PMT17-02952 City of Menifee Permit No.: PMT17-02952
29714 HAUN RD.
�ACCEL/� MENIFEE, CA 92586 Type: Residential Plumbing
" - MENIFEE Date Issued: 12/08/2017
PERMIT
Site Address: 31266 MELVIN ST, MENIFEE, CA 92584 Parcel Number: 358-21D-001
Construction Cost: $500.00
Existing Use: Proposed Use:
Description of ADDING BATHROOM TO EXISTING MASTER BEDROOM,
Work: APPROVAL RECEIVED FOR ADDITIONAL BATHROOM/SHOWER FROM ENV. HEALTH
Owner Contractor
JEFFREY JAY WILLIAMS ,
31266 MELVIN ST
MENIFEE, CA 92584
Applicant License Number:
JEFFREY JAY WILLIAMS
31266 MELVIN ST
MENIFEE,CA 92584
Phone: 9512165466
Fee Description Oft Amount(SI
Receptacle, Switch,Outlet&Fixture 17 196.00
Sewer 1 150.00
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$663.50
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permk_Template.rpt Page 1 of 1
BUILDING & SAFETY PERMIT/.PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER O
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOUSPA O SIGN
SUBTYPE: O ADDITION efALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK A�Jf —in rna,,Ftkfodw, ' C/
I-
PROJECTADDRESS ' I Lb ld ivn Sf Mo, ga58`I
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME ^- \R f j-r-C G., W[ )1kvvk5 q
ADDRESS J�ry.l9b Q� Ih tYll la-rJ
PHONE (���) aye- 5 yb6 EMAIL &1'11 0o (2MOI •LO"
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I ^ SMIP
INVOICE PAID AMOUNT C
AMOUNT •� CCASH 0CHECKH CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECKII 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org Building Dept.
LAND USE APPLICATION
OFFICE USE ONLY
❑ 3880 Lemon Street•Suite 200•Riverside•CA•92501—(951)955-8980 NOV 1 1 2017 PEES`�CODE: E:
❑ 47-950 Arabia Street•Suite A•Indio•CA 92201 —(760)863-7570 t-7— O 2 -g 2,Gt `o 141 10' I '
EHS# ON# LMS#Cl * •�Iej PN: s(5g—
TR/PM LOT# USE OF PERMIT:
pLG1Y� Olr�i'�%S�
SECTION A
Name
OWNER: Address2
iQU^ I'N / cityjY1eYl1 C. zip
Phone l—I G JI �+,) — �rr� SmallIIsFq L(60
Company Name t' w 4 I3 A eny ontractor
AGENT/
CONTRACTOR: Mailing Address me 10JA
/ 7{ city Men! ZipL1
Phone ` I,51) I — 5 q 6 VJ 1 Email )WOOlI616OD bwvci�•r-Qm
J / 1�
Site Address G 7N �7t Ci l�'1U11 )rt ZI 9d6 L
PROPERTY INFO:
WaterAenC /Well o,; 1A11iG1 raL Lot Size -90 C`C..fc
APPLICANTS SIGNATURE:
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. �p
❑Holding Tank Agreements Required Floor Plan and/or Plumbing Layout Required 3�,yy1 Wrfj
V'Certificate of Existing OWTS Required(C-42) COMOicw Special Feasibility Boring Report Required
❑WQC13 Clearance Required ❑Detailed Contour Plot Plan Required(1 to 5 foot intervals)
❑Soils Percolation Report Required
SITE EVALUATION INSPECTION REMARKS:
EHS INITIALS/DATE:
SECTION „7;71ij s
❑NEW 1 ❑REPAIR/REPLACEMENT ❑EXISTING ❑PUMP ❑ATU ❑CONNECT TO SEWER I FIXTURE UNITS# BDRMS-#.--- ---
Soils Percolation/Boring Report By: Date: Project# mn:F:T[IT iI r ;•fit=
C-42 Certification By: Date: Ucensetf,_- a y� /3 `K i•�6
a 5 ► 51- �
Septic tank cap.: Soil Rate: Tested Depth: Max. trench depth:
Sq.FL Bottom Area: Total Linear FL: 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: ❑ WA ❑Overburden Factor.
Pit Diameter. No.pits: Depth below Inlet(91): Pit Total Depth: Max.allowable depth:
CONSTRUCTIONIINSTALLATION REMARKS:
-5-0y"\- Ito
Io I S 5 o kL c.�
47- 'COL$10-y' a �Wd . (mot.lit .
SECTION D
This Application Is
,�Approved O Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth In
Section C shove.No construction is permitted in the required reserved 100%Expansion area.
