PMT18-03750 City of Menifee Permit No.: PMT18-03750
29714 HAUN RD. Type: Residential Plumbing
t® MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 07131/2018
PERMIT
Site Address: 29090 VARELA LN, MENIFEE, CA 92585 Parcel Number: 327-290-013
Construction Cost: $14.650.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING LEACH SYSTEM, INSTALL NEW TIGHT LINE, 2 NEW 75 L FT LEACH LINES
Work: AND D-BOX
Owner Contractor
CYNTHIA SMITH A R S AMERICAN RESIDENTIAL SERVICES OF
29090 VARELA LANE CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD#201
Applicant Phone:9012719700
JIM PHILLIPS License Number:765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
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 staled,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_Permil_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 o I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the fallowing reason:
License Class Pl' License No. ��� _ By my signature below I acknowledge that,except for my personal residence
Expires 3I 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 I
WORKER'S COMPENSATION LA ION have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under pe 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 submitted or at the following website:
by Section 3700 of the Labor Cade,for the performance of work for which www.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy 8 Date
❑I have and will maintain workers compensation 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 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
/ v Jo� �� U� with all applicable city and county ordinances and state laws relating to
Carrier / I building construction.I authorize representatives of this city or county to
Policy#O-P(o3DSD8631 Expires_ enter the above identified 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 certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE N
workers compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,1 shall forthwit rovisions. Will the applicant or future building occupant handle hazardous material or a
Applican Date 3� mixture containing a hazardous material equal to or greater that the
amounts spfied on the Hazardous Materials Information Guide?
WA I .FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 oYes ca'Na
U FUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
D 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 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguideline
CONSTRUCTION LENDING AGENCY ❑Yes t,
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 Is uun ary of a school?
(Section 3097 Civil Code) oYes al
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjurythat I am exempt from the California He Ith&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazarc ou rial reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes No } �/
Business and Professions Code).Any city or county that requires a permit to - Date J 0
construct,alter,improve,demolish or repair any structure,prior to its ROPER WNER 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 EP ENOVATION 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 owners and property
than($500). managers who do the paint-disturbing work themselves or through their
o I,as owner of the property,or my employee with wages as their sale 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.Rov/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. o 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.
SAFETYBUILDING & PERMIT/PLAN CHECK APPLICATION
y! `
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA []SIGN
SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION [:]ELECTRICAL ❑MECHANICAL
[]NEW ❑J PLUMBING [I RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace existing leach system,install new tight line,two new 75ft leach lines and d-box
PROJECTADDRESS 29090 Varela Ln,Romoland,CA 92585
ASSESSOR'S PARCEL NUMBER 327-290-013 LOT TRAq"Y of Menifee
OWNER NAME Cynthia Smith tiif
ADDRESS 29090 Varela Ln, Romoland,CA 92585
PHONE (951)250-3745 EMAIL Reeeived
APPLICANT NAME
ADDRESS 1520 W Linden Street Riverside, CA 92507
PHONE (951)341-9371 EMAIL
CONTRACTOR'S NAME AIRS Rescue Rooter OWNER BUILDER? ❑YES ONO
BUSINESS NAME
ADDRESS 1520 W Linden Street Riverside,CA 92507
PHONE (951)341-9371 EMAIL
CONTRACTOR'S STATE LIC NUMBER 765155 LICENSE CLASSIFICATION C36
VALUATIONS $ 14,650.00 SO FT L SO FT
APPLICANT'S SIGNATURE L DATE P
DEPARTMENT DISTRI TION y CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING RLANNIN NGINEERING FIRE GREEN I SMIP X
INVOICE •Q, �C PAIDAMOUNT
AMOUNT //',/• O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
�c oqo Va re/:-t
it 3a7 -� �10- v! 3 _
COUNTY OF RIV"r"WI�E
DEPARTMENT Of r Nl. II .:.` ,n:i NTAL HEALTH
I I ONSITE WASTEWATEI 1 RLATMENT SYSTEM
I ° I Dwelling j Zoo r:v septic Tank
2 I Commercial � Sit Ft of Leach Line
Q _ Seepage Pits _ No. '?ia_BI_TD_MD_
x I I _ Connect to Sewer _ Concrete Pump Chamber
VJ _ Connect to Existing 5
i
Q • Installation of leach lines are not to exceec ft.in depth
• Install risers to grade,leaving lids accessit le for cleaning.
ti I Note: Larger tanks (2000 gallons or greater) require 2 risers to access primary
chainF6� N
/ �D pprdG �I ,le effluent filters must b installed to facilitate servicing.
qto o�i- w$atte� r Witerhng devices shall discharged into the septic system without
12le n 06i the California Regional W,ter Ouality Control Board.
171ationshall conform to the current U C
I Any grading in the area of proposed di p lines shall require new approval by this
Dgalment.
.V I ate: 7-31- EHS: o
9
IV / /
City of Menifee
1 N H 0 J Building Dept.
30FF /� L
f- •n 51�rL� '\ d JUL 31 2018
L1 GAL,
Received
ITY OF MENIFEE
BUILDING AND SAFE10JIPEPARTMENT
PLAN APPROVAL
REVIEWED BY
r DATE
'Approval of these plans shall not It construed to be a permit for,or an
approval of,any violabor�9LVY Provisions of the federal,state or city
regulations and ordinances. This set of approved Plans must be kept on the
jobsite until completion.
t2-escue
lSav w IIojw s �
Cc— [ 525-0 f)
Gi� /� 9G�/Ss-
City of Menifee
Building Dept.
JUL 31 2018
Received
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
OWTS INSPECTION CARD
APN: 567 — Q9D —013 Permit No.: ON
Site Address: Q,� D 9 D VOLQ (at (—r) City: F4--(Ina. P-C Zip:
To schedule an inspection please call ldl Riverside 9SI-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
Septic Tan k
Leach Lines/Bed
a e Pits
ent
SP\ rlateral_
D-Box
Risers
Effluent Filters
Final Inspection
TO BEPOSTED ATJOBSITEINPLAIN VIEW
UP 55)R6 6/16)