PMT18-00919 City of Menifee Permit No.: PMT18-00919
29714 HAUN RD. Type: Residential Plumbing
" C7V � MENIFEE, CA 92586
MENIFEE Date Issued: 0 3101/2 01 8
PERMIT
Site Address: 23214 BIGGS LN, MENIFEE, CA 92587 Parcel Number. 351-123-014
Construction Cost: $3,500.00
Existing Use: Proposed Use:
Description of REPLACE 1000 GALLON SEPTIC-SAME SIZE AND SAME LOCATION
Work:
Owner Contractor
TINA FURGESON LANIK ENTERPRISES INC
23214 BIGGS LANE P 0 BOX 891416
MENIFEE,CA 92587 TEMECULA, CA 92589
Applicant Phone:9516767114
LANK ENTERPRISES INC License Number:458947
P 0 BOX 891416
TEMECULA, CA 92589
Phone: 9516767114
Fee Description 01t� Amount IS)
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 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_aldg_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 1 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 o I am exempt from Iicensure under the Contractor's State License Law for
Professions Code and my license Is in full force and effect. u the following reason:
License Class.A Q C-47L License —1, By my signature below I acknowledge that,except for my personal residence
Expires '� Signature R 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-bullder 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 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 avallable 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 for which www.leginfo.ca.eovycalaw.html.
this permit Is issued.
Poncy R Fl_WC(qEG36931 Date
o I have and will maintain worker's compensa(ion Insurance,as required by PROPERTY OWNER OR AUTHORIZED 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 worker's 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
Card fi
Carrier C nT% �`7q with all applicable city and county ordinances and state laws relating to
—r building construction.I authorize representatives of this city or county to
Policy# Expires I 8 enter the above ad property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date -)
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I cer0fy that in the performance of the work for which this permit is issued, —27
1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 4
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,I shall fo It m with those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant Date 1 0 mixture containing a hazardous material equal to or greater that the—1
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE SECURE WORKER'S COMPENSATION COVERAGE IS D Yes ,emo
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 forguldellnes
CONSTRUCTION LENDING AGENCY D Yes POO
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) Dyes wqo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMO
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)Indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Ryes D No
Business and Professions Code).Any city or county that requires a permit to Date 7 1
construct,alter,Improve,demolish or repair any structure,prior to Its PROPERTY OWNER OR AU EO 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 Contractor's State EPA RENOVATION REPAIR AND PAINTING fRRP)
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 than($500). required practices.This includes rental property owners and property
managers who do the pain[-disturbing work themselves or through their
i o L 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( I portion of the work,and the structure Is www.eoa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-SOM24-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a
Property who,through employees'or personal effort,builds or Improves the D An EPA Lead-Safe Certified Renovator will he responsible for this project
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. D No EPA Lead-Safe Certified Firm is required for this project because:
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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
Irr Acknowledgement.
BUILDING & SAFETYPERMIT/PLAN CHECK APPLICATION
Ndenifee
DATE: 311 PERMIT/PLAN CHECK NUMBE V
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
DESCRIPTION OF WORK
PROJECT ADDRESS 2 3 Z 14 ILL%s Ln. - ZIP
c
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS �Z 32
PHONE EMAIL
APPLICANT NAME .S
ADDRESS Z dI T
PHONE 91 ,51 6-1 to —it t L{ EMAIL Y�
CONTRACTOR'S NAME Gkir 60 Ve. OWNER BUILDER? O YES *NO
BUSINESS NAME (1 f L
ADDRESS P. O. 1 j
PHONE qsl 10710 -11 EMAIL
CONTRACTOR'S STATE LIC NUMBER S e)-ci4, LICENSE CLASSIFICATION C=42,
VALUATION$ 35aQ 'OC SO FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE l .pU SMI I GREEN
PLAN CHECK FEE INVOICETOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Men fee, CA 92586 951-672-6777
WWW.Cityo jmeni(ee.US
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
OWTS INSPECTION CARD
APN: / Permit No.: ON
Site Address: oZyoZ Iq (3 r AqS ({� City: / l/et ik Zip:
To schedule an inspection please call ❑ Riverside 951-955-8980 or ❑ Indio 760-863-7570
All cancellations/reschedules must be received prior to 8am on the day of inspection or additional fees will apply.
