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0303-001 (PLBG)' r LICENSED CONTRACTOR DECLARATION , 1 PERMIT# � I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT Y to H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT TRACT 04 W Professionals Code,and my License is in full force and effect. w, License# Lic.Class Exp.Date JOB SITE APN I LU 265214 C42 MC �/W03 ADDRESS M­721.A,V.>r'.ar'1i1VE 60 t` t— X �� ) tf OWNER CONTRACTOR/DESIGNER/ENGINEER— Z Date Signature of Contractor CD 0 r� i.-, OWNER-BUILDER DECLARATION BLAY-E B DDOC1; A-! Cr ��7;'001, V14M,WC J W W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's 90-721 IMMYS GO 11,91 BOX 183 ~ N License Law for the following reason: LAW QU% TA C:A 9223 t7�ST�ZL°h`71 a"1>�c[1�'iirt CA S'22'14 Z_ ( ) I, as owner of the property, or my employees with wages as their sole C760)329.,6875 f') I;1# 086 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professionals Code). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensed Lti contractors to construct the project (Sec. 7044, Business & Professionals Code). `WSTAIJ,1500 GAI, SEPTIC SYSTEM A.6'x ZG'SW Pa3QE PIT () I am exempt under Section , B&P.C.for this reason Ln N Date Signature of Owner ON a Q WORKER'S COMPENSATION DECLARATION • p z I hereby affirm under penalty of perjury one of the following declarations: Lo r fa- O ( ) 1 have and will maintain a certificate of consent to self-insure for workers' '�Aid)f�'f1CJ1Sr1e7>f3G X W compensation, as provided for by Section 3700 of the Labor Code, for the O � d performance of the work for which this permit is issued. m Q U I have and will maintain workers'compensation insurance,as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this 11 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier �,4'TIc itZl (E, Policy No. 446.0FA 41-M RUlNUM)COST 1. �ONFIRUC°T'SCI.N ob Z) r 0 Ty:KR1kT[;1";t+"i�1K 6`i3MMARY J (This section need not be completed if the permit valuation is for$100.00 or less). Pi UM.911HO FEE _�, pR 1 al-000.419.000 ( ) 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 subject to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.) Date: - Applicant- Warning: pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to$100,000,in addition to the cost of compensation,damages 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 r-r� application. 1.Each person upon whose behalf this application is made&each person at j 4B^ 0TAT_C:CEN.M.1)'€°', 01T hN v 1)UN-TUTWI,. $60.00 whose request and for whose benefit work is performed under or pursuant to m any permit issued as a result of this applicaton agrees to, &shall, indemnify o n. & hold harmless the City of La Quinta, its officers, agents and employees. N 2.Any permit issued as a result of this application becomes null and void if c� a to Tt3TAL,P 'MITTeX K;¢)'1,Jts,j NOW 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. 4 I 1 IIIIIIII VIII III VIIIIIII I certify that I have read this application and state that the above information is � t_ii 72 • correct. I agree to comply with all City, and State laws relating to the building i �U IE construction, and hereby authorize representatives of this City to enter uponthe above-mentioned property for inspection purposes.; / �f�ECE011=_-� D BY e , DAT F A D INSP C OR�. , �° l �! b �� `Signature (Owner/Agent) Date A i 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 t Final Final POOLS - SPAS BLOCKWALL APPROVALS 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 — (� 3_� Final COMMENTS: Final 3 // d3 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) 80 7,4 THIS APPROVAL GRANTED BY THE �,d ,,�r.