PMT18-04471 City of Menifee Permit No.: PMT18-04471
29714 HAUN RD.11
MENIFEE, CA 92586 Type: PoollSpa-Residential
MENIFEE MENIFEE Date Issued: 09/13/2018
PERMIT
Site Address: 32612 HAYDEN RD, MENIFEE,CA 92584 Parcel Number: 360-312-008
Construction Cost: $30,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA,750 SF,WITH ROCK SLIDE
Work:
Owner Contractor
KEITH GREELEY ,
32612 HAYDEN ROAD
MENIFEE, CA 92584
Applicant License Number:
KEITH GREELEY
32612 HAYDEN ROAD
MENIFEE,CA 92584
Phone: 9518090379
Fee Description City Amount IEI
Swimming Poolfln-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Electrical 1 23.35
$523.35
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 building 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_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 I am under provisions of with a licensed contractor(s)pursuantto 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 License No. 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 bythis permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder 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 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 www.leginfo.ca.govlcalaw.html.
this permit is issued.
Policy s 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 ❑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
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 ll Expires n r[he a ove id ti ad prop rty for inspection purposes.
(This section need notto be completed is the permit is for one-hundred Date
dollars($100)or lessROPERTY OW E AUTHORIZED GENT
❑I certify 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#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjectto the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant orfuture building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes ❑No
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(5100,000),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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES 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 am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law forthe reasons)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dyes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish orrepair anystructure,priorto its PROPERTYOWNER 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(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
receiving compensation for most work that disturbs paint in apre-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
❑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 1-800-424-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 thatthe 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
�,nyyyyot built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
t+LIh I,as owner of the property am exclusively contracting with licensed
tractors 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.
DATE: September 12, 2018 PERMIT/PLAN CHECK NUMBER - QU
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL ®RESIDENTIAL 0MULTI-FAMILY O MOBILE HOME (SPOOL/SPA CC SIGN
SUBTYPE: OADDITION (D ALTERATION C)DEMOLITION C)ELECTRICAL C) MECHANICAI�
®NEW OPLUMBING C)RE-ROOF NUMBER OF SQUARES-
DESCRIPTION DESCRIPTION OF WORK New inground pool and spa.
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLER
PROJECTADDRESS 32612 Hayden Rd. ZIP 9258 f
ASSESSOR'S PARCEL NUMBER 360-312-008 LOT 21� TRACT 30(o(04
OWNER NAME Keith Greeley
ADDRESS 32612 Hayden Rd. Menifee, CA. 92584
PHONE (951)809-0379 EMAIL kgreeley571@gmail.com
APPLICANT NAME Keith Greeley
ADDRESS 32612 Hayden Rd. Menifee, CA. 92584
PHONE (951 )809-0379 EMAIL kgreeley571@gmail.com
CONTRACTOR'S NAME n/a OWNER BUILDER? ®YESC)NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 30,000I ST 750 LSQFT 139
APPLICANT'S SIGNATURE V5 (D6 � DATE September 12, 2018
DEPARTMENT DISTRIBUTION ACCEPTED BY: V CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE rM1/1VlJ,J�
INVOICE TOTAL ,. GREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee,CA 92586(951)672-6777
www.cityofmenifee.us
NIF
>g° = County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org ) ee
����,• Building Dept.
SEP 13 2018
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM
❑3880 Lemon Street•Suite 200•Riverside•CA•92501-(951)955-8980 Received❑
47-950 Arabia Street•Suite A•Indio•CA 92201-(760)863-7570
G - t
Properly InformatioI{1 APN: 3Y/O 3/2 �8 Date of Inspection: Z -3 g
1. own er:Ke(.TIiGr.--o_ Ls, Address: '?ZGtZ Ae-0. t2.b City: ' i Z''8�
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 $ •Z 3•�� and determined that
the tank capacity is `,'00 gallons and that there is sq.ft.of leach line bottom area. There are q—
bedrooms in the dwelling and there are 3V fixture units.
b. There are 77 leach line(s),each gsft.long Depth r ft. ❑ 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):
-9 Concrete ❑ Fiberglass ❑Steel ❑ Other:
b. Internal dimensions of septic: Length ft. Width IS- ft. Depth ft.
c. Condition of tank(please check yes or no for each question): Inlet Tee present? Yes ❑ No
Tank Structure deteriorated? ❑Yes 0 No Outlet Tee present? ®Yes ❑ No
Effluent Filter Present? 0 Yes ❑ No Two compartments? ZI Yes CINo
d. Condition of D-Box: Level? ElYes ❑ No/✓� Replaced? ❑Yes';Q No laarmird""
5. a. While pumping the tank,did effluent flow back into tank from absorption system? ❑Yes 63 No 8%144$
b. Prior to pumping,was the liquid level in the tank above the outlet tee? ❑ Yes :0 No 951-M1.9m
c. Was the area around the lids oxidized? ❑ Yes El No Po Box 528
d. Is design of system gravity feed? -P Yes ❑ No �,S Nueva Ca,
e. Were well(s)observed on this or adjacent propertyr ❑Yes lot No M67
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. ElLeach lli}i,n,,,,es ft. El Seepage Pits _ ft.
g. Is sewer within 200 ft.of structure and abuts property line? El Yes yu No
Additional Comments: ,(-o t2bSz.� $,�.,; r,, P
h. How long has dwelling been vacant?(if applicable) months weeks NIA
6. a. It is my opinion that the system appears to be in good working order and can be expected to function property with
UUU proper maintenance. No repairs are necessary at this time.
b. ❑ It is my opinion that the system is not in good working order and will not function properly without the following
repairs:
I certify under penalty of perjury that the foregoing is true and correct.
Signature: Print Name:
Contractor License No.: C t(Z 6'(6 l tl S Expirafion Date: '7�,70 • 7L0 L-t�,
Pumper Co.: R/A ere_Ll i V L/we Phone Number: q(r( Z.$ • 10?q
Address: 4h 04 K S Z Q City: N W�t-V5 zip: RZJT—
EP0.91(REV 03116)