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PMT17-00052 City of Menifee Permit No.: PMT17-00052 29714 HAUN RD. Type: Residential Plumbing <ACCELh? MENIFEE, CA 92586 MENIFEE Date Issued: 0110 912 01 7 PERMIT Site Address: 30120 PUERTO VALLARTA WAY, Parcel Number: 360-020-023 MENIFEE, CA 92584 Construction Cost: $7,560.00 Existing Use: Proposed Use: Description of NEW LEACH LINES FOR EXISTING SEPTIC Work: Owner Contractor KAREN SENGER TRI COUNTY DEVELOPMENT&CONSTRUCTION 30120 PUERTO VALLARTA WAY INC MENIFEE,CA 92584 12321 MAGNOLIA AVENUE SUITE C Applicant Phone:9093225411 TIM HUMPHREY License Number:988026 TRI COUNTY DEVELOPMENT&CONSTRUCTION INC 12321 MAGNOLIA AVENUE SUITE C RIVERSIDE, CA 92503 Fee Description Dty, Amount(El 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_Permk 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 o I am exempt from licensure under the Contractors State License Law for Professions Code and my license is In full force and effect. G 1 the following reason: License Class �� License No. p 0 f/ By my signature below I acknowledge that, for my personal residence Expires 10—3D— 17 Signature g except t 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 ❑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 forworkers 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 ,www le=info.ca.eov/calaw.html. this permit is issued. (i Policy If d'Io Gd Date PROPERTY OWNER OR AUTHORIZED AGENT ❑I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which D By my signature below 1 certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: / � /r '/ application and the information I have provided is correct.I agree to comply 0 " Carrier 'tom j l'`'v t 7'AI _ �" V`� J( with all applicable city and county ordinances and state laws relating to p building construction.I authorize representatives of this city or county to Policy k 1 1✓� b 1 Expires �� 7 enter the above identified property for inspection purposes. (This section need notto be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT D I certify that in the performance of the work for which this permit is issued, ygiy�C I shall not employ any persons in any manner so as to became subject to the CITY BUSINESS LICENSE p rJ�/ ♦;�J workers compensation laws of California,and agree that if 1 should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Cade,I shall forthwith c ply 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 j amounts specified on the Hazardous Materials Information Guide? `? WARNING:FAILURE TO RE WORKER'S COMPENSATION COVERAGE IS ❑Yes qyl� UNLAWFUL,AND SH SUBIECF 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($100,000),IN occupant require a permit for the construction or modification from South ADDITIONTOTHE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quallty Management District(SCAQMD)?See permitting checklist - IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes o 016— I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes g,Nc, OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements underthe State of California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Business and Professions Code).Any city or county that requires a permit to Date --1/J — construct,alter,improve,demolish or repair any structure,prior to its PROPER WNERO IZED AGENT Issuance,also requires the applicant for the permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors State EPA ENOVATION,R AND PAINTING 1RRP1 License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more than($SDD). required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves or through their ❑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.eoa.eov/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 Contractors State License Law does not apply to an owner of a ` property who,through employees'or personal effort,builds or improves the D An EPA Lead-Safe Certified