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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)