PMT17-02434 City of Menifee Permit No.: PMT17-02434
29714 HAUN RD. Type: Residential Plumbing
�AACCELAk7. MENIFEE, CA 92586
MENIFEE Date Issued: 07/12/2017
PERMIT
Site Address: 32293 ASCOT WAY, MENIFEE,CA 92584 Parcel Number: 360-370-004
Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE SEPTIC IN SAME LOCATION/SAME SIZE-1000 GALLON SEPTIC TANK
Work:
Owner Contractor
H ECTOR ALVAREZ
26135 TASMAN ST
Applicant License Number:
HECTOR ALVAREZ
26135 TASMAN ST
MENIFEE,CA
Phone: 9512306378
Fee Description gttv _Amount 151
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 Permit_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 contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and [rt am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason: -T n , c- fi ._ ve r ✓
License Class License No. By mysignature 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
WORKER'S COMPENSATION DECLARATION Improvements covered by this permit.I cannot legally sell a structure that I
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 the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this appllcation is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www I inf ca. ov calaw.htmi.
this permit is issued. - 2
Polity p
~ Date
inI have and will maintain workers compensation insurance,as required by PROPRTNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which 9,8y 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 owners behalf.I have read this
number are: application and the information 1 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 fL Expires enter e.bo identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred �A6�1// Date ( 2
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p
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 orfuture building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts spec�tfed on the Hazardous Materials Information Guide?
WARNING FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes:F IFo
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 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 guidelin
CONSTRUCTION LENDING AGENCY O Yes
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 boun ary of a school?
(Section 3097 Civil Code) ❑Yes a
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
Contractors License Law for the reason(s)Indicated below by the Califor arHealth&Safety Code,Section 25505 and 25534 concerning
douf Sri reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 es
Business and Professions Code).Any city or county that requires a permit to Date 7
construct,alter,improve,demolish or repair any structure,prior to its pROPE OWN 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(RRP)
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( 00). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,w111 do( )all of or( )portion of the work,and the structure is www.eoa_1 g_Lov/lead/lead or contact the National Lead Information Center at
no
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 ❑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. tt CRY Of cMenjfee o No EPA Lead-Safe Certified Firm Is required for this project because:
❑I,as owner of the property am exclusively conttrracllInng R'id�t'F'ty Dept.
contractors to construct the project(Section 7044,Busi ess and Professions
Code:The Contractor es s State License Law do not ap an 1+201V If your project does not comply with EPA RRP rule please fill out the RAP
Acknowledgement.
RIsCeIV2d
BUILDINGPERMIT/PLAN CHECK APPLICATION
Menifee
DATE 2- A PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY MOBILE HOME ❑POOUSPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK e
PROJECTADDRESS Z 2 .-� c IT2ro 214
ASSESSOR'S PARCEL NUMBER 1j(QQ • 3 1D•lJ�t LOT -2, TRACT
PROPERTY OWNER'S NAME ADDRESS
p goy -�, ti -, S o f c^ �ICI c CO
PHONE{ FjI)Z `�6 " (/'{ 7 S� EMAIL ��/G�rc2 IC ' RL-t� C
APPLICANT NAME r c 2
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? OYES❑NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFI N
VALUATION$ (,� . I SO FT L SQ FT 10 L
APPLICANT'S SIGNATURE , c, to - A \ ✓6 DATE 7- 2
DEPARTMENT DISTRIBUTION UO CITY OF MENIFEE BUSINESS/LICEyS�NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP V
INVOICE G � PAID AMOUNT
AMOUNT I S' OCASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# :.'CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City qTniieDep
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 15P{Oty t
www.cityofinenifee.us Inspection Request Line 951-246-6213 ju� ,, 't01�
. � 1'1�t�Z4-Ll JX`1ch
r OFFICE COPY I
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3
CITY OF MENIFEEar
BUILDING AND SAFE DEPARTMENT tow
PLAN APPROVAL
� N
REVIEWED B 12-
DATE " I
`Approval of these plans all not be construed to be a permit for,or an
approval of,any violati of any provisions of the federal,state or city r'
regulations and ordin ces. This set of approved plans must be kept on the y
jobsite until compl on.
