0307-023 (PLBG)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
FF— Chapter 9 (commencing with Section 7000) of Division 3 of the Business snd
tv W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date-
r --
422155 C 3 6 c,..-- Q1 1f2t.
o ZO I �D tae =� Signature of Contractor—�' � f ,A
� I— o OWNER -BUILDER DECLARATION`
W a I hereby affirm under penaltyof perjury that lfam exempt from the Contractor's
N License Law for the following reason:
Z_ ( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
ce) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
C)
d Q WORKER'S COMPENSATION DECLARATION
C:> Cr I hereby affirm under penalty of perjury one of the following declarations:
p () I have and will maintain a certificate of consent to self -insure for workers'
X W �: compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q () ( ) I have and will maintain workers' compensation insurance, as required by
OU
Q Section 3700 of the Labor Code, for the performance of the work for which this
CC
rn F— permit is issued. My workers' compensation insurance carrier & policy no. are:
NJ- Z Carrier �� F112I3 Policy No. i$33A1-0Z
coo5
J(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subjectato'the
workers' compensation laws of California, and agree,:that*if `I should become
3 subject to the workers' compensation provisionsof5ection 3700 ofAhe Labor
Code, I shall forthwith comply with tFiose provisions ~~
/Date: iZ ApplicantK -
Warning: Failure to<secureNNlorkers',,Compensation coverage is unlawful and
shall subject an,dmployer to criminal penalties and civil fines up to $100,000, in
addition to the ostt of,compensation,'_ ages as provided for in Section 3706
of the Labor Code, interest,and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and, State laws relating to the building
construction, and hereby authorizerepresentatives of fhf's City to e
nter upon
the above-mentioned property -for inspection purposes:
Signature (Owner/Agent) �� Date
�.o BUILDING PERMIT PERMIT:...
DATE VALUATION LOT O17 &A TRACT
07/0212M�i_,�OtJAf!
JOB SITE
APN
ADDRESS 54 5.M ANIMIDA OTA&IO(
OWNER
CONTRACTOR / DESIGNER / EN (NEER
IVIOU 11TI IVRNSO:N
ROM R0M7F.R.
54•S52 AV0.41DA OI3IZEWIT
796 N, 3T ATE S ,
LAQ'Jt IA CA 92253
L°IETWT CA 9254:
.
(909)6SRw8S�12 �` f.:I;1'.,�i i fir3tJ
USE OF PERMIT
PLL%IvlI ING
ADDITION OPWIAM'E EJECTOR IN Ci ld'MC' ION WITH SEPTIC
ADANDONEWNT &2FWF R C0WHE.V- SUPPLEWNTA.1, TO
Pl�Kiid 1 �';0031)7.0��.
VALUATION 110W.00 L.3
ESTMAIrEh7 COST OF CON5MI1CTC"i9ION
IM)OZO
ELECTRICAL 101.000-420•000 $15,73
PlIUMBTNCI "IE 101-000-419-000 $21.00
9
SUB-TO.tAL CON= TIM034 AND PLAN C.IT91CT
LA'S'S PRI? -PAID M,3
S0.00
c� 1 PE]ft +1.i;1' M.6 DUE NOW
Js
-JUL 02 2003
TA.
T.
RECEIPT
DATE�„�
B.Y. /
DATE FINALED
INSPECIQR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final -
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
EquitySpec
Consulting Engineers, Inc.
July 1, 2003
Mr. George -Stevens
54552 Obergon
La Quinta, CA 92253
Attention: Mr. George Stevens via fax to 760-564-2674 and USPS
Reference: SFR 54552 Obergon new sewage ejector
La Qunita, CA 92253
Dear Mr. Stevens,
Per your request, I have reviewed the product data for the Liberty 372/LE51A pre -assembled sewage
ejector, your site plan and plumbing demand for the above referenced residence. The proposed work
includes running approximately 75 feet of 3" ABS sewer line from the existing house sewer at the rear
of the house, around the house to the existing sewer lateral at the front of your lot. This existing lateral
is approximately eight feet below grade; the existing house sewer is approximately 30" below grade at
the point of connection to the new ejector.
The Liberty 372 system with the LE51A pump with 1/2 HP motor is adequate to handle the demand of
the 28 drainage fixture units and the friction loss and vertical lift of the proposed piping installation.
Thank you for the opportunity to provide this letter report. If you have any questions, please call or fax.
Sincerely,
E i ec Consulting Engineers, Inc.
David A. Celmer, P.E.
Chief Mechanical Engineer
License number M-22768
DAC/com
gstvnsew.doc
cc: Kirk Kirkland, City of La Quinta Building Department via fax to 760-777-7011
Inland Empire Office:
4508 N. Sierra Way, Suite 115
San Bernardino, CA 92407
V: 909 881-727 F: 909 881-5237
E: egtyspec@mindspring.com
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