PMT17-00915 City of Menifee Permit No.: PMT17-00915
29714 HAUN RD.
'�/-�CCELA? MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued:
03/28/2017
PERMIT
Site Address: 25647 FARMINGTON RD, MENIFEE,CA Parcel Number: 358-100-051
92584 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of ABANDON EXISTING SEPTIC SYSTEM, INSTALL NEW SEPTIC SYSTEM AND LEACH LINES
Work: **INSPECTOR TO VERIFY EXISTING SEPTIC TANK HAS BEEN FILLED WITH APPROPRIATE
MATERIALS**
Owner Contractor
JONATHON MITCHELL LE PEW INDUSTRIAL INC
25647 FARMINGTON ROAD 41735 ELM STREET#303
MENIFEE,CA 92584 MURRI ETA, CA 92562
Applicant Phone:8889615971
JONATHON MITCHELL License Number. 988020
25647 FARMINGTON ROAD
MENIFEE, CA 92584
Phone:9512266201
Fee Description Qtv Amount f$
Sewer 1 150.00
Building Permit Issuance 1 27.00
Additional Plan Review Plumbing 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$186.60
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_Templale.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts far the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and 01 am exempt from licensure under the Contrector's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By my signature below 1 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
❑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 workers 7044 of th Business and Professions Cade,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this appl' tion 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.le info ov calaw.html.
Policy#
Date
❑I have and will maintain workers compensation insurance,as required by PR Ell OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which 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 Downer or authorized to act an the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all a plicable city and county ordinances and state laws relating to
building ons ction.I authorize representatives of this city or county to
Policy# Expires entert abo a Identified property for inspection purposes.
pp ��
(This section need not to be completed is the permit Is for one-hundred Date
dollars($100)or less pit TY NER OR AUTHORIZED AGENT
0 I 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 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 comply 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
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
1 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) 0 Yes ❑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 exemptfrom 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 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(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 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
❑I,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.eaa.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 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. 0 No EPA Lead-Safe Certified Firm is required for this project because:
I,as owner of the property am exclusively contracting with licensed
l:pntractors 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 RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE — PERMIT/PLAN CHECK NUMBER T 1
TYPE: O COMMERCIAL * RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES City Of Men fee
9tilleiing Lt...
_ I
DESCRIPTION OF WORK +i C. � uNK inJJ'�-e I!a�-I Ji-1 y Dept.
MAR 2,r,'017
PROJECTADDRESS q997Yceivasd
ASSESSOR'S PARCEL NUMBER 100 • 051 LOT TRACT
OWNER NAME 1Jt}60/j ` f
ADDRESS 10 7 �Grh11` rJ ✓�l Iti2�U���C
PHONE GJS l- d}�(R--(p 1 EMAIL
APPLICANT NAME " p (n�-kUIV r
ADDRESS 7 r1V�0 J 2 u)h ,'-
PHONE 0)S (�=a j I EMAIL • 0/V� O/J ®M l o. rti
CONTRACTOR'S NAME % j m
1 OWNER BUILDER? RYES O NO
BUSINESS NAME �� -TAYJ j.^I fog
ADDRESS L m 0, U )%Auy-rfe2 - G
PHONE EMAIL EMAIL e
CONTRACTOR'S STATE LIC NUMBER Q V2 04-0 LICENSE CLASSIFICATION E-
VALUATION$ Q OQ AP SO FT L SO FT
PLICA NT'S SIGNATURE DATE
CITY STAFF USE ONLY mmw�W
DEPARTMENT DISTRIBUTION y CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT •� 5•.� O CASH O CHECK# CO CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDIT 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 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
City of Menifee
8ullding & Safety Dept.
(E) c Crete MAR 2`;.8 2017
�o
driveway %� C21VDd
ry� Existin ingle st�ory�017
house tore . in
- zoo\nn,o pane
' \ �OSA6'man eddPoen '
(E) concrete pati Y
CITY OF ME NWEC (E) septic tank
BUILDING AND SAFETY DEPARTM NT N J�-emu.4
PLAN APPROVAL
MP.R�
REVIEWED B b�
*Approval of these plans shall not be construed to be a permit for, r 5ub•'° y�G L-�
approval of,airy violation of any provisions of the federal,state or c
regulations and ordinances. This set of approved plans must be kept the . . •22 • • -
jobsite until completion, eee Mn rem sjiipo !!
5'-0" easement typ
at property lines s s� 1°
U'
M
� Ms
S
_ 9 o
n o �
�0
o -b
Jonathon Mitchell 1
, o
25647 Farmington Rd
I J
Menifee, CA 92584
APN#358100051-9 'T
7 -� .. 7 ® .