J
22 C G
M
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COUNTY OF RIVERSIDE J
DEPARTMENT OF ENVI RON MENTAL HEALTH
ONSITE WASTEWATER TREATMENT SYSTEM
Dwelling hDCO Gal. Septic Tank
Commercial Sq. Ft.of Leach tine
Seepage Pits _ No a_BI_TD_MD_
v _ Conned to Sewer _ Concrete Pump Chamber
_Connect to Existing
• Installation of leach lines are not to exceed fL in depth
• Install risers to grade,leaving lids accessible for cleaning.
Note: Larger tanks (2000 gallons or greater) require 2 risers to access primary
chamber.
Approved cleanable effluent filters must be installed to facilitateiservicing.
• No on-site water softening devices shall be discharged into theseptic system without
clearance from the California Regional Water Quality Control Board.
• Installation shall conform to the current UPC:
T • -Any grading in the area of proposed do lines shall require.new approval by this
�► p Department. a
T '; o Date: — �l—I EHS: UrGIGG 1
bu
�1 t Menitee
pt
•Q Q afety Dept.
� M M Bulldin '
z JUL 12 201► .
nMee.
Q I�{pOr2tV��
1.
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COWIN OF a SIDE
DEPARTMENT GF ENVIRONME LTH 9
ONSITE WASTEWATER TREATMENT SY
D
Dwelling ItOb Gal.Septic Tank
Commercial Sq. Ft.of Leach Line
Seepage Pits _ No a_BI_.TD_MD_
Conned to Sewer _ Concrete Pump Chamber
_ Connect to Existing
Installation of leach lines are not to exceed ft.in depth
• Install risers-to grade,leaving lids accessible for cleaning.
Note: Larger tanks (2000 gallons or greater) require 2 risers to access primary
chamber.
Approved cleanable effluent filters must be installed to facilitate servicing.
No on-site water softening devices shall be discharged into the septic system without
clearance from the California Regional Water Quality Control Board.
Installation shall conform to the current UPC:
• Any grading in the area of proposed drip lines shall require new approval by this
Department.
�q Date: 6' aft` 1.T EHS: Yo �f if (� i U
W O e L L ;
O D
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r City of Menifee
^dOO 301A=10 Lv `L Building & Safety Dept.
S JUL 12 2017
Received
RIVERSIDE CTY/LEMON FACILITY County of Riverside
DEPT OF ENVIRONMENTAL HEALTH
3880 LEMON ST. #200 EPARTMENT OF ENVIRONMENTAL HEALTH
www.rivaoeh.org
O LAND USE APPLICATION
OFFICE USE ONLY
06/29/20 T 7 DDDDDI eerside•CA•92501-(951)955-8980 RE CODE: FEE:
#1410 11:58AM JOHN0003 -p p
io•CA 92201 -(760)863-7570 17 q
722060 $714.00 LMS# APN: 2/
772210 $14.28 rJ(70-3 70 �Oa-
i`. USE OF PERMIT:5e yC
***TOTAL $728- 28 -
CASH $800.00
CHANGE $71.72
UVvivcn: Address GG SZ.00 p' S�ti ?ti r° �G. \„ cityrri /� zip (q T
Phone fS Z89- /I/ 2 Email J iV re-Z 1R1@IC /1SLJ D��•
Com an Name A .-L,I,t Agent/Contractor
AGENT/
CONTRACTOR: MailingAddress Z ' • f- cityre v,- .' Zi
Phone ( — Z Email p� C I o d r C o
PROPERTY INFO: Site Address 3 Z z C/ Col L✓a cityMe-] • �C t— zip
Water Agenc /Well I Lot Size Z �2`` ACV, c S
APPLICANT'S SIGNATURE: DATE: �, Z > /
SECTION 13 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(C142) ❑Special Feasibility Boring Report Required
❑WQCB Clearance Required ❑Detailed Contour Plot Plan Required(1 to 5 root intgtytalsbf Menifee
❑Soils Percolation Report Required la y
SITE EVALUATION INSPECTION REMARKS: DUUUMV
EHS INITIALS/DATE: ..
