasibility Boring Report Required O WQCB Clearance Required etailed Contour Plot Plan Required(1 to 5 foot t t rvals) oils Percolation Report Required x -ci ' U 5.2rV¢. 1-2j4e4 SITE EVALUATION INSPECTION REMARKS: EHS INITIALS/DATE: SECTION C NEW 1 ❑REPAIR!REPLACEMENT 'O EXISTING O PUMP ❑ATU ❑CONNECT TO SEWER;__ ,FIXTURE UNITS# 3d BDRMS# Soils PenVation/Boring Re rt By: , Date: Project# - U eta eo fe chnitra C / ! 2�SS T I = _ -^ 60 6-42 Certification By: Date: Licegse#.r. C. •In Septic/ta' k pp.: Soil Rate: Tested Depth: Max:'fi'eiiCA`tlepth: - �,�j t70 Sq.FL Bo m•�iea: Total Linear PL: Line(s): Length: feet - Each 3 feet wide Sidewall Allowance: Ft Rock/ Sq.ft.Running foot Rock below drain line: —in. or �Iastic Chambers -each Lines/bed special design for slope: ❑WA ❑Overburden Factor. 'it Diameter. No.pits: Depth below Inlet(bi): Pit Total Depth: Max.allowable depth: :ONSTRUCTION/INSTALLATION REMARKS: SECTION D 111s Application islfi-Approved 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. iHS Signature: / Date EPO.92(REV 7/16) olaldbufion:WHITE—Office File;YELLOW—altlp.Dept.PINK—Applicant