County of Riverside
_ ®s, DEI•. RTMENT OF ENVIRONMENTAL t,,ALTH
www,rivcoeh.org
OWTS INSPECTION CARD
APN: �S y ,__ Permit No.:: ON. /Lo311
Site Address: 2�q� 1 `^^ f Itmio \ � fa City: 1 �� r� Zip:1 35 9 J_
To schedule an inspection please call Riverside 951-955-8980 or O Indio 760-863-7570
All cancellations/reschedules must be received prior to Sam on the day of inspection or additional fees will apply.
OWTS Components Date Re-Inspection Inspector
of Inspection Date Initials
Septic Tank
Leach Lines ed 80
Nwxbw
Seepage Pits
epticTan A an onme
Sewer Lateral
Effluent Filters
IIns ection
TO BE POSTED AT.70BSITEINPLAIN VIEW
EPO 55(REV 4/16)
City of Menlfee
Bullding & Safety Dept.
MAR 2;8 2017
Received
-,*'Lam
rc _.. County®n 6tiversld 'Z- 8�g' - q6/- 517/
0= DEPARTMENT OF ENVIRONMENTAL HEALTH �y ��T �ry�
o.. P,,, www.riveoeh.org
nF ' LAND USE APPLICATION -
- .m nyr:.rtm.±ram- � � OFFICE USE ONLY
K8880 Lemon Street•Suite 200•Riverside•CA•92501-(951)955-8980 +I PE CODE: FEE:
7
❑ 47-950 Arabia Street•Suite A•Indio•CA 92201-(760)863-7570 t 1 — FLOW
(/-1�D 7L f> •2b
EHS# -7 0 I�7/ ON# / // / LMS# APN: G
TRIP �� �' i LOT# �-L' .�J USE OF R ITr^ S � Building & Safety D pt.
SECTION A MAR to- 2011-
`T.. D
Name tM l �tVI C. � jo rk ei
` e1 �
-}
OWNER: Address cy� �� gV'� �`1 mc-tn Ctt V^GVvt� 6"
Phone (S^ ei r� �' m /Email
Company Name Agent/Contractor
AGENT/
CONTRACTOR: Mailin Adddddrrdssss L 7 3,� �lw S'E Su--�� Ci k /�vc.t�-�j2115^G .
Phone p p �f Jam``� 7 rr Email /1'71 --\ 0 hC e_ J -=Llg2/,,Srg �' cd7.e.-
Site Address �G �� ��tc -/.cur yr Cit Grill c C;d Zi� `J
PROPERTY INFO: '.rr a
Wafer Agency/VJeII M1—V �'( Lot Size
APPLICANT'S SIGNATURE: DATE: l D
SECTION B Below-For Office Use Only
CHECK BOX IF REQUIRED
If any box is checked.this application shall be considered 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 Boring Report Required -
❑WQCB Clearance Required ❑Detailed Contour Plgt PI n Required(1 to 5 foot tnlervsls)
ElSoils Percolation Report Required ,
e uired1V1 -
SITE EVALUATION INSPECTION REMARKS:
Ck
sf�h a ra �v sue/ of siy� a SaD LF a
bAlaln wmW- [.Ji/?t (!� d� Ril", , EHS INITIALS/DATE: rx.
SECTION C
NEW 1 ❑REPAIR/REPLACEMENT I ❑EXISTING ❑PUMP ❑ATU ❑CONNECT TO SEWER I FIXTURE UNITS# BDRMS#
Soils Percolation/Boring Report By: Date: Project#
C-42 Certifi tion By: Date: License#'
CL
SepU tank p.: Soil Rate: pj{ Tested Depth: .Max. trench depth:
Sq.oCSOO(.9 ai 'T Total 6 00rDFL6:-l/ Line(s): Len [h.. 100 feet - Each 3 feet Mde _ -
Sidewalll Allllowannce: W Ft.Rock/ ��- Sq.ft.Running foot Rock below drain line: _in.=or Plastic Chambers _
Leach Ltnes/bed special design for slope: ❑ WA ❑Overburden Factor.
Pit Diameter. No.pits: Depth below Inlet(bi): Pit Total Depth: Max.allowable depth:CONSTRUCTION/INSTALLATION REMARKS: 1 �, t-,WI `T
Rywk r f n _ d Y� lS• / - I (,(�`,y}A._.t-
S'-i6M 1 n- OvSi 7b 17eIi� GZOIO�`hms—
SECTION D
This Application is pproved El Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth in
Section C above. o nstruction is permitted in the required reserved 100%Expansion area.
EHS Signature: Date:3
EPO.92(REV 711 ' Disbibution:WHRE—Office RIG;YELLOW—Bldg.Dept.PINK—Applicant