SECTION C Received
❑NEW I ❑REPAIR/REPLACEMENT ❑EXISTING ❑PUMP ❑ATU ❑CONNECT TO SEWER- . FIXTURE UNITS# BDRMs#
Soils Percolation/Boding Report By: Date: Project# _
C42 Certification By: Date: License#
Septic tank cap.: Soil Rate: Tested Depth: Max. trench.depth: --
Sq.FL Bottom Area: Total Linear FL: Line(s):
Length: feet - Each 3feet wide
Sidewall_Allowance: FL 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(bi): Pit Total Depth: Max.allowable depth:
CONSTRUCTION/INSTALLATION REMARKS:
i�l(Z, 6kon Ll47-2 alLe et. d
SECTION D
This Application islo Approved O Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth in
Section C above.N construction is permitted In the required res "ad 100%Expansion area.
EHS Signature: / Data/� -�9 _ /7
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EP092(REV]H6) /r� . . DisWbution:WHITE—OKie FIIe;YELLOW—BItlg.Dept.PINK—Appricenl
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136.60 ft �
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a City of Menifee
Building & Safety Dept. a s
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JUL 12 2017
m IF
Received
4--0
NOTICE: THIi IS NOT A BUILDING PERMIT DISTRICT
APPLICATION TO CONSTRUCT 40
lr0lj�
Permit No
DEPARTMENT OF BUILDING AND SAFETY _
COUNTY OF RIVERSIDE
Owen Contractor._.____.—__..—.__.._.
Address�_-ZY_ '-_-?/,Lf— Addrcss—_.-- _ Address..._._.
City. .. l /Ed.�_ 9, 4V
6. City----
Phones ?6 r 37_c+_�� Phone—_.----_-___ Phone—_.—�__.__ _._.._
1.
W I Iwe) the undenigned. hereby Certify and.xknowlvdga that I h+ai have read the application and agree that if Curb and Gutter,S and
Paving, �-
,and/dr Dedication of right of way is UY the County of RncrsitlC, the Riverside Cciinfy pepadment of Buddirsg and Salary i
.� shall not make a Final Inspeclmn until Said requiramenls have been mel. I am also aware Ihal no work is to be done within the County R/W I
t9 without an "z oschmenl parmit. p
NOW, therefore,It is agreed that 1 twel will not "c.Dy Said Vf0M?Iy and will not cause said propert to be occupied until .4v,0 have t
camPlied with all laws of the COuniv of Riverside and the State of California 9ovarn�ng Said properly.
- DATE SIGNATURE OF OWNER AND"OF?AGENT 1
"Appiaral by Signature Mtn the Follotiing QcDaretnenK Ciiasd Bel
Must Be Obtained Prior to the Issuing of a Construction Permit. FFt
SPACE NO. -- i
i r I USE OF STRUCTURE
JOB ADDRESS SINGLE FAMILY L} DUPLEX [�
LEGAL DESCRIPTION F PROPERTY
- APARTMENTS AGRIC. L�
M - -' - COMMERCIAL n INDUSTRIAL L� I
F COMMUNITY f
Z NO, OF SUBMITTED PLANS V USE OF PERMIT __ _ ,�,; : . ALTERATIONS [�
„ a -CASE NO.
NO. ___ ___. _____......_...... __..___
Z NO.OF PARKftIG SPACES REQUIRED
< ZONEda ' <ETBACKS: FRONT ____SIDE_" L REAR
"m GRADING PERMIT REQUIREO1 YES NO ❑ LOT SIZE « -
SETBACK ORDINANCE k ___ OF.__._._. FEET REQUIRED ON ._.__T-_ r' -- _ STREET 33
p
DATE z4:.L_'_f _ SIGNATURE OF LAND USE OFFICIAL _ f
.DEDICATION REQUIRED: YES ❑ NO [l NO. OF FEET .
CURB AND GUTTER REQUIRED. YES ❑ NO ❑ _STREET
a~t
CAN CURB AND GUTTER FEASIBLY BE INSTALLED% YES NO I_I
D HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
B
O IMPROVEMENT? YES C NO C '
SIGNATURE OF ROAD DEPT. OFFICIAL__—_.__...
SWIMMING POOL$ PUBLIC fir_
'-'+ ..r,.•.4 %' -+ _•__ _ 1
�► SEWAGE DISPOSAL
. .� FOOD ESTABLISHMENT
WATER POLLUTION _ REMARKS
FLOOD CONTROL
AIR POLLUTION —_- -----_+--
b OIY OF NWY
i — YOUR PROPERTY MAY BE SUBJECT TO
-- FLOOD. RIVERSIDE COUNTY ASSUMES
—" NO RESPONSIBILITY IN EVENT OF FLOOD.
