PMT16-03405 City of Menifee Permit No-: PMT16-03405
29714 HAUN RD. Type: Residential Plumbing
't;kCCELA-r?' MENIFEE,CA 92586
MENIFEE Date Issued: 10/18/2016
P E R M I T
Site Address: 29180 AVENIDA DE LAS FLORES, Parcel Number: 341-142-003
MENIFEE,CA 92587 Construction Cost: $6,500.00
Existing Use: Proposed Use:
Description of SEPTIC TANK REPLACEMENT
Work:
Owner Contractor
MELISSA FLORES LE PEW INDUSTRIAL INC
29180 AVENIDA DE LAS FLORES 41735 ELM STREET#303
M URRI ETA, CA 92562
Applicant Phone:8889615971
DAN LE PEW License Number 988020
LE PEW INDUSTRIAL INC
41735 ELM STREET#303
MURRIETA, CA 92562
Fee Description ON Amount($)
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 offidal from thereafter requiring the oorrection of errors in the plans and
specifirations or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinanm 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_Permlk_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,andwho contracts forthe projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penaltyof perjurythat I am under provisions of
Chapter!)(commencing with section 7000)of Division 3 of the Business and o 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:
LicenseClass U el veqA. 0 R. Z> By my signature below I acknowledge that,except for my personal residence
Expires M — k::7 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 this application is submitted or at the following website:
by Section 3700 of the La bor Code,for the performance of work for which wvvw.Ieginfo.ca.gov/calavv.htmI.
this permit is issued.
Date
Policy# PROPERTY OWN ER OR AUTHORIZED AGENT
elf_hZe and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,forthe performance of the work forwhich n By my signature below I certify to each ofthe following:I am the property
this permit is issued.My workerrs compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number am: application and the information I have provided is correct.I agree to comply
With all applicable city and county ordinances and state laws relating to
Carrier AC-07-d building construction.I authorize representatives of this city or county to
Policy# !"36 Expires 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
o I certify that in the performance of the work for which this permit is issued,
I shall not em ploy a ny persons in any ma nner so as to become subject to the CITY BUSINESS LICENSE#
worker's compens#i*lats of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to �e wo ee c i ensation provisions of Section 3700 of the Labor
it
Code,I sha orth 1 c in)ly IQ those provisions. Will the applicant or future building occupant handle hazardous material or a
\ 0 mixture containing a hazardous material equal to or greater that the
Applicant Kfo yte Date amounts specified on the Hazardous Materials Information Guide?
AARNING.FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ciYes oNo
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($100,00111),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 guidelines
CONSTRUCTION LENDING AGENCY oYes oNo
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) uYes allo
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
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,a Iter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AG ENT
issuance,also requires the a pplicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING ffiRP1
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 Ncensure 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-certlfied firms and com ply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes renta I property owners a nd property
than($500). managers who dothe paint-disturbing work themselves or through their
o 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-govllead or contact the National Lead Information Center at
not intended or offered for sa le.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ri 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 a re not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one yea r 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. a No EPA Lead-Safe Certified Firm Is required for this project bemuse:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Sect-ion 7044,Business and Professions
Code:The Contractor's 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 (C>,l (6 - IJb PERMIT/PLAN CHECK NUMBER rMT 16'-Q�L406
TYPE: OCOMMERCIAL O;ZRESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW O- PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK IL/-- 4-�
PROJEcTADDRESS 0) 4� Cl 9 L5 9
ASSESSOR'S PARCEL NUMBER '34 1 --t Lo — uc�;g LOT TRACT
OWNERNAME
ADDRESS
PHONE EMAIL
APPLICANT NAME LL-- P L---u —),zeq- ( - S�� ?-,—
ADDRESS tZj�q -5'F 6Q
PHONE '?�-( - '�7 1'7 EMAIL aC-,
CONTRACTOR'S NAME OWNERBUILDER? OYES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C
VALUATION$ SOFT L SQ FT
APPLICANT'S SIGNATURE DATE P
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT
AMOUNT I OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DILNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www,cityofmenifee.us Inspection Request Line 951-246-6213
war Qo
Melissa Forte
APN#341-142-003
Lic.#C42-988020 29180 Avenida De Las Flores, Menifee, 92587-9610
COUNTY OF RIVERSIDE
DEPARTMENT OF ENVIRONMENTAL HEALTH
ONSITE WASTEWATER TREATMENT SYSTEM
v/Dwelfing CL-L Gal. septic Tank Papj M rr-&n
Conrmnarclal
Seepage Pits — Sq.Ft.of Leach Line city of Manifee
— No.Dia_B!_TD_MD— Building & Safety Dspt.
