PMT16-03475 City of Menifee Permit No.: PMT16-03475
29714 HAUN RD.
4��CCECA—> MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued, 1012112016
P E R M I T
Site Address: 33225 HELEN LN,MENIFEE, CA 92584 Parcel Number: 384-01 D-008
Construction Cost: $6,000.00
Existing Use: Proposed Use:
Description of REPLACEMENT SEPTIC SYSTEM
Work:
Owner Contractor
MARK COEHEN ALTRUISTIC CONSTRUCTION SERVICES
33225 HELEN LANE P 0 BOX 340
MENIFEE, CA 925134 WINCHESTER, CA 92596
Applicant Phone: 9518832944
BRIAN BALLINGER License Number: 968580
ALTRUISTIC CONSTRUCTION SERVICES
P 0 BOX 340
WINCHESTER,CA 92596
Fee Description City Amount($
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$185.60
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of emars 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 BldgPermitffemplaterpt 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 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 n 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 Class-L—Y9\� UcenseNo. !76es-80 By my signature below I acknowledge that,except for my personal residence
Expires J7-31- 9017 signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION im provements covered by this perm it.I cannot legally sell a structu re that I
have built as an owner-builder if it has not been constructed in its entirety by
c I hereby affirm under penalty of perjury one of the following decia rations:I licensed contractors.I understand that a copy of the applicable law,Section
have a nd will maintain a certificate of consent of self-insu re for workees 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
this permit is issued. www1eginfo.m.gov/calaw.html.
Policy# Date
o I have and will maintain workees compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My workees compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less —Date
Xcertify that in thi performance of the work for which this permit is issued, PROPERTY OWNER OR AUTHORIZED AGENT
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 9
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 370D of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Isnk-1 Date /o-2/-/6 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 o No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applimnt or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($10D,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST�AND ATTORNEYS FEES Coast Air Quality Management District[SCACM D)?See permitting checklist
forguldelines
CONSTRUCTION LENDING AGEN oYes oNo
I hereby affirm that under the penalty of perjury them 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) ciYes oNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
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
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWN ER OR AUTHORIZED AGENT
that he or she is licensed pursuant to th e provisions of the Contracto r's State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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
a nd the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint In a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childca re facility to be RRP-certified firms and comply with
than($500), required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
ci 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.eva.goy/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 Contractoes State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible forthis 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. a No EPA Lead-Safe Certified Firm is required for this project bemuse:
o 1,as owner of the property a in exclusively contracting with licensed
contra ctors to construct the project(Section 7044,Business and Professions
Code:The Contractoes 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
& SAFETY PERMIT/PLAN CHECK APPLICATION
,-��"O'Menifee
DATE M.Am PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ),CaSIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-N UMBER OF SQUARES_
DESCRIPTION OF WORK HePl"Aje-41-- &a/��
PROJECTADDRESS H e-le, LZ In 6
ASSESSOR'S PARCEL NUMBER LOT TRACT
C"tnIfee
I"
OWNERNAME R,1111241 A" 8-dfuty Uept.
ol&q 14--
ADDRESS ,T-e, / L�,u
PHONE EMAIL ut,1 2 1 2916
APPLICANT NAME &('LAn 4 e- Recpived
ADDRESS
'Ic
PHONE !?Zi/- g3o- 9 �Z�lq EMAIL CbCSSZ-19� Aa e5 0 1
CONTRAcrOR'S NAME (3 roA OWNERBUILDER? OYES*NO
BUSINESSNAME
ADDRESS 12-0, 6()"-
PHONE 9S1- �)36) EMAIL
CONTRACTOR'S STATE LIC NUMBER qUsyo LICENSE CLASSIFICATION
VALUATION$ 6, 000 SQ FT L SO FT
APPLICANT'S SIGNA URE DATE /0-2
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP X
INVO ICE- CASH OCHECK# OCREDITCARD VISA/MC
F
AMOUNT PAID AMOUNT
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
rOWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLE17ER 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 951-245-5213
County of Riverside city of Menifee
DEPARTMENT OF ENVIRONMENTAL HEALTH Building & Safety Dept.
www.rivcoeh.org OCT 2 12016
OWTS INSPECTION CARD Received
APN: ON No.: EHS No.:
SiteAddress: qS 4eje4A JjA Mv"1-Pe_e__
To Schedule an Inspection Please Call (951) 955-8980
OWTS Components Date Re-inspection Inspector
I of Inspection Date Initials
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WWW.ALTRUISTICSEPTICSERVICE.COM (951)848-4069 P.O. BOX U