Y-
i %%hg rY 0{ CANARY"-FILi, PINK—APPLICANT
Salt
Alt '? ?Old epr:
Np' . 1 1- Ctfz43u
il1FPkRYh4 iY Oi:Ii1 MNG A SAFETY !
COUNTY Of Mmof
s.
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES
INCFEES_PoKo.
Ft. ® $ UNITS
�Ts' 7NDFL. 50,Fr: YARD SPKLR SYSTEM
.,S FOR SO,FT. Fy MOBILEMOMESVC /0 G BARSINK i
s GAR. S0.FT. 26 POWER OUTLET '� Bd ROOF fNtA1FS .
cM CARP. SO.FT- CPT• DRAINAGE PIPING
1
WALL 50.FT. 4 DRINKING FOUNTAIN
i <
URINAL
ESTIMATED CONSTRULSION VALUA7rON $
WATERPMNG
D:OT&tVo1 to be mud n's propdrry laa voluolfon SWIM POOI,PVT
FLOOR DRAIN
MECHANICAL FEES SWIM POOL,COMM WAIERSOFTENER
VENT SYSTEM FAN Q EYRP,COOL Q HOOD 51Gu WASHER(AUTOHWSHI
APPLIANCE []DRYER GARBAGE DISPOSAL
FURNACE C]UNIT Q WALL 0FLOOR [Q SUSPENDED
LAUNOBY TRAY
AIRHANDLINGUNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM. — B.T.U. TEMP USE PERMIT SVC WATER CLOSET
COMPRESSOR WATER
POLE,TEMP/PERM LAVATORY
t-Ig"INGSY5TEM ❑ FORCED C] MVITY AMPERES SERV ENT
SHOWER
BOILER, .-. B.T.U.
SO.FT. pk c BATH 7UB
SQ.FT. 4 c WATER HEATER
SO.FT.RSID 15 114 SEWAGE DISPOSAL 0 Ord,
SO.FT.GAR @p iic MOUSESEWER
PERMIT FE€:. GAS PIPING dQ
• - PERMIT FEE PERMIT FEE
*4>y-' - uOC nubAE MICRO FEE MEGH.FEE PL CF:FEE CONST.FEE ELECT.F EMIFEE FEE PLUMB.FEE r
S(y
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hYm•Fm 3 :m,mPbv we-yerw+in env mamar»Pr ro be-..,lkw 1P11,,wurkmen'FFPm.
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EircA'SydEm Addy— co, 21P Wwlari Comp.
'' LL P THIS PERMIT SHALL BECAME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF Y+vdmdbr ro 0
LPN'X DNRip WORM FOR 120 DAYS 5HALL ALSO CAUSE PERMIT TO BECOME VOID. Oi MD(,ITE:E IL
I HEREBY AGREE THAI ALL WORK IN CONNECTION GECTION W.-TH THIS PERMIT WALL BE DONE IN ACCOPOAN _CLty Dep
WITH THE LAWS OF RIVERSIDE COUNTY AND THE.57ATF.OF CAUFORNIA. BU`tdT'ZJ ry
SO IN.�ACCOIDAANa,THAT
ITTH THE INDIVIDUAL
5d OF THE E BUSINESS AND PROFESSIONS CODE OF O PREP41-0 THE PLANS AND THEHAS
STATE O
'vm]N-208 ir1P..M7!!®F. CAUry')wx. J
t-17 2II4 34
*maws PE&WDEPARTMENT OF BUILDING d SAFETY .�.
PERM TNOnJ �COUN;Y OF RIVERSIDE
-,tT
i ..
