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PMT18-01490 City of Menifee Permit No.: PMT18-01490 29714 HAUN RD. Type: Residential Plumbing <^—CCELA MENIFEE,CA 92586 MENIFEE Date Issued: 04/0 212 01 8 PERMIT Site Address: 23550 CIRCLE DR, MENIFEE, CA 92587 Parcel Number: 350-071-003 Construction Cost: $12,000.00 Existing Use: Proposed Use: Description of REPLACE EXISTING SEPTIC TANK AND LEACHLINES-SAME LOCATIONS-750 GAL TANK AND 2 Work: 59 FT LEACH LINES WITH 36 INCHES OF ROCK Owner Contractor NAMGIAO DAD CURTIS DUMP TRUCK&BACKHOE SERVICE INC 23550 CIRCLE DR 21130 UNION STREET MENIFEE,CA 92587 WILDOMAR,CA 92595 Applicant Phone:9516746156 CURTIS DUMP TRUCK& BACKHOE SERVICE INC License Number:552745 21130 UNION STREET WILDOMAR,CA 92595 Phone: 9516746156 Fee Description Oft( 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 $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 Bldg_Pemiit 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 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 following reason: License Class _ ' ense No. �5 By my signature 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 improvements covered by this permit.I cannot legally sell a structure that 1 WORKER'S COMPENSATION DECLARA 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 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 for which this permit is issued. www.leginfo.ca.gov/calaw.htmi. Policy p Date - n I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Cade,for the performance of the work for which ❑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 with all applicable city and county ordinances and state laws relating to Carrier building construction.I authorize representatives of this city or county to Policy# Expires pritar the above identified property for Inspection purposes.� �{ (This section need not to be completed is the permit is for one-hundred Date ��r t dollars($100)or less POP RTY OWNER OR AUTHORIZED AGENT pfcertify that in the performance of the work for which this permit is issued, shall not emolov any persons In any manner so as to become subject to the CITY BUSINESS LICENSE N 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 II rthwith comply w h those provisions. Will the applicant or future building occupant handle hazardous material or a Applipn Date - mixture containing a hazardous material equal to or greater that the I amounts specified on the Hazardous Materials Information Guide? WARNING: A(YURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ONci UNLAWFUL, ND 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($100,111DO),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 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes 6No 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 9,14O 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)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous�Jaterial reporting. Business and Professions Code).Any city or county that requires a permit to es 11 yyjQo ,L / 4 construct,alter,improve,demolish or repair any structure,prior to its RTY`W /L Date issuance,also requires the applicant for the permit to file a signed statement PRD RTY OWNER OR AUTHORIZED AGENT that he or she is licensed pursuant to the provisions of the Contractor's State EPA VENOVATION.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 required practices.This includes rental property than($500). q P p p he owners and property managers who do the paint-disturbing workthemselves orthrough their ❑I,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.epa.aov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-900-424-LEAD(5323). Code;The Contractor's State License Law does not apply to an owner of a D 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 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 Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE DATE: C3 - (S PERMIT/PLAN CHECK NUMBER PLANNING CASE NUMBER TYPE: O COMMERCIAL --O RESIDENTIAL " MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW Q PLUMBING O RE-ROOF NUMBER OF SQUARES I� DESCRIPTION OF WORK C V -Ph I ' I SO In VDlbi�- PROJECTADDRESS O�._.PJ� Ci�c(P �f ZIP p ASSESSOR'S PARCEL NUMBER 3,5D ©T n0_3 ✓OT TRACT 6 1 7 OWNER NAME (' (j ADDRESS C _ Cb P.. Ca PHONE EMAIL APPLICANT t!NAME 'ffQ, (C RAC r-h S ADDRESS ,p, L r PHONE vlS�� �Q�y- (litb� EMAIL r CONTRACTOR'S NAME I(' rj OWNER BUILDER? O YES ®"NO BUSINESS NAME ADDRESS PHONE G�S� ����irJ EMAIL S CONTRACTOR'S STATE LIC NUMBER �`�,(�� LICENSE CLASSIFICATION VALUATION$ ODSQ FT L SQ FT�] �,(,'/ APPLICANT'S SIGNATURELtALIDATE OTY STAFF USE ONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CIN OF MENIFEpEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE 40 rL.