BPLB2017-0028Applicant:
Contractor:
C];1„
VOICE (760) 777-7125
78-495 CALLE TAMPICO
38703 VISTA DRIVE
D�.
CATHEDRAL CITY, CA 92234
LA QUINTA,`GALIFORNIA 92253
DESIGN &DEVELOPMENT DEPARTMENT
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Llc. No.: 482180
BUILDING PERMIT
Date: 2/9/2017
Application Number:
BPLB2017-0028
-` .
Owner:
Property Address:
'49575 AVENIDA MONTERO
RICHARD KERR
APN:
646182023
209 E MICHIGAN AVE
Application Description:
KERR / INSTALL NEW SEPAGE
PIT
BATTLE CREEK, MI 92253
Property Zoning:
Application Valuation:
$11,000.00
Applicant:
Contractor:
ALMS UNDERGROUND CONSTRUCTION INC
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
CATHEDRAL CITY, CA 92234
(760)324-1911
Llc. No.: 482180
LICENSED CONTRACTOR'S DECLARATION f
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C21, C422 License No.: 482480
Date`i / Contractor, _ .r
—8
OWNER -BUILDER DECLAR N
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its 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 License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged_ exemption. Any violation of Section 7031.5 by any applicant fora
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
I ) 1, 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 and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves.thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however; the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(� I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( ) I am exempt under Sec: B.&P.C. for this reason
Date:
Owner:
_-/CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is. a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the•followirig declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued:
I have and will maintain workers' compensation insurance, as required by'
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: ACE AMERICAN INSURANCE COMPANY Policy Number: RWCC48821078
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: a0 1.7 Applicants.
WARNING: FAILURE TO SECURE WORKERS' COMPEN ION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application. t
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 application , the owner, and the applicant, each agrees to, and -
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any actor omission related to the work being performed, under or
following issuance of this permit.
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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Dat 9 FRl 20 J i Signature (Applicant or Agen
.; FINANCIAUINFORMAT.ION
DESCRIPTION. ACCOUNT QTY
AMOUNT
BSAS SB1473 FEE 101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-00007-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SEPTIC SYSTEM
101-0000-42401
0
'$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SEPTIC SYSTEM PC
101-0000-42600
0
$5.07
Total. Paid for PLUMBING FEES: $17.74
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Bin ##
Permit #
nn
Project Address:
t'
City of La Quin to
Buifding 8i; Safety Division
78-495 Caffe Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Owner's game: '
A. P. Number:
Address: ..119-57,57'f1 v 1Y) r,+. y- o
Legal Description:
City, ST, Zip:
Contractor: r e.
Address:3 2,7 o 2
Telephone: �%
o e. O 3
>6 / 9
$6 8'
Project Description:
City, ST, Zip: 92 Z3
_..----"--•-
.Ls7 Sfat. .vt•e. Sem o. �. �
TeleP hone: 2 Y
7
e_ 1 a'
State Lic. # : $2/ S D
City Lie" #c % 6
Arch.,-Engr., Designer:
Address:
City, ST, Zip:
Telephone.
one:
n aneY
Costructi n Type: Occupancy:
:
State Li. ,-
t #
c •
Project type (circle one • New Add'n Alter Repair. m
Demo
0
Name
Name of Contact Person:
Sq. Ft.:
#Stories:.
# Units:
Telephone # of Contact Person:
Estimated Value of Project: / / as b v
APPLICANT:. DO NOT WRITE BELOW THIS LINE
#
Submittal
Rcq'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount ,
Structural Calcs.
Reviewed, ready for corrections.. .
Plan Check Deposit
Truss Calcs..
Called Contact Verson
Plan Check Balance'
Title 24 Calcs.
'Plans picked up
Construction '
Flood plain plan
-
Plans resubmitted
Mechanical
Grading plan
2'. Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''J. Reyierv, ready for correctionstissuc.
Developer'Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
4 County of Riverside
PrP-- ��. •
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
LAND USE APPLICATION
OFFICE USE ONLY
LJ 3880 Lemon Street • Suite 200 • Riverside • CA • 92501 - (951) 955-8980
0-47-950 Arabia Street • Suite A • Indio • CA 92201 - (760) 863-7570.
PE CODE:
FEE:
EHS # 7 L+
TR/PM 3y y [i
APN:
ON # I LMS # A r.
I LOT # e- USE OF PERMIT:.
SECTION A
j
Name
OWNER:
Address /-
Ji %.5 V2 / /j C
City Lti ,:.��`-
Zip
Phone"//
Email
AGENT/
Company Name A Y�\5 ,� def: r'7 A ent/Contractor
CONTRACTOR:
Mailing Address F< -7 7 -3 ;5 to
Cit Co' f6z fo, l C-,
Zlp V aZ3
Phone 760
Email
PROPERTY INFO:
Site Address q V 7-5 ve /"-10 lite rC
Cit L 'k
zip.
Water Aaencv/Well C V WJ� Lot Size
APPLICANTS SIGNATURE: e,' � DATE: 6 �"t'✓� Z C7 I
SECTION B UBelow— For Office Use Only
CHECK BOX IF REQUIRED.
If any box is checked,, this application shall be considered denied until the information is provided.