Renovator will be responsible farthis project 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 provingthat it was not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because: t. ❑1,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 ftRP Acknowledgement. SAFETYBUILDING & PERMIT/PLAN i ";Menifee DATE PERMIT/PLAN CHECK NUMBER — Wo5q� TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW LUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK L �,kl PROJECTADDRESS ASSESSOR'S PARCEL NUMBER �6 �TGT �_ TRACT OWNER NAME Ka (� ADDRESS qqU I' 4o G Uo PHONE -l J ` 5� j,1('I EMAIL APPLICANT NAME ADDRESS VG& , r5 PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? O YES O NO J BUSINESS NAME �1 C, GLI/ ADDRESS . 1 \W` ,� L I PHONE ��( S� ` EMAIL \ y ^ �` CONTRACTOR'S STATE LIC NUMBER C L.F.a ` ��B( 6 LICENSE CLASSIFICATION VALUATION$ V� SQ FT L SQ FT l APPLICANT'S SIGNATURE �� DATE I ` CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION SMIP CIIYOF MENIFEE BUSINESS NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN INVOICE ��G PAIDAMOUNT AMOUNT J 0CASH OCHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER 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 i COUNTY OF RIVERSIDE DEPARTMENT OF ENVIRONMENTAL HEALTH dN 60 7 Lic.#C42-988020 ®NSITE WASTEWATER TREATMENT SYSTEM �.h /® -�5 0 SePbc Ta ,� YSD ® ��� Sq.Ft.of Leach Lino C�aWl1 . See~ ift Nm Di2 m Bl®� ""� Sr"a Comets chump C ®ConrAlcitilo Exldfiq InsMlhtioeefMashMnesamaottoeilaged Install dM M W&ft,leaving lids a=ssibta t®r elvaning. N��Lxger (2g00 gallons or greatarD ra�uiro a d�lq aotiaa pinery, • Approved rJeaNbM eatnanP Biters Hauer tre instolled M feraldaM aarvidng. NO oM4rawaMlaDllening deWon shall be discharged Into the septic Wamm withal olee►arroa km l*CaMomia Regional Water®ua6ly Control Board. • lrrstaladaa dW=ft,. to ft wnenl UPC: ' M ft ale of Fapwed drip rs4s ehag reopmatpygry Datx a o City f Menif e C , Buildin & Safety Dept. JAN 0 9 2017 Q Received AYOF MENIFEE �T G7iND SAFETY DEPARTMENT r � 4N APPROVAL �jj REVIEWED DATE un oval of these plans shall of be construed to b it for,or an 1 1� 'pr:,val-of,any violation of an�r provisions o { state or city regulations and ordinances. Tis set of approved plans ust be kept on the ite unt m if completion.. County of Riverside DEPARTMENT OF ENVIRONMENTAL HEALTH www.rivcoeh.org d o City of Menifee Building & Safety Dept. CERTIFICATION OF EXISTING SUBSURFACE DISPOSALAI(rSJllI2017 A880 Lemon Street•Suite 200•Riverside•CA•92501-(951)955-8980 ❑47-950 Arabia Street•Suite A•Indio•CA 92201-(760)863-7570-;13 `ry. �/ Property Informatio : APN: ,< (q© - 0 Jn�0 Date of Inspe on: ` � / I. Owner: ���V C t.1 5 ylG e rAddress: d rllr/r1 2 I/Ga I L,, t1 City: 1!-\ FAILURE TO PROVIDE ALL REQUIRED INFORMA TION 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. a. I examined existing subsurface sewage disposal system at the above location on _ and determined that the tank capacity is ::45C'�allons and that there is _3VC�sq.ft.of leach line bottom area. There are bedrooms in the dwelling and there are fixture units. b. There are leach line(s), each _�ffft. long Depth ft. 14-Rock ❑ Plastic Chamber c. There are Seepage pit(s), each _ ft.in diameter,and _ ft. TD. ft.BI. 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): ❑ Concrete 03,Fiberglass ❑ Steel ❑ Other: b. Internal dimensions of septic: Length __� — ft. Width (ji ft. Depth (-( ft. c. Condition of tank(please check yes or no for each question): Inlet Tee present? QLYea ❑ No Tank Structure deteriorated? ❑ Yes Qn-No Outlet Tee present? l�'Yes ❑ No Effluent Filter Present? El Yes LLNO Two compartments? GIYes ❑ No d. Condition of D-Box: Level? QYes ❑ No Replaced? ❑ Yes ❑ No 5. a. While pumping the tank,did effluent flow back into tank from absorption system? EI.Yes ❑ No b. Prior to pumping,was the liquid level in the tank above the outlet tee? CLCes ❑ No c. Was the area around the lids oxidized? ❑ Yes Cll-No d. Is design of system gravity feed? Cfl-Yes ❑ No e. Were well(s)observed on this or adjacent property? ❑ Yes RNe If yes,indicate distance of well from: Septic tank _ ft. Leach lines _ Seepage Pits _ ft. f. Distance from springs,lakes,and natural water courses(check all that apply): ❑ Septic Tank ft. ❑ Leach lines ft. ❑ Seepage Pits ft. g. Is sewer within 200 ft.of structure and abuts property line? ❑ Yes C9To Additional Comments: h. How long has dwelling been vacant?