EHS ' naWre: L d ( Date:
E EV7HS) j DlsIri6Won:WHITE—Office Rla:YELLOW—&tlB.OePL PINK—Applicant
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
—!& www.riveoeh.org
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)863-7570
Property Information: APN: Date of Inspection: 8/10/17
1. Owner: WILLIAMS Address: 31266 MERVIN ST City: MENIFEE
FAILURE TO PROVIDE 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 the above location on 8/10117 and determined that
the tank capacity is 1250 gallons and that there is 300 sq.ft.of leach line bottom area. There are 2
bedrooms in the dwelling and there are 5 fixture units.
b. There are 2 leach line(s),each 50 ft. long Depth 1.5 ft. M 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):
M Concrete ❑ Fiberglass ❑Steel ❑ Other:
b. Internal dimensions of septic: Length 5 ft. Width 4_83 ft. Depth 633 ft.
c. Condition of tank(please check yes or no for each question): Inlet Tee present? ®Yes ❑ No
Tank Structure deteriorated? ❑Yes IN No Outlet Tee present? M Yes ❑ No
Effluent Filter Present? M Yes ❑ No Two compartments? M Yes ❑ No
d. Condition of D-Box: Level? M Yes ❑ No Replaced? ❑Yes M No
5. a. While pumping the tank,did effluent flow back into tank from absorption system? ❑Yes M No
b. Prior to pumping,was the liquid level in the tank above the outlet tee? ❑Yes M No
c. Was the area around the lids oxidized? ❑Yes ® No
d. Is design of system gravity feed? ®Yes ❑ No
e. Were well(s)observed on this or adjacent property? ❑Yes M No
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 ® No
Additional Comments:
h. How long has dwelling been vacant?(if applicable) months weeks M N/A
6. a. M 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. ❑ 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 penaKy of perjury that the foregoing is true and correct
Signature: ^ � Print Name: MARCO FLORES
Contractor License No.: 829093 Expiration Date: 1/31/19
Pumper Co.: 24/7 PUMPING Phone Number: 760 900 3323
Address: 10 E VINE ST#208 City: REDLANDS Zip: 92373
EPO-91(REV 03116)
9
���'TIC INVOICE brdur t�
b6
We Specialize in... 26115 Nova Lane• Menf(ee,CA 92585
Septic Pumping Repairs- Risers (951)259-6133
Bill to- fir.xoa3�3 www.247pumping.com
�� 4J11-1.11�A• s Job location:
Jwll i_�fUxS 6) 3t266 ST
9 - -.716 - 51" Yes i t= 6fL J2'5
Date: Contact: P.O.No: Escrowtl: Terms: Driver. Rrv;
Source: TGP:
Pumped Septic Tank AMOUNT
Prana7 Srda Socondary SYJe
Z�D Gallons 22�>
❑ Primary ❑ S=ndE y initials
Pumped: ❑ Cfarillor U cesspool U Grease Trap ❑ Saop&gsN Gallons
❑ Pumped H61JkgTank ❑ Pumped eas:n ❑ Other
Gallons
U Labor l oigging '314r kffl. —ChaMe
U EWtronicProbe!LocationrCamara[MPBCIion His Cd$
._IHr. '3Hr.Minimum Charge
U Snaking U LKt :7 Stanc>Fipo ❑ Riser
Ll Odiff
Comments/Reeornman edRepairs:SepticSankcnssguulaors - Total S
I�iC�te drain fell failure.This seepage Pits are overflowing andror back'flomhg From drain fields may
may cause system to Rf up,unless drain f0kis are repaired or replaced. Inifiafs
New Septic TM* -
Seepage Pit teach Lards- Sower
13 Risers U Baareria ❑ MainlcnariceAgreement
Payment Method U Check t] Cash U Charge ❑ V15A U p
13
(last 3 dyks on bade of card)
Noma;
_ —Sgrt�r% Licit
rate our so
rvice .d _Expo
Additional CommLJ
ents 1 Remarks
Custc-TiGrSe�,,ira
ri
PLEASE TH'S CAREFULLY-THIS IS A LEGALLY BINDING AGREEMENT:
Work Ordas lnfomration: Our pumping prices do not Includo any locating,excavating,back fiUng,or repaving work of any kind. We are not responsible
for any damage caused by the necessary use of heavy equrPrnent fa complete the jab. We are not responsible for septic tank lids that may break or felt
into tank during sennCe. We are not responsible for damage to landscaping,sprinklers,utgitiss,cement or concrete work IntlafL �
Payment is due and must be paid for uporr completion of the job,unless otherwise agreed to in writing. You were noglied when n you called in this
work order that if you cancelled service after driver arrived you will be responsible for a$95 tip charge. There is a$35 charge for every check that
Is not honored by your bank for any reason. In event payment is not made as agreed,Client wilf pay all collection costs court cows,
administrative fees And a mechanic lien fee of$300 and administ,,ative iee it$12$for , attorney fees,
removal lien;this includes a monthly 1.5Yo(18%tape)orn service
charge on the unpaid baaance andany additional charges lhal mayoocur. Note: We cannot guarantee the working ondifion of your so f sys ic tem.
We ONLY pump your Septic System(s)WE ARE NOT responsible for the working condition of your system. InIIals
I HAVE READ,UNDERSTAND AND ACCEPT THE ABOVE,I AUTHORIZE THE WORK
Signature;. _ —Dale• Ci �i