❑ Holding Tank Agreements Required
❑ Certificate of Existing OWTS Required (C-42)
❑ WQCB Clearance Required
❑ Soils Percolation Report Required
❑ Floor Plan and/or Plumbing Layout Required
❑ Special Feasibility Boring Report Required
❑ Detailed Contour Plot Plan Required (1 to 5 foot intervals),
SITE EVALUATION INSPECTION REMARKS:
EHS INITIALS/DATE:
SECTION C
❑ NEW EPAIR / REPLACEMENT ❑ EXISTING ❑ PUMP ❑ ATU ❑ CONNECT TO SEWER I FIXTURE UNITS # BDRMS #
Soils Percolation/Boring Report By:
Date:
Project#
C-42 Certification By: '�/
Date: /
License#
Septic tank cap.: Soil Rate:
Tested .Depth:
Max. trench depth:
Sq. Ft. Bottom Area: Total Linear Ft.:
Line(s):
Length: feet - Each 3 feet �McI
Sidewall Allowance: Ft. Rock/ Sq. ft. Running foot
Rock below drain line: in. or ❑ Plastic Chambers
Leach Lines/bed special design for slope: ❑ N/A ❑ Overburden Factor:
Pit Diameter. L7 r I No. pits: % I Depth below Inlet bi :•� Pit Total Dept':
Max. allowable depth:
CONSTRUCTION/INSTALLATION REMARKS:
��. �z��1 -� C - zP ..�� ;� -t
SECTIONt f %
This Application is Approved ❑ Denied regarding the design of the OWTS.as indicated on the accompanied plot plan using the requirements set forth in
Section C above. No construction is permitted in the required reserved 100% Expansion area.
EHS Signature: t „ `.}-- / _
I I7,^,_.E.G,, y� t v,���� ✓�� Date: •� f
EPG -K- ,�:b� ! - Disinbution, WHITE _ EL O
� Office File: Y_ L.�N – 31Cg. Oept.. INI: – Acolicant
0
b, County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivc-ceh.arg
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM
❑ 3880 L,.,,, Street - Suite 200 - Riverside - CA - 92501 - (951) 955-8980
❑ 47-950 Arabia Street - Suite A - Indio - CA 92201 - (760) 863-7570
-Property Information: APN: Date'of Inspection: 7
Kerr 'Addr 5 75 -4 ve o nleon QA;VN+r1,-
1. Owner: t1w Address: Cit�y:
FAILURE TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT 0VINER FROM'OSTAINING
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 . 7 reA L?oi 7 and determined that
the 'Lank capacity is jo01D 'gallons and that there is - s , q. ft. of leach line bottom area. There are 3
bedrooms.in the dwelling and -there'are fixture units'.
b. There are [each line(s), each ft. long Depth Rock
0 Plastic Chamber
c. There are Seepage pit(s), each 6� ft. in diaineter, and ft: TD.
ft. BI.
The leach bed is ft. by ft., total sq. ft. o . f leached area. Depth is ft.'
4, a.
C onstruction of septic tank (Please check one of the following):
.
La"Concrete 0 Fiberglass .0 Steei Cl Other:
b.
Internal dimensions of septic: Length ft. Width 6 ft. Depth
C.
Condition of tank (please check yes or no for each uestion Inlet Tee present?
❑ Yes ❑ NO
Tank Structuredeteriorated? C) Yes 911,11COutlet Tee present?
❑ Yes ❑ NO
Effluent Filter Present? 0 Yes O'No Two compartments? .
LTYes El No
d.
Condition of D -Box: Level? ❑ Yes ❑ No Replaced? ❑ Yes ❑ No'
a.
'Alhile ' o6mping tank, did effluent flow back into tank from abscroticr, system? -C�'Yes 0 No
b.-.
Prior to pumping, was the liquid level in the tank above the outlet 6L= -e? eyes ❑ No
c.
Was the area around the lids oxidized? ❑ Yes YNo
d.
Is design of system gravity feed? &Yes- 0 No
e.
Were well(s) observed onJhis or adjacent property? ❑ Yes &No
If yes, indicate distance of well from: Septic tank ft. Leach lines Seepage Pits
f.
Distance from springs, lakes. and natural water courses. (check all that apply):
❑ Septic Tank ft. 0 Leach' lines ft. CJ
Seepage Pits ft.
g.
Is sewer within'200 ft. of structure and abuts property line? ❑ Yes No
Additional Comments:
h.
How long has dwelling been vacant? (if applicable) :a- months weeks
❑ N/A
6. It is my opinion Chat the system appears to be in good working order and can 'ieexpected to function properly with
proper maintenance. No repairs are necessary at this time.
b L
It is my opinion that the system is not in good working order and will- not functicn properly �Nithout the following
repairs.- 0 fk5-(-7
�oxge
'J
I certify under penaltI, of perjury that the foregoing is true and correct.
Signature, Print Name: -
Contractor License No.: U i-/
Expiration Date: A p r 7
Pumper Co.. -Phone Number,
Address: 733 ,?0
City. 4,
Zip: .97- .2- -3 Ll
ALMS UNDERGROUND CONSTRUCTION, INC....
38703 Vista .Drive, Cathedral City, CA" 92234 F
CA Lic. 482180
760-324-1911 Office 760-324-9541 Fax 760-578=.1510 Ce.11-
Almsunderaroun'd.(@omail.com
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