PMT16-04366 City of Menifee Permit No.: PMT16-04366
29714 HAUN RD. Type: Residential Plumbing
<A-CCFUA-> MENIFEE, CA 92586
MENIFEE Date Issued 01/03/2017
P E R M I T
Site Address: 28891 AVENIDA GAVIOTA, MENIFEE, CA Parcel Number: 341-121-OD6
92587 Construction Cost: $13,000.00
Existing Use: Proposed Use:
Description of ABANDON EXISTING SEPTIC TANK, INSTALL NEW SEPTIC TANK WITH RISERS AND EFFLUENT
Work: FILTER AND INSTALL NEW LEACH LINES
Owner Contractor
RICK HANSEN CURTIS DUMP TRUCK&BACKHOE SERVICE INC
PO BOX 1481 21130 UNION STREET
LAKE ELSINORE, CA 92531 VOLDOMAR, CA 92595
Applicant Phone:9516746156
JAN CURTIS License Number: 552745
CURTIS DUMP TRUCK&BACKHOE SERVICE INC
21130 UNION STREET
VIALDOMAR, CA 92595
Fee Description city Amount(S)
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 Bidg_Pernift-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 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 0 1 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;
UcenseClass.4 C.—HPL— LicenseNo. L1 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 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.leginfc.ca.gov/calaw.html.
Policy# Date
ci I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,forthe performance of the work for which n By my signature below I certify to each ofthe 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
numberare: 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 Date
dollars($100)or less PVRTY OWNER OR AUTHOR17ED AGENT
--eri certify that in the performance of the work for which this permit is issued,
Ishallnotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
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 3700 of the Labor
Code,I shaFforthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant "NQ/Y1_(f JL� I A AMA� Date amounts specified on the Hazardous Materials Information Guide?
WARNING:F41URE TO SECURE WORKER'S COMPENSATION COVERAGE IS uYes p-No
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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FO occupant require a permit for the construction or modification from South
R 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 0 yes "o
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) a Yes J�Nzi-
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
California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous in t i Importing.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 oYes ci
Business and Professions Code).Any city or county that requires a permit to Date
conshruct,alter,improve,deMO115h or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,a Iso req uires the applica nt for the permit to file a signed statement
that he or she is licensed p ursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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
cr 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPXs Renovation Program visit:
compensation,will do I I all of or I I portion of the work,and the structure is www.epa.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 Contractor's 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:
Q 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.
City ot Menifee
Building & Safety Dept.
JAN 0 3 2017
Received
CITY OF ME FEE
BUILDING D SAFETY DEPARTMENT
PLAN APPROVAL
ya
X REVILEIMEDBY-tkew- 051k-i
DAT
"Approval of these plans shall got �clnitruecltobeapermitfororan
IL I approval of,any violation of any prrvisions of the federal,state or city
130
f regulations and ordinances. This set of approved plans must be kept on d
,N I V1
*M1'�',": jobsite until completion.
COUNTY OF RIVERSIDE K
DEPARTMENT OF ENVIRONMENTAL HEALTH
ONSITE WASTEWATER TREATMENT SVSTEM
z0Z9 AfeaLseptictranit
—Commercial Sq.FIL of Leach Lim 3 <
-seepage Pits —NO-DF8—B1—TD-1AD 49
—Connect to Saw Cmuft PLUM ChWdw
—Connect to Existing
Instaliagon of bach ram am not to mmd rL in dam
Ingag risers to gmde.leavbv Ws accassille GWa—mv.
=Ls�ff WAS(20W gallons a gmatO mWlm 2 rMis to accen pirmy
Appmved cleanable tffiftnt fillaM mnt be irtstalled to facilitate wWckq
No on-ske mter softenIng d6icas shall be d&hargec!into the ae*aygem WithDW
deamnm ftm the Cafforna Regional Water QuaI4 Contmi board.
Installation shall conlon to the ctinent UPC:
AnY gm(filig in the 0ma of Proposed dn-p finn$
cepawneffl. liallorwal bythis
Date: h Llz�EHS.
City of Menifee
A Building & Safety Dep
DEPARTMENT OF ENVIRONMENTAL HEALTH - J " J N 03 2017
www.rivcoeh.org
LAND USE APPLICATION
ROCeived
:'a OFFICE USE ONLY
80 Lemon Street-Suite 200-Riverside-CA-92501—(951)9,95-8980 PE CODE: FEE:
47-950 Arabia Street-Suite A-Indio-CA 92201—(760)863-7S70 Cli—I /-)C 2!�-y Z_
ON# AIIN:
Ll-� (� 1 0-L DO G
LU I #—/I Ujt:UF FERMIP.
bt:t;I ION A re ja I&C AL SeRtl I' Azin I C (--p c to
Name rx&D_r-�
OWNER: Address P-L>- (30 Y_ ( (-( ,6 � — I city L,t(A- LS i lzipC(),S3(
Ph— CA e, t 7-:l ail
Comeany Namei/i
AGENT/ S
A 6
CONTRACTOR: Mailing Address.21 ls;p i cn Cit iwornar-
Phonscl,,Swo-� —fals(�:1 ail
Ern
PROPERTY INFO: SiteAddress � V��( � .
, C,
Ci n iJ: zip
L,t�
Water Agency/Well Lot Size
APPLICAN*PS SIGNATURE: J DATE:
SECTION B Below—For Mce use unly
dH—ECK
BOXW"l.0
If any box is checked.=Pflubon shall be Considered denied Until the information i 'd
s prom Pei
0 Holding Tank Agreements Required U Hoor Plan and/or Plumbing LayOL9_RE,qq!red
11 Certificate of Brisling OVrTS Required(C-42) 13 Special Feasibility Boring Report Riiduluid
0 WQCB Clearance Required 0 Detailed Contour Plot Plan Requi*15CI j(j 5 foot intervals)
[]Soils PercolatonRe rtRe uired
EVALUATION INSPECTION 7A
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4, 1=11�INI I IA�S/P��Tg
SECTION C
0 NEW 0 REPAIR I REPLACEMENT 0 EXIST1 NG [01 PUMP (3 ATU 0 CONNECT TO SEWER FIXTURE U
Soils Perculation/Boring Report By: Date; Project#
42 Cerfificals By: SLk Dale: Ucenseff
I I'M-1, ick Y9 rn it J(_%�_b�hcl-( &
07777 1 Soil Hate: Tested Depth: Max trench dep
Sq.FL Bottom — I I otal Linear FL: Une(s):
Length 3& feet - Each 3 feet wide
Sidewall Allowance: Ft.Rock/ —7 Sq.It Running foot Rock below drain line: in. or OPlasticCharribers
Leach Unsalted special design for slope: OWA erburden Factor.
Pit Diameter
No.pits: Depth below Inlet(bily it Total Depth: Max allowable depth:
GONSTRUCTIOWINS I ALLATION REMARKS:
_§_E_C_n0N D
This Application is pproved 0 D It cIx Ing the design Of the OWTS as indicated on the accompanied plot plan using the requirements set forth in
Ed
�T�
Section C above.No wnstructfign-i perim a n faquired reserved 10D%Expansion am.
EH8 Signature:
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