PMT16-03783 City of Menifee Permit No.: PMT16-03783
29714 HAUN RD. Type: Residential Plumbing
<A-CCELA-4" MENIFEE, CA 92586
MENIFEE Date Issued: 11/2912016
P E R M I T
Site Address: 33150 NANCY LN, MENIFEE, CA 92584 Parcel Number: 384-090-015
Construction Cost: $7,500.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING SEPTIC TANK WITH A NEW 1,000 FIBGERGLASS TANK WITH EFFLUENT
Work: FILTER
Owner Contractor
ROB NATZIC CURTIS DUMP TRUCK&BACKHOE SERVICE INC
33150 NANCY LANE 21130 UNION STREET
MENIFEE, CA 92584 VALDOMAR, CA 92595
Applicant Phone: 9516746156
JANICE CURTIS License Number: 552745
CURTIS DUMP TRUCK& BACKHOE SERVICE INC
21130 UNION STREET
WILDOMAR, CA 92595
Fee Description Ply. 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 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 I 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)pursuantto the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ci I am exemptfrom ficensure 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-( License No. By my signature below I acknowledge that,except for my personal residence
Expires-6 Signatur kA-A-n 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 OECLARAne� 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 a nd will maintain a certificate of consent of self-Insu re 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 Labor Code,for the performance of work for which -
this permit is issued, www.IeRinfo.ca.gov/caIaw.htm1.
Policy# Date
o I have and will maintain worker's 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 worker's 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 lam 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 Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
,zl certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE III
workees compensation laws of California,and agree that if I should become
subject to the worker's compensation provisions of Section 3700 of the Labor KAZARDOUS MATERIAL DECLARATION
Code,I sh"i-thwith comply with those pro".sions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Appficant�—f,�-AAP-(L.0 i_Ll� Date amounts specified on the Hazardous Materials Information Guide?
WARNING:WLURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes a No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AN D CIVI L FINES UP TO ONE HUN DRED THOUSAND DOLLARS($100,000),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(SCAQMD)?See permitting checklist
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) ci Yes n No
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
checkma rk(s)I have placed next to the a pplicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to uYes c No
construct,alter,improve,demolish or repair any structure,prior to its --Date
issuance,also requires the applicant for the permit to Me a signed statement PROPERTY OWNER OR AUTHORIZED AGEWT
that he or she is licensed pursuant to the provisions of the Contractoes state EPA RENOVATION,REPAIR AND PAINTING IRRPj
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 com ply with
a n Applicant for a permit subjects the applicant to a civil pena Ity 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 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( I all of or( I portion of the work,and the structure is www.epa.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 Contractoes State License Law does not apply to an owner of a 0 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. ci No EPA Lead-Safe Certified Firm is required for this project because:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 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.
BUILDINCi & SAF771 P"MIT/PLAN CHECK APPLICATION
Nov 2 2 201b
�",Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: COMMERCIAL f-/1 RESIDENTIAL n MULTI-FAMILY n MOBILE HOME POOL/SPA SIGN
SUBTYPE: []ADDITION F]ALTERATION [-]DEMOLITION [-]ELECTRICAL [-]MECHANICAL
[71NEW R]PLUMBING n RE-ROOF-N UMBER OF SQUARES—
DESCRIPTION OF WORK Abandon existing septic tank and replace with anew 1,000 fiberglass tank wi#U�IUBVMitee
Building & baTuLY Ot Pt.
PROJECTADDRESS 33150 Nancy Lane Menifee CA 01-104 Nov 2 9 ZU15
ASSESSOR'S PARCEL NUMBER 369-200'U" J(b4 -E)C1DPLS0'T ' — TRACT —R.,eived
PROPERTY OWNER'S NAME Rob Natzic
ADDRESS 33150 Nancy Lane Menifee CA
PHONE 951-741-6156 EMAIL
APPLICANT NAME Janice Curtis
ADDRESS 21130 Union Street Wildomar CA 92595
PHONE 951-674-6156 EMAIL cdtbs@msn.com
CONTRACTOR'S NAME Curtis Dump Truck&Backhoe SeNce, Inc. OWNERBUILDER? []YESPNO
BUSINESSNAME Curfis Dump Truck&Backhoe SenAce, Inc.
