PMT17-02683 City of Menifee Permit No.: PMT17-02683
29714 HAUN RD.
<A-CCEL/? MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 0 8101/2 01 7
PERMIT
Site Address: 28311 MOUNTAIN VIEW PL,MENIFEE, Parcel Number: 350-122-007
CA 92587 Construction Cost: $2,500.00
Existing Use: Proposed Use:
Description of INSTALL NEW 1200 GAL SEPTIC TANK WITH NEW LEACH LINES,ABANDON EXISTING TANK AND
Work: LEACH LINE
Owner Contractor
DAVID DAVIDSON -
28311 MOUNTAIN VIEW PLACE
MENIFEE,CA 92587
Applicant License Number:
DAVID DAVIDSON
28311 MOUNTAIN VIEW PLACE
MENIFEE,CA 92587
Phone:3233362348
Fee Description Qtv Amount($1
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE - 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$186.50
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 carded 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_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
hereby affirm under penalty of perjury that 1 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 ❑I am exempt from Iicensure under the Contractors 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 I acknowledge that,except for my personal residence
Expires Signature in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that 1
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 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 application is sub ' e rat the follow, website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. d m o. . ov calaw.
Policy# _. Date R
D I have and will maintain workers compensation insurance,as required by OPEi Wf4E R RIZED 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 owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construc' . onzerep entatives of this city or county to
Policy# Expires enter ti o veidemfie operty fo nspection purposes.
(This section need not to be completed Is the permit Is for one-hundred Date
dollars($100)or less
NEftO DTHORIZEb AGENT
o I certify that In the performance of the work for which this permit is issued,
1 shall not emolov any persons in any manner so as to become 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 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 o Yes o 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 o Yes D No
I hereby affirm that under the penalty of perjury there is a construction WIII 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?
tiWction ❑Yes o No
NER URDRATIONS 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 al 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 o 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 IRRPI
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 Iicensure 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
as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
ompensation,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 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o I,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 RRP
Acknowledgement.
PERMIT/PLANBUILDING & SAFETY APPLICATION
Menifee
DATE of (? ( PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL RESIDENTIAL [—]MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL Clty of S M nifee
El NEW PLUMBING [I RE-ROOF-NUMBER OF SQUARES Boding $ tyDept.
DESCRIPTION OF WORK 2017
PROJECTADDRESS )I L[,�J`'Q[. yl / G>`/ `L
ASSESSOR'SPARCELNUMBER �S, !g2_=1 &7LOT TRACT
PROPERTY OWNER'S NAME
ADDRESS
PHONE _- j��g EMAIL -
T�
APPLICANT NAME
ADDRESS
PHONE ? ��� 2J EMAIL ,
CONTRACTOR'S NAME OWNERBUILDER? S❑NO p
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
O �
VALUATION$ O v L SQ FT
A PPLICANT'SSIGNA;r R DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP k
INVOICE I PAIDAMOUNT �f—�/1 O n
AMOUNT :���// OCASH CHECKri .CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 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. ,/
/ www.rlvcoah.org 4 I t_.v
d// LAND USE APPLICATION p�
/ /ji d70 / OFRCE USE ONLY
J 7- PE eoDE -,FEE,
3880 Lemon Street•Suite 200•Riverside•CA•92501—(951)955-8980
❑47-950 Arabia Street• uite A•Indio•CA 92201—(760)868-7570 CI e q- "A 1424 _ � _ �e ;9'EHS# + . 06'Z ON# O� LMS# Al 1 APN:sSU
TR/PM O S' LOT 6Y 3 USE OF PERMIT: Cj��s rk[(s t-&1 njnrU �X��fr ",(C
Si
ECSCO�71i
Name I•
OWNER: Address LQ Vi • t CI f zip qa59T -7
Jam-_ -/
Phone Email /Ci JAY �• aw
AGENT/ Company Name A entfContractor
CON/TRACTOR: MailingAddress Boy city -e CA Z
/v/ Phone Email
PROPERTY INFO: Site Address 2 .I•' •n �e cityf• ze i,
WaterA enc/well W Lot Size C00
i
APPLICANT'S SIGNATURE: DATE:
.�^�" ••._ u. e�low For_. ce IAA r :,.- ::;41
,...
CHECK BOX IF REQUIRED
If arh box is checked this application shall be considered denied until the information is provided. e
r❑ olding Tank Agreements Required ❑Floor Plan and/or Plumbing Layout Required BuildSafet Dept.:
C ing &
Certificate of Existing OWTS Required(C-42) ❑Special Feasibility Boring Report Required
❑WQCB Clearance Required ❑Detailed Contour Plot Plan Required(1 to 5 foot intervals)
❑Soils Percolation Report Required 11
SITE EVALUATION INSPECTION REMARKS:
an EHS INITIALSIDATE: d
❑NEW REPAIR/REPLACEMENT I XEXISTING 1 ❑PUMP 1 ❑ATU I ❑CONNECTTOSEWER I FIXTURE UNITS# - BDRMS#J4 -
Soils PercolatronlBodng Report By: Date: Project#
CA2 Cpzp Y By. 5ee p 6vs luL Date:�I J ) License#Ll n R rY S )
Septic tank cap.: Soil Rate; Tested Depth: / U Max. trench depth:
I2L / x,_j �
Sq.Ft Bottom Area: ,5e Total Linear FLI 5.U Line(s): r' Len the feet- Each 3feet wide
Sidewall Allowance: Ft.Rockf Sq.It.Running foot Rock below drain line: +T in. or lactic Chambers
Leach Lines/bed special design for slope: O WA ❑Overburden Factor.
Pit Diameter. No.pits: Depth below Inlet(bi): Pit Total Depth: Max.allowable depth:
CONSTRUCTIONBNSTALLATION REMARKS: �� u v �yyLJ 7uh- G L
Cf LAt OL" a. La�
ILgua1 — lL q.41-'t k U UwTS dYI IGZ�^'�u'YI C(� / C7Y�t TIY
This Application Is.EV Approved ❑ nled raga ing the design of the OWTS as indicated on the accompanied plot plan using the requirements setforth in
Section C above.No constructlopels permitted I the required reserved 100%Expansion area.
EHS Signature: Date: f1
epo.92 may vlsl DlsOibutlore WHIiE—Oxfice FJC YELLOW—&day DePL NNX—apolmnt
I
i
APPROXIMATELY 9,000 S.F. BACK LOT AREA
ADJACENT
LOT
�(E) G.L. FENCE
EXISTING WASTE LINE
POINT OF CONNECTION
EXISTING LEACH LINE --------------_"_._._._._--.-.-._._. _._._._._._._._
............. ............. -- -- ........
— — — — — — — — —. 4r�o���i• . sT�Nc
r — — - -
1 1 EACH FIELD EX15TING
��� � NEW � CONNECT
- - - -
- - - - - - --)- - - - - I200GAL
q ' SEPTIC TANK'
EXISTIN
i 1 1 PATIO
L
EXISTING
UNDERGF
-.- - - - - - - - SEPTIC
:NEW LEACH FIELD AND SEPTIC TANK
?- "f/ e- ACCORDING TO SOILS ENGINEER
l r" ''J >: ! DE51GN AND COUNTY OF RIVERSIDE
ENVIRONMENTAL DEPARTMENT APPROVAL
r
i / r
F
TIC TANK AND LEACH LINE TO
CTED ONLY UPON INSTALLATION
C SYSTEM IMPROVEMENT. EXISTING
ND TANK TO BE FILLED WITH SLURRY