PMT18-05351 City of Menifee Permit No.: PMT18-05351
29714 HAUN RD.
_ AV MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 11/05/2018
PERMIT
Site Address: 28500 AVENIDA ESTRELLA, MENIFEE, Parcel Number: 341-071-001
CA 92587 Construction Cost: $5,300.00
Existing Use: Proposed Use:
Description of REPLACE SEPTIC SYSTEM-LEACH LINES ONLY. EXISTING 3'X40' LEACH LINE TO BE
Work: ABANDONED. 240 SQ. FT. OF LEACH LINES USING PLASTIC CHAMBERS TO BE ADDED.
Owner Contractor
CASTLE CREEK INVESTMENTS DIAMOND W EXCAVATING
21285 SHOEMAKER DR PO BOX 1675
MENIFEE, CA 92587 WILDOMAR, CA 92595
Applicant Phone: 9516745476
PAULA WILLETTE License Number: 554199
DIAMOND W EXCAVATING
PO BOX 1675
WILDOMAR, CA 92595
Phone: 9516745476
Fee Description QQt y Amount(D
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_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)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 Contractor's State License Law for
Professions Cod and my license is in full force and effect. the following reason:
License Class �UcNo. f L 1 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 I
WORKER'S COMPENSATION DECLARATION 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
www.leginfo.ca.gov/calaw.html.
this permit is issued.
Policy# Date
❑I have and will maintain worker's 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number a • t application and the information I have provided is correct.I agree to comply
awith all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy#q �,�CcliS R'Expires �v 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
❑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#
worqth
' ation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjker's co nsation pr visions of Section 3700 of the Labor
Codwith com I withth s provisions. ^ Will the applicant or future building occupant handle hazardous material or a
�^ Vmixture containing a hazardous material equal to or greater that the
App Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes Z51No
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 for guidel' es
CONSTRUCTION LENDING AGENCY ❑Yeso
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 bou dart'of a school?
(Section 3097 Civil Code) ❑Yesl
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 perjury that I am exempt from the Californi Safet Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the h ardous ma i Ire in
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �Yz p� g '
Business and Professions Code).Any city or county that requires a permit to oyes No rf{—,1�
Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER 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 Contractor's State EPA RENOVATION,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
❑1,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.gov/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 Contractor's 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 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:
❑1,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
I F!� t
f MT 1%6*
DATE: - 10 PERMIT/PLAN CHECK NUMBER
GRADING/ PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: C) COMMERCIAL-RESIDENTIAL MULTI-FAMILY MOBILE HOME <::: POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL MECHANICAL
NEVI PLUMBING RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS YES NO
PROJECT ADDRESS ( Aye(--,[ EAbf� lQ ZIP
ASSESSOR'S PARCEL NUMBER 1 -y�J-DDI LOT TRACT
OWNER NAME
ADDRESS
PHONE I EMAIL
APPLICANT NAME l `
ADDRESS •(3451�S �Y1
PHONEq'5' 3;Z'�)S103 EMAIL l
CONTRACTOR'S NAME OWNER BUILDER? YES NO
BUSINESS NAME l c
ADDRESS
PHONE q'-5: l �;)4 �547-ifc, EMAILft�(Joff��C)(2 (.COIv�
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ SQ FT L SQ FT I
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: �r CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE •-
INVOICE TOTAL 0 GREEN QO SMIP
OWNER BUILDER VERIFIED 0YES 0NO DRIVERS LICENSE# NOTARIZED LETTER YES NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
ENIF
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County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
OWTS INSPECTION CARD
APN: J —V / ��Q l / Permit No.: ON
Site Address: a J(JV 7W,9 14' S7 �-4 rf(` city: AeIl�Z
ip:
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
Septic Tank 7W
each Lin ed �
Seepage Pits
Septic Tank Abandonment
Sewer Lateral
Risers
ection
TO BE POSTE®A TJOB SITEIN PLAIN VIEW
EPO-55(REV 4/16)
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALT�
www.rivcoeh.org
....... .....
2018
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM
El 3880 Lemon Street-Suite 200-Riverside-CA-92501-(951)955-8980 Received
U 47-950 Arabia Street-Suite A-Indio-CA 92201 -(760)863-7570
Property Information: APN: 341.071.001 Date of Inspection: 11-1-18
1. Owner: - Castle Creek — Address: 28500 Avenida Estrella city: Menifee
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 /I- and determined that.
the tank capacity is '2.6'0 gallons and that there is J20 sq.ft.of leach line bottom area. There are
bedrooms in the dwelling and there are fixture units. 12 p
b. There are leach line(s),each IVO ft. long Depth ft. J0 Rock L] 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):
Q Concrete Q Fiberglass L3 Steel 0 Other: P16?5 r/
b. Internal dimensions of septic: Length 9 ft. Width 4� ft. Depth _�(_ ft.
c. Condition of tank(please check yes or no for each question): Inlet Tee present? 0 Yes Ll No
Tank Structure deteriorated? E3 Yes LINO Outlet Tee present? 0 Yes L3 No
Effluent Filter Present? 0 Yes JR No Two compartments? Yes LI No
d. Condition of D-Box: Level? L3 Yes L3 No Replaced? E3 Yes E3 No
5. a. While pumping the tank,did'effluent flow back into tank from absorption system? A Yes LI No
b. Prior to pumping,was the liquid level in the tank above the outlet tee? JU Yes LJ No
c. Was the area around the lids oxidi7ed? El Yes Q No
d. Is design of system gravity feed? ig Yes L3 No
e. Were well(s)observed on this or adjacent property? EJ Yes 53 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):
LJ Septic Tank ft. LI Leach lines ft. L3 Seepage Pits
g. Is sewer within 200 ft. of structure and abuts property line? J Yes 0 No
Additional Comments:
h. How long has dwelling been vacant?(if applicable) months weeks LJ N/A
6. a. L3 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. A It is my opinion that the system is not in good workin order and will not functon properly without the following
repairs: Leqr_� LJ'nC_ )5 14.ql" 7 — gee/acc
I certify under penalty of perjury that the foregoing is true and correct
Signature: Print Name: Wally Willette
Contractor License No.: '/ 554199 Expiration Date: 1-31-20
Pumperco.: Diamond W Excavating Inc. Phone Number: 951.674.5476
Address: 21285 Shoemaker Dr. city: Wildomar Zip: 92595
EPO-91(REV 03/16)