Connect to Sewer — Concrete Pump Chamber
�- Zconn'ect to Existing OCT IS 2016
Installation of Leach lines are not to exceed it in depth
Install Isers to rade,Leaving lids accessible?oor-@;a-n—jng.
Note: Larger tanks (2000 gallons or greater) require 2 rism to soceag prkngry Received
chamber. solo
Approved cleanable effluent filters must be installed to facilitate servicing.
No on-ske water softening devices shall be discharged into the septic
clearance from the California Regional Water Quality Contra[Board. system without
Installation shall conform to the current UPC:
Department. 1p in shall require new a I b th
Any grading in the area of proposed dri Ii is
a 'j
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Date; EHS:
7 nS
X CITY OF ENIFEE
BUILDI* AND SAO DER
PLAN Al 1PROVAL.,
REV EW ED BY; Alk III;
VIP %p ese-oans'sliall not be MSWW b
.',P- aqK?vall tiol*ti.on of any provisions if the
regulati n ordinances, This set of aproved
jobsik�u mpletion,
(pet", '.Zu\zles-)t-L"
8.88.9161.5971 417.35 Eh Street, Suite 303 Murrieta, CA 92562 wWwAepewindustrialam
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COUNTY OF RIVERSIDE
DEPARTMENT OF ENVIRONMENTAL HEALTH
LAND USE APPLICATION
OFFICE USE ONLY
43880 Lemon Street-Suite 200-Riverside-CA-92501—(951)955-8980 PE CODE: FEE:
L3 47-950 Arabia Street-Suite A-Indio-CA 92201—(760)863-7570 6-1 q
EHIS# * --7` 1 APN- 341-142-003
Ma; l Nldoli ZT=" la I USE OF PERMIM'Pit "plaumolcd
SECTION A
Name Melissa Forte
OWNER: Address 29180 Avenida De Las Flores, Menifee, CA UC I ! a ZU16
Phone Email
AGENT/ CompanyName Le Pew Industrial Inc Agent/ContractiR ft IMP"
CONTRACTOR: MailingAddres 41735 EIM street#303 Murrieta Ca- 92562
Phone 888-961-5971 Email danalppewindustroal-com
Signature �- Q At Date October 17, 2016
PROPERTY INFO: SiteAddress Sarne as Above
Water Agen it MOD Lot K
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 0 Floor Plan and/or Plumbing Layout Required
•Certificate of Existing OWTS Required(C-42) 0 Special Feasibility Boring Report Required
L1 WQCB Clearance Required 13 Detailed Contour Plot Plan Required(I to 5 foot intervals)
0 Solis Percolation Report Required
J1QN INSPECTION REMA13KS:
I 010ce of /\4:12
J2 0'8 C. h rNITIALSIDATE:
SECTION C lqsc:l
ONEW I W] REPAIR/REPLACEMENT 01EXISTiNG OPUMP DATU I DCONNECT TO SEWER _I FIXTUREUNITS#' I-aDRMS#
Solis Percolation/Boling Report By: Date: ProjectV . .....3 1 r
C-42 Certification By: Date: License#
Le Pew Industrial 10/14/16 :.. : C-42 988020
Septic tank c Sol]Rate: Tested Depth: Max. tre,inch depth:
Sq:Ft.Bottom Area: Total Linear Ft: I-Ine(s):
I Length: feet - Ea'ch1i ie'W de
Sidewall Allowance: Ft.Rockf _Sq.ft.Running foot rain line: in. or 0 Plastic Chambers
Leach Lines/bed special design for slope: 0 NIA 0 Overburden Factor:
Pit Diameter. No.pits: Depth below Inlet(bl): Fit Total Depth: Max.allowable depth:
CONIMCTI N/I TALLATION REMARKS:
SECTION D
This Application is pproved 0 Denied regarding the design of the OWTS as Indicated on the accompanied plot plan using the requirements set forth in
Section C abov 0 construction is permitted In the required reserved 100%Expansion area.
EHSSignalurl,� Date:
DEH-SAN-M (Rev.11/14) Distfib.11on:WI-11TE-Office File;YELLOW-Rdly.Dept PINK-Appliont