ADDRESS 21130 Union St.WildomarCA92595
PHONE 951-674-6156 EMAIL cdtbs@msn.com
CONTRACTOR'S STATE LIC NUMBER S52745 LICENSE CLASSIFICATION AC-42
'�t5b
VALUATION$ 'D z�� SQ FT L SO FT
APPUCANT'$SIGNATURE DATE
DEPARTMENT DISTRIBLMON CITY OF MENIFEE BU
LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GIEN SMIP 0-6yC70
IPA MOUNT IOCASH OCHECK# OCREDITCARD VISAINIC
I PA�D A I
PLAN CHECK FEES DAMOUNT OCASH OCHECK# OCREDITCARD VISAINIC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LErrER 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
County of Riverside
I UV DEPARTMENT OF ENVIRONMENTAL HEALTH
V,
ZI" www.rivcoeh.org
OWTS INSPECTION CARD
APN: '3%LA— Q ot C)— C)I 'S 0 N N o.: EHS No.: i(J09)
SiteAddress: J, I Ctn (,94 1 U� -
To Schedule an Inspection Please Call (951) 955-8980
CWTS Components Date Re-Inspection Inspector
of Inspection Date Initials
Septic Tank 10
Leach Lines/ Bed
Seepage Pits
Septic Tank Abandonment
Sewer Lateral
D-Box
Risers
Effluent Filters
Final Inspection
TO BE POSTED A 7-JOB SITEIN ALAM VIEW
EPG 54(REV 9/15)
City of Menifee
Building & Safety Dept.
NOV 2 9 2016
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM
3880 Lemon Street-Suite 200-Riverside-CA-92501-(951)955-8980
LI 47-950 Arabia Street-Suite A-Indio-CA 92201-V60)BM-7570
Property Information: APN: 4f,-q =�)8:P� pr,�t�( Date of Inspection: (,p
1. Owner: lblo it)a Address: Iry City: alp'n�!�C2
FAILURE TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT OWNER FROM OBTAINING
ENVIRONMENTAL HEALTH APPROVAL
2. Show design and location on a scale of 1:20 or 1:40 of the sewage disposal system and 100%expansion area in relation to
dwellings,structures,wells,rock outcroppings,drainage,watercourses,etc.
3. & I examined existing subsurface sewage disposal system at the above location on &nA4_&and determined that
the lank capacity is lleW gallons and that there is sq.ft.of[each line bottom area- There are
bedrooms in the dwelling and there are — fixture units. City of Menifeel
b. There are _4_1 leach line(s).each long Depth L/A ft. 2rRock El PIAM&A§ePallety D pt.
c. There are — Seepage pft(s),each _ ft.in diameter,and ft.TD. ft.BI.
NOV 2 9 201
d. The leach bed is — ft.by _ ft.,total _ sq.ft.of leached area. Depth is _ ft.
4. a. Construction of septic tank(Please check one of the following):
WConcrete 13 Fiberglass 0 Steel Ll Other: Roceive
b. Internal dimensions of septic: Length _ ft. Width ft. Depth ft. 6
c. Condition of tank(please check yes or no for each question): Inlet Tee present? Yes Ll No
Tank Structure deteriorated? El Yes 0 No Outlet Tee present? �Kes L1 No
lu
EI Yes U'N'o
Effluent Filter Present? Two compartments? El Yes_�`No
d. Condition of D-Box: Level? p4e. Ll No Replaced? El Yes El No
5. a. While pumping the tank,did effluent flow back into tank from absorption system? L3 Yes 2<o
b. Prior to pumping,was the liquid level in the tank above the outlet tee? L3 Yes 2<o
c. Was the area around the lids oxidized? _�] Yes AT5o
d. Is design of system gravity feed? Q'Yes 0 No
a. Were well(s)observed on this or adjacent pro - Pelfe_sc.�,,)
If yes,indicate distance of well from: Zp:ric tank Leach lines/_�Iff Seepage Pits ft.
c
I. Distance from springs,lakes,and natural water courses(c all that apply):
L3 Septic Tank — ft. Q Leach lines ft. L3 Seepage Pits
g. Is sewer within 200 ft.of structure and abuts property line? Ell Yes��o
Additional Comments;
h. How long has dwelling been vacant?(if applicable) months weeks L3 N/A
6. a. 0 It is my opinion that the system appears to be in good working order and can be expected to function properly with
proper maintenance. No repairs are necessary at this time.
b. )2rl�is my opinion that the system is not in good working order and will not function properly without the follovAng
repairs: r�R�a(aeo :6A CE"10,7eit-
I certify under penalty of perjury that t!W foregoing is true and correct.
Signature: 4�� Print Name:
Co=ntr se No.: - 6 - piration Date:
_- 6
o..
Puil 07. _ z-_-Y P- Phone Number- CJ
Address: Zi p:
EM-91(REV03/16)
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