CONSTRUCTION ESTIMATE NO: ELECTRICAL FEES NO. PLUMB!NG FEES=;•":_.�:I�'`��
1,1S>fT FL $0,FT. Crc $ UNITS
er.D FL. 50.lR. Cr LROOFOP.A:INS
SYSTEM
FOR. SO FT 0 MOBILEHOMESVC. ZO 019 -
GAR. SO.FT_ ® / POWER OUTLET 360SCARP. SO.FT, Q PIPINT.WALL 5O Ff Cm, OUNTAIN
SQ FT &ESTIMATED CONSTRUCTION VALUATION $ G Gt7
NOTE,Not to he used as Property lon voluanon sWIM POOL,PVT FLOOR DRAIN
MECHANICAL FEES swim POOL,Comm WATERSOFIENER
VENT SYSTEM []FAN ❑EVAP COOL ❑ HOOD SIGN WASHER IAUTOI I DISH
APPLIANCE ❑DRYER GARBAGE DISPOSAL
FURNACE ❑UNIT {-I WALL [I FLOOR ❑3�SUSIPENDED LAUNDRY TRAY
AIRHANIRINGUNIY 1-- J CFM IDLE METER KITMENS!NK
ABSORPTION SYSTEM E�BT.U. TEMP USE PERMIT SVC WATER CLOSET
COMPRESSOR �HP ROLE,TEAAP.PERIA LAVATORY
HEATING SYSTEM ❑ FORCED CI GRAVITY AMPERES SERV ENT SHOWER
BOILER EIB.T.U. SO FT p, c BATHTUB
SO.FT. Cq c WATERHEATER
SO FT RESID r& 1-14 SEWAGE DISPOSAL /(q O
50 FT GAR C5 i1¢ HOUSE SEWER
GAS PIPING
PERMIT FEE PERMIT FEE PERMIT FEE
DEL AL u0e.Hu.EE MICRO FEE NECH.FEE PLCK FEE CONST FEE ELECT,FEE, SMI FEE FEE PLVMB.FEE
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wiavdh ;i$t.•Ce3r�ff �°�tlO1 'a. laan+ep
errovrTLcd - � � 2�1�
MoRi611�E1 " AdAW C¢y 5o WaWn'CprM
• f�#(f P - • 1%1$PERMM SHALL BECOME VOID If WORK IS NOT iR S.Cg5Fs71DN 6F vxdNBE,y�
• . tP,�. r • WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME COMA VOID.
s HEREBY AGREE THAT AALLA�WORK IN CONNECT10N WITH THIS PERAUF W14 BE DONE IN ACYARDANCE �.�
•• .+.,..
;yS:c :_'.�• ?� WITH THE LAWS OFRIVERSIDET LINTY ARD THE STATE OF CALIFORNIA,
I HEREBY CERTIFY TIMY LHE INDIVIDUAL WHO PREPARED THE PLANS AND SPECWICATIONS HAS DONE
' 50 IN ACCORDANCE IMTH SECTION 5541 OF THE 8USINESS AND MtOFESS10N5 CODE OF 7HHSTAs,E OF
HY.R4.9alliwr.1,i71 CAUFORIN A.
•
J
v
NO (- OPeRAPON GATE INSPECTOR NO. OPERATION DATE INfiPECTOR
Z - r ESUILDING APPROVALS - MECHANICAL APPROVALS �,
r. T Sei Sack 33 Venlilmim SYStem .::
rig,L Prmi 34 Plenom15 0vds r Y.f
7A SIo6 Grade 35 F.nnaca Compare• :yx
3* .Steel
' 36 inku 80upei: -
4 Grcvt 81oe1;i 37 Cambumon Art
5 Band GCCms 38 Camprator
6 Wool Deck 19 Appl.Clearantt
7 Fuming 40 Fre cart"
8+' Venn 41 5make IAmmion Dev¢e
9 Garaoe.Fire Wall 42 Can:meroal Hood
10 Frcvpla:e P.l. 043 Find
1oA Freplcea To. C ',o" ADDITIONAL INFORMATION
11 Ealerior Larh
12 Imerhol Larh
12A Drywall
. 13 Finish Cvhde
INWLATION Thick
Vo(ua
-7A, Wells(BmN
128. CeiliryiBaml
12C failing IBlownll [�
14 llRal i
_ PLUMBING APPROVALS -
.15 Ground Plumb T— I
16 Woler Pipirp --- - - 1
1
17 Rough Plumb f
ie .Venn"
f
19 Sewoge Dapotc,
20 5ewar
21 horde Healer
22 Water Softener
23 Water 5erv:tt
24 Gus TCSI 24
?5 Fk� -� r ��' SEWAGE SYSTEM SIZE 9c LOCATION
Tank Pit l Line f
REA2 OF FROPEM LINE
ELECTRICAL APPROVALS I'
26 w Pole C G
27 u+dvdan ..