OWTS Components Date Re-Inspection Inspector
of Inspection Date Initials
eptic T /(/�1O
eptic-rank Abandonm t tun f0�
er a eral
U o
Rise
Final Inspection
TO BE POSTED ATJOBSITEINPIAIN VIEW
EP0.55(RE 4/16)
rA__ �.+�L�'��/[�LyD� -1 T'`ay'�'$�? ,y��1{��j T�3=i�' {,ij��a�/y���`Yy%�(..-y�/��i yYJ'g-q-�.',` �i y �/�
JDF-PAR 1 I'.' Ei Y 0 LIV S/ iP,0 NMY_.1V Y AL 1 S6iA I_. E Y
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM
Land Use&Water Resources
Western Riverside County Eastern Riverside County
3880 Lemon Street•Suite 200•Riverside•CA•92502 47-950 Arabia Street•Suite A•Indio•CA•92201
Phone:(951)955-8980•Fax:(9511)955-8988 Phone:(760)863-7570•Fax: (760)863-70113
Property Information: APN: ,35l —1;23" 01 q. Date of Inspection: d � I D- I )D
1. Owner: Tl n CA rlrl,V 4e S(j-, Address: 'J, 19, l.:r-i cite 11"hoo j e_¢
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
attached dwellings,structures,wells, rocks,watercourses,etc.
3. a. I examined existing subsurface sewage disposal system at the above location on and determined that
the tank capacity is t Q b r; gallons and that there is 3(126 sq.ft. of leach line bottom area. There are
bedrooms in the dwelling and there are
7l fixture units. 1a r V�
b. There are .2 leach line(s),each �& ft. long. Rock ❑Plastic Chamber
d. There are Seepage pit(s),each in.diameter,and f.TD. ft BI
e. The leach bed is ft by ft,total sq.ft. of leached area.
4. a. Construction of septic tank(Please check one of the following):
❑ Concrete ❑ Fiberglass Steel ❑Other.
b. Internal dimensions of septic: Length ) o ft. Width f ft. Depth ft.
c. Condition of tank(please check yes or no for each question): Inlet Tee present? ka Yes ❑ No
Tank Structure deteriorated? IPYeS ❑No Outlet Tee present? -M Yes ❑ No
Effluent Filter Present? ❑Yes,)3 No Two compartments? Yes ❑No
d. Condition of D-Box: Level? ❑Yes ❑No Replaced? ❑Yes ❑ No Septic Effluent? ❑Yes ❑ No
5. a. While pumping the tank,did effluent flow back into tank from absorption system? ❑Yes A No
b. Prior to pumping,was the liquid level in the tank above the outlet tee? ❑Yes ❑No
c. Was the area around the lids oxidized? ❑Yes`IiPNo
d. Is design of system gravity feed? WYes ❑ No
e. Were well(s)observed on this or adjacent property? ❑Yes OPNO
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 is within 200 ft.of system and abuts property line? ❑Yes g No
Additional Comments:
h. How long has dwelling been vacant?(if applicable) months weeks �21 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
proper maintenance. No repairs are necessary at this time.
b. l It is my opinion thapt the system is not in good working order and will not function roperiy without the following
repairs: _�I O-Ifi(,( S!� 10 N, Gt A �L cQ Vl'��Q f� 6 rr 0111.� cai�wNw
I certify under pena ty of p duty that t foregoin i c.s true and correct.p e
Signature: Print Name: A',w, f h �t-
Contractor License No.: Expiration Date: Gf 73 p 7
Pumper Co.: I _ Phone Number: - J/
Address: a,i'\t SO W i ,�-City: I Pi qy Zip:
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