�t e�- �f21,C• , DEPARTMENT OF ENVIRONMENTAL HEALTH i IS VALID FOR ONE (1)YEAR FROM DATE OF APPROVAL 1 go) 41 i i I i i ( G��s>" m _ m m 3 CD �. /f ' I p m z � f FL — 3 _`oro `L �? a m E o 0 mi I U )Li! m m` � fi a� >a LU g L , •�c� �) o c v f0 a W C13 OL //'�y'� m �0,9� u51 U ro O �n " 0 -0 o q� = __ " _ 0s v3d = u �} �z I� !� � EcEsm (ts co LLl W (n Q Q '� N 3 6 io 1 ro E ------'-------'. - t ^ > Na) u O 3 O Cin __.- _ ._.-...__.-._........_..__.__...... _...._._._...._ V c o m Go y LU c E0 . cr wo m Li! c m ' E o� v a5MEa"iE oa L- r a) o Nr°ro o .E ° U a; co �" < m � iNa 3 c (v o'y � v N � SC i�L'. 0. � 3m � c � 3 ` C W > L y ` m > G -� N a C � . C ao •� LL it mm Q QlL N w R J � 00E �? � ° O00 > aa — O (n > = c a ti -� ro 2 QQQa .N F- I �I�I� I� I � � o 0 a Cl I I � i • j � n i f I � � 1 J I j l } T 13 �....__ ..__._. o a COUNTY OF RIVERSIDE HEA�:TH SERVICES AGENCY DEPARTMENT OF Eth/ R0NMENTAL HEALTH FoodP'L;isposal Trailer Park f_:: ?_ I::c Tank Motel,Apt., Hotelr.cach Line � X _!"evellirg —�._.IJ'C, �t:ji _/0 �BI�TD_j_q�MD Seepage F (�t2-.cev:ercl Commercial Building __....... r,:r..n to Sewer _ Swimming Poolr:t to Existing S.S.D.S. XNo on-:,site regenerating water softening devices r, ' ;: :sch4arged into the individual sewagedisposal _._. .. system herewith approved without clearance from ih;r. VVP.wr Qua!ity Control Board. - - k Water supply serving this installation must be from an approved source k All sewage disposal installation must conform with requirements of current Undorm Plumbing Code. Any cutting,grading or filling in excess of two(2)feet will nullify sewage disposal approval. _=Approval has been obtained from the Regional Water Quality Control Board for installation of the sewage disposal system. This is to certify that the Riverside County Environmental Health Services approves the subsurface sewage disposal plot plan to obtain building permit for installation,constru ion. DATE 3 //�o b BY T� DEPARTMENT OF.PUBLIC HEALTH IS VALID FOR ONE (1) YEAR FROM DATE Of APPROVAL. :+ ASSESSOR'S PARCEL NUMBER COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY ", — 1 to — O\ 0 DEPARTMENT OF ENVIRONMENTAL HEALTH APPLICATION FOR WASTE WATER DISPOSAL APPROVAL APPLICANT: Submit this form with four copies of a SCALED plot plan (1"=20'to 1"=40'SCALE)drawn to County specifications as indicated on the attached check list.A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County of Riverside.Approval of this application shall remain valid for a period not to exceed one year from date of payment. LMS# Agent, Contractor, Contact Person Address City State Zip Telephone r Owner Ad ress City State Zip Telephone a 1.i Z Job Property Address City Zip �- U Lot Size Water Agency/Well Use of Permit, PIP, SUP, PUP, etc. Legal Description DBA W Dwelling, MH Site Prep., etc. S3 Signatu of App li nt - Date r' —(S3—U- /' FOR OFFICE USE ONLY CHECK BOX IF REQUIRED. If any box is checked, this application shall be considered rejected until the n n,--failed Contour Plot Plans Required (1 to 5 foot interval) information is provided and the fee paid. Resubmittals later than 90 days _ after date noted below may require repayment of fees. s `=J `''-' " cx ca ❑ Holding Tank Agreements Completed „-, ,Lz - Z C., O ❑ Certification of Existing S.D. System Required > Z5 G. h_ WC] WQCB Clearance Required I v_ ;;`, Tom_; U) (Attach for DOH-SAN-007, Santa Ana Region Only) ❑ Soils Percolation Report Required Sz :-• C Q LC. ❑ Special Feasibility Boring Report Requiredti- IJ anal a wr........... _ _ ❑ Rereview Required Initials Date Please call 24 hours PRIOR to inspection. C/42/Soils Percolation Boring Report By Lic/Project# Date Soils Map Page Soil Type Approved By Date No. of Systems Type of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand ❑ Holding Tank ❑ Replacement Bedrooms, Fixture Units Grease Intcp/Lint Trap I ❑ New ❑ Addition y Existing ❑ Connect to Sewer y� 1 Gal. Gal. Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. Bottom Area Ft. ft. rock/ sq. ft. running ft. Install Line(s) ft. long ft. wide of Bottom Area Inlet Tested Depth ❑N/A with min. inches rock below drainlines U Proposed Bottom Tested Depth or Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet(B1) Seepage Pit Maximum Other: O Applicable Total Depth DDllowable ~ TD�' Iq U N/A Overburden Factor ❑5' 6' W U) Well Review Approved: Date: Well Drilling Permit# SIGNATURE Grading Plan Approved: Date: SIGNATURE , Plan Check Only Approved: C Date: IF 0 REMARKS: v 6 J\✓S -��,. v 1N 'Q� �-t�s i�V► 1,1 /- I i��1 �•L This application LsAPPROV /DENIED for the category check din .C-SECTION B abovgardi a design of a disposal system as indicated on the accompanied plot plan,using the requirements set forth in SECTION •7�-� C above.A building permit is necessary for the installation of the above- Revenue Code 3 J Fee $ (— designed system. No construction is permitted in the required reserved 100%expansion area. S _13 Check# (1) Septic Tank must be 100' minimum from any wells. 1 �Z (2) Leach lines must be 100'minimum from any wells, including expansion Date 3jInitial —r 0 area. C) (3) Sewer lines must be 50' minimum from any wells. W U) (4) Seepage pits must be 150'minimum from any wells, including expansion RIVERSIDE: 909-955-8980 area. INDIO: 760-8637-7000 Signature SOUTHWEST: 909-600-6180 3 C) Date �- DEH-SAN-122(Rev 8101) Distribution:WHITE—Office File;YELLOW—Applicant;PINK—Bldg.Dept.;GOLDENROD—Plans/Records G I: v Al Cesspool Service, Inc. r' P.O.Box 580188,North P;.Im Sprigs,CA 92258 JOB INVOICE `Since 1959' (760)329-6875 Fax(760)251-3405 State Lic.4265214 Customer Order No. Date Ordered —703 www.alcesspool.com Order Taken BY D ePromised E BILL TO P w NE r ADDRE§Sr IZNICIAN CITY HELP JOB ADDRESS q SERVICE ❑PUMP SEPTIC TANK HAS SEPTIC TANK BEEN DUG UP? ❑Yes ❑No ❑PMT.ON SITE REQUESTED ❑PUMP SEEPAGE PIT AT ITS RISER ❑OFFICE BILLING QUANT. DESCRIPTION OF PRICE AMOUNT Pumping Fee per 1000 Gallons(or fraction) Waste Discharge Fee per 1000 Gallons M� Locating and Opening Fee(l hr.Min.) Out of Area Fee r 6 IS' ❑ THE LEACHING SYSTEM HAS FAILED. ❑ THERE IS AN OBSTRUCTION"UPSTREAM"OF THE SEPTIC TANK It will be necessary to contact a line cleaning company. ❑ WE RECOMMEND MAINTENANCE PUMPING OF THE SEPTIC TANK EVERY ❑YEAR ❑ OTHER YEAR ❑ 2-3 YEARS To remove built up solids.This will increase the life of your leaching system. ❑THIS PUMPING WILL PROVIDE ON LY TEMPORARY RELIEF AND NOT SOLVE CUSTOMERS SEPTIC PROBLEM BECAUSE OF THE ABOVE. ❑ CUSTOMER HAS BEEN GIVEN AN"ESPLAINATION"PACKET. ASERVICE CHARGE OF$22 WILL BE DUEON ALL RETRUNED CHECKS. •• '"�� _ A FINANCE CHARGE OF 112%PERMONTH,18%PERYEAR,VAII BE " CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. IF PAYMENT IS BY CHECK ' DRIVERS LIC.