28 St,•n Emronw
29 Wiring
24A GrNndcogyr f_ ') P/L PIL
290 Barclirg
30 Feturas &$n y t
31 Sarvice pity eP '
gulldin9-
92 PBId L i 2 loll
STREET NAME.
z
Ji~' '• Y` •asl
wit
fill
f Y[
Oj
Vl 3M'`i
:�.fLiaf�R �•:.� ..r. . •
� �-�:;�°��;:":•;r� , - • City &��tyDe -
`'JC�}ist;; ^gr,"^`::,"; ^`iJ.• .B�ildin9 6
it�M.��Y.C_�•.. ��•.'4`'f�-,.. : ` � ..
•' fir.,+ ..Co-�:'*i:F'�.:.P:�''�:?G.. ,
9
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A' J
f.. f
im PAWN ,
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All
p\ty &gate Y�ePt.
���e1ved
State of California estec
Business,Transp°itdfian_and Housing Agency ;L° µe.
FOR INSPECTION PLEASE CALL :PARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
- DMilon-of Codesarid Standards
Michael Sanders HCe415 APPLICATION FOR
,.-0 AltemateApprova f]ll - . TechnIcal-Services,. 11,1rispectlor0d Obtain Insignia ...
619-$40-9705
'SECFIONI-UNIT INFORMATI N - -
e�
eoreregaeslf services mrmef
1 LICENSED CONTRACTORS DECLARATION (Check
.. - � - (Check Apprdpdate Box) (/I
- 1 hereby affsrn under penalttyy of perjury that"I am licensed under provisions of _ DTN/PeflTid N0.
ChaplerB(commencing with Section 70001 of Division 3 of me Business and Professions" O Manufactured Home/Mobgehome _
Corte andmy license's in full force and effect. O Multtiamgy Manufactured Nome D /y{
"
Ucensa Class pc.No. Esp.pate. Commercial Modular(Occupancy Group T Fee I `
D Special Purpose
Contractor Date Leal MpLd�(r•s., Det l �Y
" Decal Number
2.-0WNER-BUILDER DECLARATION
I hereby offrm under penalty of perjury that I am exempt from me Contractors' Se�m`�.q�! hw^•'lels(} N Nu ber AA NO.
pceme.Law forthe fallowing m mn: t " (C J,,.. l ��'�
" - - � R7 TO" Y
rec.7031.5,Buvnessand Pmfessfons Code:Any city°rcounty which requiresaperm(t Manufacturer Namel Modal Name,
-
is construct alter,improve,demolish a mparrmy structure,Prior to IM ance,�abo.
requires me applicant for such permit to fife a signed sfaMment foot he.or she b FIT BY _
lice med pursuant m-the provisons.!of the Contractors' license Law Chapter 9 -co chi vim Section 7000 of Dmsion 3 of fhe.Business and Professom Code)or - -
i at.he or.she is exempt there tram and-the boss for the alleged exemption. Any Year of Manufacture
vfofatian of5ealiorr703 I byanyappficantfor�a�ppemritsubjects me applicant to adwT .�
penblty o(not mdieRh°n five hundred d°Oors(ySDDJJ Insignia/HUD Label Number(s)
UFO] 1 as owner of the property, or my employass With wages as that sole
`conSse�tfon soil do fhework and the structure Is not lntentledaf ottemtllor sale. SECOONR- WN /APP CAMINFORMATION" -' _
(Sec.7044, Business and Professions Code: The Contractors'License Law does not Owner, " p,l•o2 i u Y.jo
apply to.on owner of property,who builds or Improves thereon,and who does such
work.hlmseff.or'herseff op ltfrough,:.his'or:her own employees provided that Such Z -' "' LA"
.Improvement is. .not Intended or offered-for.,sofe. Ithowever,:the.bdldng or -Ad, - s --�-
tmprovement Is sold wilhN,ore.year of completion the owner-bull der will have me
�burdenofprowngthaF heorshe dsd not buUd brlmprove(orthe purpose of sale.). City MU('(i".' 'CauniT_4=,n- &
[ has owner of the property, am exclusively contracting with licensed Location Address
confrac�ors to construct the project
`See2044,-Business and professions Code:The C°ntracfors'Ucensel.aw does nof.apay arkName(1(AppGe°ble) P #
D'dn owner of property who builds orlmpraves Memoirs,and who contracts for s°c�"h - - s -
pm)echvrith a contractogs)ficensedpursuantto me Conhoctors'.pcense Lam). A0p !cant
tW
. -( _llpm exempt undersea. .,- B.&P.C;for:Mlsrearom.... '�Tilephone-AppkonLaEaneowier_
re
.. . f r County . . LP
x(owl F�.Y iF t`t�r? J7I: 7 t [a Z I7 _ _ `` °
v s t :FL_,_ ' 70F .
