PMT17-00912 City of Menifee Permit No.: PMT17-00912
29714 HAUN RD. Type: Residential Plumbing
<A-CCELA-' MENIFEE, CA92586
MENIFEE Date Issued: 0 312 812 01 7
PERMIT
Site Address: 31111 GEARY ST, MENIFEE, CA 92584 Parcel Number: 358-150-019
Construction Cost: $5.000.00
Existing Use: Proposed Use:
Description of REPLACE LEACH LINES
Work:
Owner Contractor
JAMES&CATHERINE DUNN DIAMOND W EXCAVATING
31111 GEARY STREET 21285 SHOEMAKER DRIVE
MENIFEE,CA 92584 WILDOMAR,CA 92595
Applicant Phone: 9516745476
WALLY WILLETTE License Number:554199
DIAMOND W EXCAVATING
21285 SHOEMAKER DRIVE
WILDOMAR, CA 92595
Fee Description Oft Amount f51
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 slated,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_Perrnit_Templale.rpl 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 o I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect p the following reason:
License Class C y Z License No.S!5r-♦7/9/ g signature below I acknowledge that,except for m y m y nature g p y personal residence
Expires t-3/-/8 Signature in which 1 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.)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
' www.leainfp.ca.eov/ca law.htm I.
this permit is issued.
Policy# Date
161 have and will maintain workers 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 workers 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.)agree to comply
Carrier S'TGTC FG ha 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 19P Z-5 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
❑I certify that in the performance of the work for which this permit Is issued,
shall not employ any persons In any manner so as to became subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith
co
ply with those provisions. o Will the applicant or future building occupant handle hazardous material or a
Applicant W r.CY W Date `3-Z 6 -/-2 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 ❑Yes ❑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 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(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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 ❑No
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
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 oYes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED 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 RENOVATION,REPAIR AND PAINTING(ARP)
License Law(Chapter9(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
D 1,as owner of the property,or my employee with wages as theirsole 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.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 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 for this 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 proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Cade: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 RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE 03/27/2017 PERMIT/PLAN CHECK NUMBER % '�� `joa
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION [-]ELECTRICAL []MECHANICAL
❑NEW []PLUMBING [-IRE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replacement of leach lines
n^p� ullding & Safet
PROJECTADDRESS 31111 Geary Street v�vVLA! Y De I.
ASSESSOR'S PARCEL NUMBER ;e V- 1F�- OT' TRACT MAR 2 8 2011
PROPERTY OWNER'S NAME Received
ADDRESS 31111 Geary Street
PHONE (951)956-6663 EMAIL rennym20l6@icloud.com
APPLICANT NAME Wally Willette
ADDRESS 21285 Shoemaker Lane
PHONE (951)318-5772 EMAIL wldomar@aol.com
CONTRACTOR'S NAME Wally Willette OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME Diamond W Excavating Inc.
ADDRESS 21285 Shoemaker Lane,Wildomar,CA 92595
PHONE (951)318-5772 EMAIL widomar@aol.com
CONTRACTOR'S STATE LIC NUMBER 554199 LICENSE CLASSIFICATION C-42
VALUATION$ $5,000.D0 SO FT L SO FT
APPLICANT'S SIGNATURE DATE 03/27/2017
FIN-STAFF USE ONLY
DEPARTMENT DISTRIBUTION �[ CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP
INVOICE 1Q�+ PAID AMOUNT
AMOUNT l�T',„,JJ OCASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKN 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
f, www.rivcoeh.org
OWTS INSPECTION CARD
APN: ���J r)' s0_p I q Permit No.: ON ( L '
Site Address: I I ` � ('', Q n-CIATs� City: l�Q rL i'l ..k Zip: �J 15�1 ,
To schedule an inspection please call ❑ Riverside 951-955-8980 or ❑ Indio 760-863-7570
All cancellations/reschedules must be received prior to 8am on the day of inspection or additional fees will apply.
OWTS Components Date Re-Inspection Inspector
of Inspection Date Initials
Septic Tank e `
Leach Lines/Bed _ g
Seepage Pits
Septic Tank Abandonment
Sewer Lateral
D-Box
Risers
Effluent Filters V/
Final Inspection
TO BE POSTED ATJOB SITEIN PLAIN VIEW
ED -55(RW4/36)
oNwrK; County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
LAND USE APPLICATION
OFFICE USE ONLY
)d13880 Lemon Street•Suite 200•Riverside•CA•92501—(951)95wm
PE CODE: FEE:
❑47-950 Arabia Street•Suite A•Indio•CA 92201—(760)863-757p`3—]y�,EHS# ON# LMqPTR/PM p Cos, LOT# _ iUS :SECTION ANameOWNER: Address r'p/ y �/ eQ � lcit `'✓f �i!�l/ F C e ziPhone ,J 7 r1 G— O� 7 "�Compan Name �I QIV 0_' (d Wf�Q T'I h q enUCont2ctor W Q// l (/� / (/e-7re—
AGENT/ ` ' l _/CONTRACTOR: Mailin Address z^�//z�7/,J`1� e� Cit _/W //(/6�1C(Y ZiqZ.��Phone qT1 �/`7' �7�� W /61OGYlaY b C( c/, Cerro/PROPERTY INFO: SiteAddess36�` 1y�e�1-� Cit /•/ P{�//`ree Zip G,/v�
Water Age�ncy7/Well �/11 y��-D Lot Size l �7
APPLICANT'S SIGNATURE: W (jlJ(C�(!�
r101
CTION B Below—For Office Use Only
ECK BOX IF REQUIRED �Ullding & Sdfe
box is checked.this a Iication shall be considered denied until the information is mvided. ty Dept.