(if applicable) months weeks ❑ N/A 6. a. ❑ It is my opinion that the system appears to be in good working order and can be expected to function property with ,�,improper maintenance. No repairs are necessary at this time. b. LY It is my opinion that the system is not in good working order and will not function properly without the following repairs: I certify under pens of perPu that the fo ing is true and correct. Signature:C Print Name: Contracto Icense No.: Expiration Date: /PI �30 /o Pumper Co.: Phone Number: 7 E / Address: City: Zip: EPO-91(REV 03/16) „o County of Riverside DEPARTMENT OF ENVIRONMENTAL HEA-ld�'` & Safety Dept. www.rlvcoeh.org JAN 0 9 2017 LAND USE APPLICATION OFFICE USE ONLY )3880 Lemon Street•Suite 200•Riverside•CA•92501—(951)955-8980 PE CODS: EE: ❑47-950 Arabia Street•Suite A•Indio•CA 92201—(760)863-7570 69 9wo 4 •ag EHS# I?0561_ ON II Gq o LMS# A1 :1 1: TR/PM opg I 5g5 LOT 0[PERMIT L1i%_IJ 1- 5 atyLt� SECTION A 1to r- 56 Name 6L ✓cc-\ SeL, N Ll_ K /I OWNER: Address A a, d Vca l lcity 1/'L�ut t'`P - Zp r_ Phone I S—/ Email Company Name Lc bneLz Agent/Contractor I'CIl u'-i b>c� AGENT/ H / CONTRACTOR: Mailing Address !i((7 �1(� �Cit t 41(,,V<L J c / zi SG Phone ` (o/ < / Email / /�6)/—C - e—r(L/:-((, �i C$ lib'. PROPERTY INFO: Site Address CDC) Ci p d• t (<«I/ Cit lMe to�I zip Water Agency/Well p Lot Size I.01 f' cr& APPLICANT'S SIGNATURE: a DATE: l t{ a-p C SECTION B elow—For Office Use Only CHECK BOX IF REQUIRED If any box is checked,this application shall b red denied until the information Is provided. ❑Holding Tank Agreements Required ❑ Floor Plan and/or Plumbing Layout Required Certificate of Existing OWTS Required(C-42) ❑Special Feasibility Bodng Report Required ❑WQCB Clearance Required ❑Detailed Contour Plot Plan Required(1 to 5 foot Intervals) 0 Soils Percolation Report Required SI E ALUATION I PECTION R MARKA, - h!� 7&0 QA Ate-1 a-Lt 0 rrm aG:�( o; EHS INITIALS/DATE: SECTION C ❑ NEW EPAIR/REPLACEMENT ❑ EXISTING ❑PUMP ❑ATU ❑CONNECT TO SEWER FIXTURE UNITS# BDRMS# _ Soils Percolaton/Sodng Report By: Dale: Project# - - --- C-42 Certific tion By: Date: License# ; !'e r a �ol� C ya Septic tank cap.: I Soil Rate: Tested Depth. Max. trench depth: Sq.FL Bottom Area: Total Linear Ft.: Line(s): Length: feel - Each 3 feet wide Sidewall Allowance: Ft.Rock/ Sq.ft.Running foot Rock below drain line: _in. or ❑Plastic Chambers Leach Lines/bed special design for slope: ❑N/A ❑Overburden Factor. Pit Diameter. No.pits: Depth below Inlet(bl): Pit Total Depth: Max.allowable depth: CONSTRUCTION/INSTALLATION REMARKS: SECTION D This Application is -t,/' proved ❑Denied regarding the design of the OWTS as Indicated on the accompanied plot plan using the requirements set forth in Section C above.No constructionA paynitted in the required reserved 100%Expansion area. EHS Signature: Date: f 7 J EPO-92(REV Me) DIs9lbuepn:WHITE—Office File;YELLOW—Bldg. LPINK—Appr, eM County of Riverside DEPARTMENT OF ENVIRONMENTAL HEALTH OWTS INSPECTION CARD ! APN: 360 -Oao --�02Sq ONN,o,./�� ' I6Q/O/t�-- I� EHSNo.: 1700OL/ Site Address•. Ylr'a Vet VCf/f4Y" i To Schedule an Inspection Please Call (951) 955-8980 OWTS Components Date Re-Inspection Inspector of Inspection Date Initials Leach Line Bed G s orrmet�� 5ewer-Lateral- D-Box Risers Efflue i Fi Inspection TO BEPOSTED ATJOSSITEIN PLAIN VIEW EPO-P(REV 9115) city of Menifee Building & Safety Dept. JAN 0 9 2017 Received