3-WORKERS COMPENSAl70N DECLARATION �-" - "(IfDifferentlhar Applicant)
I hereby affirm under penalty of perjury one of the following died°rallom.. SECTION3-CONTRACTOR,ARCHITECT'O¢ENGINEERINFORMAIION- ..
[ ] I have and will maintain a cemTicate of coment to self-insure for workers '
compensation, as provided for byy Srmtion 3700 of me Labor Code, /or me Contractor's No _
performance of me work forwhich this permltbissued: - -
[ ] I have and will maintain workers'compensation Insurance,as required byy Address
Seeffon 3700 of the,Labor Code.for the performance of the work forwh1oh this permit
'.-Issued.Mywtl1kersSmmp.yii&bnhsigonceconierandpoUcynvmbwr :' ArchI1ect/EngheerName -
Carder . .. Registration No -
PogcyNumber., -_._. . _ _ . . ..
',, - 'Address
�'I-cerlity mat h the performance of the work,for which this ppeemiff is Issued I -
sliCrtlo employany person-firs arty manner sotasto become'st, fIaectct to'workers -;:SECTION 4'+DESCRIPTION OF OR&/ACTIVITY AND VALUATION_ '
compensation laws of California,antl agree that RI should becememblectto workers : ,
mmpparuafkn provisk at S ell of me Labor Code,I shag idrihwkh comply ,Descrbe.the proposed work J ccfivdy In detoll. Affach•additiond pages I necessary. Where
riith-ihoseprovW., � � � shvcMd alterotiom or additions are proposed, complete ploys speaTicafidns, detalls. and
. , calculation ore required to be attached to this form Provide the make.and model of any
�fwpmnr 'G I appliance to be•6sitalled clod pr&We
of morn ditto comPiete elecMaa cccutafim o f° ci
rbnY �t cal
-
to
WARNING:FAILURE TO SECURE WORKERS'COMPENSATIO COVERAGE IS UNLAWFUL. In
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE
'HUNDRED THOUSAND'DOLLARS" ($100.000): IN 'ADDITION: TO THE COST OF - _ '- _ ' C
GOMPENSATION.,DAMAGES AS PROVIDED-FOR IN SECTION:3706.OFTHE LABOR-COPE,J C-v 1�E p
.1tRIEREST r(Nr1'ATroRNt>^s FEES.-' _L•t IL s
4.CONSTRUCTIONLENDING AGENCY \ke
I hereby affirm under penalty of perjury that there b a m oil agenccyy Indicate me Total Costof.the ybrkJopeP.erfm ore - --
_-formerperFormanee of•me�Work-f°r'whkh=ms Pe=it`S 3097;:CNg
Cotlej Q} SECTIONS-SIGNATUREAND.CEirnFl TION
Lenders Name . . 0 t�� �� .. . -
I/We he make pe services designated above
Lendeh Adtlress
5 - RUR ATION Wi Signature Data
-: I caddy-that I have:read this application and state that the ebor"B, ' EPARTMENT USEONLY"
maid I agree to campy with all city and county ordinances_ relCIN59 _ , . - .
Jo-buldtng�conshuctan,and herebyouther¢e representatives` 0 TV to-enter
.upon me.abovemejr.o pro'party for purposes. 'Q _ PermM EzpbaN°n paM�' ( d -
-- APPROV .]O_.CONDRIONS[see reverseaide]- - O-DISAPPROVED-(see reverse side]
- 'Issue Date:� --
Sigrnaiure OFAppgcantd Agent Dala Closed/Signofure of DWkt Representative Dale
,DISTRIBUTION: YELLOW-DEPARTMENT WHITE-AREAOFRCE PINK-OWNER/APPLICANT