•�.+�-Q INVOICETOTAL 3I S� GREEN ', SMIP OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building & Safety Department 129714 HauLr ff" (ft6A 92586 (951)672-6777 www.cityof men ifee.ugulld'Ing Dept. ✓ �'af; ENIFE '1 MAR 3 0 2018 b _ Received ..�. "RTMENT OF ENVIRONMENTAL HEALTH �W94� www.rivcoeh.org 1D 5/�( LAND USE APPLICATION (O� I n Q ( O� YY `L O 1 3880 Lemon Street•Suite 200•Riverside•CA•92501—(951)955-8980 PECO7DiE`" FEI- 47-950 Arabia Street-Suite A•Indio•CA 92201—(760)863-7570 cD^I 'f a — - 1 ,� b . Oc) APN �1 �1 fin I` 7a La t, a LOT#3 SE O PERMI r ECTION:A Name I C:l.l i l i OWNER: Address Phone Email AGENT/ Cam an Name S Agent/Contractor JONTRACTOR: Malin Address jWQrYYAz Phone I (0 Email rvAj 4�— .L 30PERTY INFO: Site Address ,rC A ni (' 0 0 T, a" I Wale enc /Well ,(Lc Lot Size 0' l )PLICANT'S SIGNATURE: DATE; 9CTION B Below-For Office Use Only IECK BOX IF REQUIRED iny box is checked this application shall be considered denied until the information is provided. Holding Tank Agreements Required ❑ Floor Plan and/or Plumbing Layout Requirel Certificate of E)dsting OWTS Required(C-42) ❑Special Feasibility Boring Report Required WOCB Clearance Required ❑Detailed Contour Plot Plan Required(1 W 5 foot Intervals) ` Soils Percolation Report Required fE EVALUATION INSPECTION REMARKS: EHS INITIALS/DATE Rso3 ECTION C. I NEW 1 ❑REPAIR/REPLACEMENT 1 ❑EXISTING ❑PUMP ❑ATU I ❑CONNECT TO SEINER I FIXTURE UNITS# BDRMS# ils Peroolation/Borin Report By: Date: Project# $2 Ce n By. I I O L,1 ho-c Sp Date: License# ptic tank cap.: Soil RatB: I O Tested Depth: Max trench depth: Ft Bottom Area: Total Linear FL: Une(s): /r�'' I� I Len : SM feet - Each 3 test wide lewall Allowance: Ft Rock! Sq.ft. Running foot Rack below drain line: ZIP—in. or ❑Plastic Chambers ich Lines/bed special design for slope: ❑WA ❑Overburden Factor. - Diameter. No.pits: Depth below Inlet(bi): Pit Total Depth: Max allowable depth: I� iNSTRUCTION/INSTALLATION REMARKS: V� (YtN,p . }r�k tl r�oaneo i� t tx�t_ �a��7 c�C� b I SS lrtt n r,OP I , A i 3�v r' rya PI-1 F u� m s ej -) LYl :QTION D s Application is Approved O Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth in :lion C above.N construction Is permitted In the required reserved 100%Expansion area. 5 Signature: Date: County of Riverside - DEPARTMENT OF ENVIRONMENTAL HEALTH www.rivcoeh.org Jity of Menifee .r+ sodding Dept. CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SWWb12 Z018 ❑3880 Lemon Street•Suite 200•Riverside•CA•92501—(951)955-89B0 ❑47-950 Arabia Street•Suite A•Indio-CA 92201—(760)863-7570 ;- 16� l �eived Property Information: APN: ��—m�i-(��_ Date of Inspection: "�p' 1. Owner: N. gYtyYYja D �> n Address: �.—S ff:: h Cx cr 11 l� city: miln(cg/ 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 d-z=-i_2 and determined that the tank capacity is _Eg7gallons and that there is .`'Rflsq.ft.of leach line bottom area. There are s� bedrooms in the dwelling and there are 2_� fixture units. b. There are leach line(s),each d�-� ft. long Depth ft. 0 Rock El 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): El Concrete ,u Fiberglass ❑Steel ❑Other: b. Internal dimensions of septic: Length L)VIZft. Width ft. Depth r.�51i7 ft. c. Condition of tank(please check yes or no for each question): Inlet Tee present? ir�Yes El No Tank Structure deteriorated? VrYes ❑ No Outlet Tee present? }uy Yes ❑ No Effluent Filter Present? ,.,!❑ Yes-ErNo Two compartments? El Yes ZNo d. Condition of D-Box: Level? Z I Yes ❑ No Replaced? ❑Yes LINO 5. a. While pumping the tank,did effluent flow back into tank from absorption system? .-9�Yes ❑ 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?y ElYes-�J No R d. Is design of system gravity feed? Yes ❑No e. Were well(s)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) ❑ Septic Tank ft. ❑ Leach lines ft. ❑Seepage Pits ft. g. Is sewer within 200 ft.of stricture and abuts property line? ❑Yes ❑ No Additional Comments: h. How long has dwelling been vacant?(if applicable) months weeks ❑ N/A O 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. 91' It is my opinion that the system is not in good working order and will not function properly without the following repairs: lh hWo IiT k 4- IAlk// Mtu lemdi/;nPS YcciC 1 certify under penalty of per ury t t IoregoIng Is true and correct. Signature: Print Name: t�!}f„� l ((f-4), 5 Contractor an o.: Expiration Date: (o 301 Pump erCo.: �/rr S /' AlAl., T✓7J(/( V ajar[17LLO Phone Number: Address: ,?)1.30 1 '�n 'y City: �/L�(��()fy,s-� Zip: LJ 7 e 0a91(REV ov16)