PMT17-03235 City of Menifee Permit No.: PMT17-03235
29714 HAUN RD.
".ACCEL/-> MENIFEE,CA 92586 Type: Residential Plumbing
" MENIFEE Date Issued: 09/14/2017
PERMIT
Site Address: 32115 HOOK LN, MENIFEE, CA 92584 Parcel Number: 372-130-004
Construction Cost: $6,000.00
Existing Use: Proposed Use:
Description of LEACH LINE REPLACEMENT WITH 3100 FT ROCK&PIPE LEACH LINES
Work:
Owner Contractor
ANTHONY FALCO CURTIS DUMP TRUCK&BACKHOE SERVICE INC
32115 HOOK LANE 21130 UNION STREET
MENIFEE,CA 92584 WILDOMAR, CA 92595
Applicant Phone:9516746156
JANICE CURTIS License Number:552745
CURTIS DUMP TRUCK&BACKHOE SERVICE INC
21130 UNION STREET
WILDOMAR, CA 92595
Fee Description 01.t Amount ISI
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 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.Exoept 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_Templete.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 perjurythat 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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the fallowing reason:
License Class C— License No.Jr5 L/,i
By my signature below I acknowledge that,except for my personal residence
Expires (0- I 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 DECLARA L N 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 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 forwhich www.legInfo.ca.gov/caIaw.htmI.permit is issued.
Policy# Date
❑I have and will maintain worker's tbn insurance,as required by compensation PROPERTY OWNER OR AUTHORIZED AGENT
p
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below 1 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.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# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date —I U' L
dollars($100)or less p ERN OWNER OR AUTHORIZED AGENT
,er<cert fy 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 CITY BUSINESS LICENSE# /f
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,Ish orthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant DateC-1�' — mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING: (LURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN WIII the Intended use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indlrated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(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(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 perm it 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
❑1,as owner of the property,or my employee with wages as their sole 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.eoa.goy/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 ❑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:
❑I,as owner of the property am exdusively 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 role please fill out the RRP
Acknowledgement.
BUILDIN & SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DATE: Ol \ PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O 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
DESCRIPTION OF WORK
f '4
PROJECTADDRESS I G� CSU f ink .� o (:pfy I l_
ASSESSOR'S PARCEL NUMBER 2)1� LOT Buildia & SBfOt Ci e
\`3h-c>�-��
OWNER NAME SEP 14 2017
ADDRESS ���t ID Received
PHONE C(.x , `�l-`�- -\ 1.� EMAIL
APPLICANT NAME :
ADDRESS
rr-'pp \ A
PHONE v1Q20_ (pi C;(p EMAIL e
CONTRACTOR'S NAME OWNER BUILDER? O YES-eNO
BUSINESS NAME
ADDRESS
PHONE Cr-A- OLJ_L ` EMAIL
CONTRACTOR'S STATE UC NUMBER �5 20LJ S LICENSE CLASSIFICATION
VALUATION$ SQ,F,T, `'� L SQ FTT� 1
APPLICANT'S SIGNATUR �"�.7�=� DATE 1— 1
CITYST
DEPARTMENT DISTRIBUTION ,^ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
1R'1�//.GJ�
BURRING PLANNING ENGINEERING FIRE
PERMITFEE SMIP K, GREEN I�
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityo f,-nenifee.us
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH BuIldlnnolcl�Q t
= _w www.rivcoeh.org
wn SEP 14 ZOt
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEIfleceIVed
❑388o 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: 7o2"��y.� (.��/ t of In pggction:
1. Owner: �OPROVI�DEALLRE�QUIREO
� Address: ��(✓C (�G`cv City:
FAIL INFORMATION SHALL PREVENT OWNER FROM OB A/N/NT G
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 9 and determined that
the tank capacity is h J00gallons and that there is � .ft.of leach line bottom area. There are
bedrooms in the dwelling and there are _ fixture units.
b. There are leach line(s),each ft. long Depth ft. ❑ Rock XPlastic 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):
(Concrete - ❑ Fiberglass ❑Steel ❑Other:
b. Internal dimensions of septic: Length � ft. Widths ft. Depth 676.1 ft.
c. Condition of tank(please check yes or no for each estion): Inlet Tee present? -LXYes ❑ No
Tank Structure deteriorated? ❑ Yes 1�J No Outlet Tee present? 2`5 es ❑No
Effluent Filter Present? --���.0es ❑No Two compartments? Lkles El No
d. Condition of D-Box: Level? yrr�rtYes ❑ No Replaced? ❑Yes ❑ No
5. a. While pumping the tank,did effluent flow back into tank from absorption system? 01es ❑ No
b. Prior to pumping,was the liquid level in the tank above the outlet tee? �s ❑ No
c. Was the area around the lids oxidized? ❑ Yes-EMo
d. Is design of system gravity feed? ❑Yes ❑No
e. Were wells)observed on this or adjacent property? ❑Yes ❑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): �3
❑ Septic Tank 16 9ft. ❑ Leach lines lf/ 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 ❑ 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
�f6per maintenance. No repairs are necessary at this time.
b. i It is my opinion that the system is not in good working order and will not function properly without the following
repairs: �tt/�rjTdd E�ELP. IC511 22P-11
I certify under penalty of perJu fh be for Ing is true and correct.
Signature: Print Name:
Contra or Lic Expira Ion Date: r
Pumper o. Phone Number: -
Address: ' �� City: i,U1�_ ^LLQ�� Zip:
EPO-91(REV03n6)