# STATE I hereby acknowledge the ndsfaclory completion of the above described work: dTOtal SIGNATURE P /^ `- "' U btt�L� �J� ` Due COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY ASSESSOR'S PARCEL NUMBER DEPARTMENT OF ENVIRONMENTAL HEALTH = — O — O1 O APPLICATION FOR WASTE WATER DISPOSAL APPROVAL ' APPLICANT. Submit this form with four copies of a SCALED plot plan(1"=20'to 1"=40'SCALE)drawn to County specifications as indicated on the attached check list.A non-refundable filing fee is required when the application is submitted.Check must be made payable to the County of Riverside.Approval of this application shall remain valid for a period not to exceed one year from date of payment. LMS# Agent,Contractor, Contact Person Address City State Zip Telephone Zt/ I .266 O r Address City ool State Zip Telephone OJobb Property Address City Zip b-1;I_ d�� !/ G.r ✓ [ZZ? Z U Lot Size Water Agency/Well Use of Permit, P/P,SUP, PUP,etc. Legal Description DBA , W5.��33 •• Dwelling, MH Site Prep.,etc. T �S ��E Signato of Applicant Date :t ?- 03- 0 FOR OFFICE USE ONLY CHECK BOX IF REQUIRED If any box is checked,this application shall be considered rejected until the ❑ Detailed Contour Plot Plans Required(1 to 5 foot interval) information is provided and the fee paid. Resubmittals later than 90 days after date noted below may require repayment of fees. ❑ Other Z ❑ Holding Tank Agreements Completed ❑ Staff Specialist Lot Inspection Required ❑ Certification of Existing S.D. System Required Thomas Bros. Page Grid WE] WQCB Clearance Required ❑ Date Lot Inspection Complete J Initials }� U) (Attach for DOH-SAN-007, Santa Ana Region Only) Remarks: ❑.Soils Percolation Report Required Q Maintenance Booklet Provided ❑ Special Feasibility Boring Report Required ❑ Final Inspection by Department of Environmental Health is required. ❑ Rereview Required Initials Date Please call 24 hours PRIOR to inspection. C/42/Soils Percolation Boring Report By Lic/Project# Date Soils Map Page Soil Type Approved By _ Date No.of Systems . Type of System(s) No. Dwelling Units (1)Septic Tank Soil Rate Grease/Sand ❑ Holding Tank ❑ Replacement Bedrooms, eFixture Units Grease Intcp/Lint Trap New C1 Addition t Existing ❑ Connect to Sewer �(�11 i SOD. Gal. Gala Sq. Ft. Total Linear Sidev+all Allowonce Leach Bed sq.ft. Bottom Area Ft. ft. rock/ sq.ft.running ft. Install Line(s) ft.long ft.wide of Bottom Area Inlet Tested Depth ❑N/A with min. inches rock below drainlines U Proposed Bottom Tested Depth or Z Leach lines/bed special design for slope: (3)Pit Diameter No. Pits Pit Below Inlet(B1) Seepage Pit Maximum Other: O Applicable Total Depth Allowable L N D tl W N/A Overburden Factor ❑5' 6' TD UI Well Review Approved: Date: Well Drilling Permit# SIGNATURE Grading Plan Approved: Date: ' SIGNATURE Plan Check Only Approved: Date: -� M REMARKS: v 11`3 61 . 6 S -w. V tt�+Q4✓ V%^ % '" 1 !-#V W-J JiLL k)Q_q.\P_XogC_kS. This applicationLsAPPR;V /DENIED for the category checkedin SECTION B abovdi a design of a disposal system as indicated on the accompanied plot plan,using the requirements set forth in SECTION 1 C above.A building permit is necessary for the installation of the above- Revenue Code 13 Fee$ designed system. No construction is permitted in the required reserved 100%expansion area. ' C Check# J (1) Septic Tank must be.100'.minimum from any wells. t� Z (2) Leach lines must be 100'minimum from any wells, including expansion Date J 3 Initial Q O area. (~j (3) Sewer lines must be 50' minimum from any wells. W (4) Seepage pits must be 150'minimum from any wells,including expansion RIVERSIDE: 909-955-8980 area. INDIO: 760-863-7000 Signature SOUTHWEST' 909-600-6180 3 0� Date DEH-SAN-122(Rev 8r01) Distribution:WHITE—Office File;YELLOW—Applicant;PINK—Bldg.Dept.;GOLDENROD—Plans/Records