olding Tank Agreements Required ❑Floor Plan and/or Plumbing Layout Required MAR 7
ertificate of Existing OWTS Required(C-42) ❑Special Feasibility Bodng Report Required 2:6 20�/
QCB Clearance Required ❑Detailed Contour Plot Plan Required(1 to 5 foot intervals)
oils Percolation Report Required
SIT EYAL ATION INSPECTION REM KS:op aclru2c i E)i.eeBH (4
V
EHS INITIALS/DATE:
SECTION C
0 NEW I .REPAIR/REPLACEMENT 1 ❑ EXISTING' ❑PUMP ❑ATU ❑ CONNECT TO SEWER FIXTURE UNITS# BDRMS#
Soils Perdolation/Bodng Report By: Date: Project# -
C-42 Certification By: Date: License#
Septic tank cap.: Soil Rate: Tested Depth: Max. trench depth:
Sq.Ft.Bottom Area: otal Linear Ft.: Line(s):
Length: feel - Each 3 feet wide
Sidewall Allowance: Ft.Rock/ _Sq.ft.Running foot Rock below drain line: . _in. or Okplastic Chambers
.Leach Linesibed special design for slope: 0 N/A ❑Overburden Factor.
Pit Diameter. - No.pits: Depth below Inlet'(bi): Pit Total Depth: Max.allowable depth:
CONSTR CTI N/INST TION K
SECTION D
This Application's Approved 0 Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth in
Section C abov No construction is permitted in the required reserved 100%Expansion area.
EHS Signature: ` Date
EPO-92(REV 711 ) Oisbibulion:WHRE—Office File;YELLOW—Bldg.Dept PINK—I o�ni
COUNTY OF RIVERSIDE
DEPARTMENT OF ENVIRONMENTAL HEALTH
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM
❑3880 Lemon Street•Suite 200•Riverside•CA•92501-(951)955-8980
❑47-950 Arabia Street•Suite A•Indio•CA 92201-(760)803-7570
Property Information: APN: 3$8- 13-0- U 19 -6 Date of Inspection:
1. Owner: Address: 3/111- G eufY ST City: ?*2 eh/fee
FAILURE TOPROVIDE 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. a. I examined existing subsurface sewage disposal system at a�t�th-e^ above location on _zz�/� and determined that
the tank capacity is OOo gallons and that there is 1 i sq.ft.of leach line bottom area. There are 3
bedrooms in the dwelling and there are fixture units.
b. There are 3 leach line(s),each 9S ft. long Depth 3 ft. ❑ Rock 0 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 it.
4. a. Construction of septic tank(Please check one of the following): -
0 Concrete ❑ Fiberglass ❑ Steel ❑ Other:
b. Internal dimensions of septic: Length 7 y9 ft. Width 'f•7 - ft. Depth q-25' ft.
c. Condition of tank(please check yes or no for each question): Inlet Tee present? 29 Yes ❑ No
Tank Structure deteriorated? ei Yes ❑ No Outlet Tee present? ® Ye ptoy of Menefee
sB & Sfe D
_ Effluentent Filter Present? ❑ Yes � � U N
No Two compartments? Yes No g a ty ept.
d. Condition of D-Box: Level? 0 Yes ❑ No Replaced? ❑ Yes M No MAR 212017
5. a. While pumping the tank,did effluent flow back into tank from absorption system? 0 Yes I7 No
b. Prior to pumping,was the liquid level in the tank above the outlet tee? AYes ❑ No Received
c. Was the area around the lids oxidized? ❑Yes JO No
d. Is design of system gravity feed? Yes ❑ No
e. Were well(s)observed on this or adjacent property? ❑Yes SI No
If yes,indicate distance of well from: Septic tank _ ft. Leach lines _ Seepage Pits ff.
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 )N No
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 properly with
proper maintenance. *No repairs are necessary at this time.
b. 0 It is my opinion that the system is not in good working order and will not unction properly without the following
repairs: Lead 7-4`lC5 . CZLc Ica //ei C09/6Ce
I certify under penalty of perjury that the foregoing Is true and correct. �
Signature: W r--7Z&t/. [ Print Name:- W qt/y _ /iv / 11 eT 2 e
Contractor License No.: Expiration Date: / -33/- /8
PumperCo.: 9fQ14?O/7d e✓ Phone Nu ber: ?S-( 674 -
Address: city. Gt�J�e�D�r�p Zip:
DEHSANd 84 fREV 11/14)