PLBG (9707-148)LICENSED CONTRACTOR DECLARATION
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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
6541) i t1
/Date` SRgnature of Contractor �/A
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following 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.
(x) 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 & policy no. are:
Carrier Policy No.
t)j!i-'I". �(Ftl(rfit�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 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 prov�SIons.
VDate: �4pplicant �%l . / <. r
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
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 authorize representatives of this City to enter upon
thePabove-mentioned property for inspection purposes.
/ignature (Owner/Agent) L — * '— Date • 4
BUILDING PERMIT
DATE '7121J97 VALUATION $4.000.40 LOT
PERMIT # CONTRO/^LL ## 2/
TRACT
JOB SITE 51-#tili A :l' � it3,c3 ��► A'E� t ZI D APN
ADDRESS
1171-07&013
AD
OWNER�� CONTRACTOR /gDESIGNER /AENGINEER Y�
iAtta�t Ad,1.1f�A-.T(d�ttti'11�.0 ��Il:F`d i�i`Il.. i�..$)T �i`� i�t_�1'JSl'a,tictiic)ly
Mt1J, IBU CA P0265 ('Wl'#'1RIAM, f'iVY CA 922-34
USE OF PERMIT
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F�.t/epi t, AiiL� j•
t ALUtl'i'+.fA
4A.10A Lf;
7 t iTM II T E'i} 'i_ ! A� 1.N.►,•/ 1.�,.Y.t �1 t� Y.� J v,t�� Y.?.i
PEetrlfil' VEX :�dJii7AAARV .
K.1 INA i INN 14-1-6 $4 N.00
:IY'_} AI.� �;2AI91R1K no)1�' 1tA1i) PIAN ( !JIW
f1�
AUL 3 0 1997
DATE
BY ! / I DATE FINALED
%4S€n
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00
$4.1.00
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
Stee6
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 Sze
Utility Notice (Gas)
ELECTRICAL P ROVALS
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
l
Final
Utility Notice (Perm)
COMMENTS:
.. y _ ., r�• •atm s r �,,r � � ... , ..- ,. � - • �a'�-.'ti` i - .
ASSESSOR'S PARCEL NUMBER
2
.COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY 77.3 - O 7? _'0 3% -0
DEPARTMENT OF ENVIRONMENTAL HEALTH
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
;;
APPLICANT: Submit this form with four copies of a SCALED plot plan (1-20 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 applica-
tion shall remain valid for a period not to exceed one year from date of payment.
/ Of CA C�l'C/iii
LOG # i7r'
Agent, Contractor, Contact Person
cn�iic/ sGr7 Ca•^ sT �c' •
Address city� State Zip
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Telephone
vg '/?t/7
Owner
�i`//s
Address City State Zip
/�C� Gcx l
Telephone
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Job Property Address /14
City �
Zip
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Lot Size
4e et r Agen , @Ir FXf fr
( ("0A(At6,f «t VAt tE y
Use of Permit, P/P, SUP, PUP, etc.
AX SFL• oa6it /�i; TD � y,�lr.
Legal Description
Lor �a 3tK � � Z 4V Lor
welll�ng u1 -Site Prep. etc XrY�
Say f7 >�Q /iAVtAt� 7A r ,
I�AcE_ df r �t WV )`r Wly
Signature of Applicant Date
CHECK BOX IF REOUIR!ED
❑ Holding Tank Agreements Completed
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval)
❑ Certification of Existing S.D. System Required
❑ Grading Handout Provided
m
❑ WQCB Clearance Required
❑ Staff Specialist Lot Inspection Required
Z
0
(Attach For DOH -SAN -007, Santa Ana Region Only
❑ Lot Inspection
U❑
Soils Percolation Report Required
LU
❑ Date Lot Inspection Completed: Initials
U)
❑ Special Feasibility Boring Report Required
Remarks:
❑ Maintenance Booklet Provided
Initials Date
❑ Final Inspection by Department of Environmental Health is required.
C/42 / Soils Percolation Boring Report by Lic4Project # Date
Soils Map Page Soil Type Approved By Date
No of Systems
Type of System(s)
O Holding Tank O Replacement
No. Dwelling Units,t/ kL0(r•
'Btfdrooms, Fixture- nits IV
(1) Septic Tank
�)(/ t %.
Soil Rate
Grease Sand
G rease-rntepiTrap
IF k f S ,'
0 New ®Addition '7V
EK
/ ?
\
Y /(�
a�
al.
I }
0 Existing F S5(r. r 544AG�
Gal.
Sq. Ft. •
Total Linear
Sidewall Allowance
Leach Bed sq. ft. of
Bottom Area
"Ft.
tt. rock/ sq. ft. running ft.
Inlet Tested Dep h ❑ NA
Install Lines) ft. long ft. wide with
min. In s rock below drainlines or
B om Area
Proposed Bottom Tested e
Z
Leach Ies/bed special design for slope:
(3) Pit Diameter
No. Pfts
Pit Below Inlet (BI)
Seepage Pit
Maximum
Other:
O
'
Total Depth
Allowable
Applicable
r
Tana Fins.
C'111
/
TO
��,
Depth
i`d
W
N/A Overburden Factor
0 5' 6'
Is
TD
A/0(UPIT6/trEA/ IS'70IS'
Well Review Approved: Date: Well Drilling Permit #
SIGNATURE
Grading Plan Approved: Date:
SIGNATURE -
Sewer Verificatio Approved: Date:
REMARKS: its ilio
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"OF aL, UiC/J �' C..! OZ atI e . C." n
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This application is�PT OV.EDtDENIED for the category checked in SECTION B
FOR OFFICE USE ONLY
above, regarding the design of a subsurface disposal system as indicated on the
aoompanied plot plan, using the requirements set forth in SECTION C above. A build-
ing permit is necessary for the installation of the above -designed system. No construc-
.30 p-
Revenue code �� Fee $ ay"
tion is permitted in the required reserved 100% expansion area.
/ (/
/6 743
(1) Septic Tank must be 100' minimum from any wells.
Check #
(2) Leach lines must be 100' minimum from any wells, including expansion area.
^
Date 7 Initial
(3) Sewer lines must be 50' minimum from any wells.
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f_......-�.
4) Seepage pits must be 150' mjniml um from any wells including• expansion area.
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Signature of Health Official p
Date
U014 -SAN 122 (Rev 9/93) Ulstrlbutlon: wmi I t—Uttice rile; YtLLUW—Appllcam; t -INK -0109. uep1.; UL)LUtNhL)L—dans/neuurus
h
} P'HO`NE CALL +` . r 3 �? o�"�• ♦ r�. ; _
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COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
Food Sewage Disposal
_
Trailer Park E)q Gal. Septic Tank? )
—�— IViotel, /apt., f•lotel�YIST Sq. Ft.pf Leach Line
DvueAirig 4D- fro. �Dia�d 91 TD rF0 : MD Seepage Pit 74- EWf
Commercial Building Connection to Sewer OIST- 649)e
S-wimming Pool Connect to Existing S.S.D.S. i�X"Dn4LZ64,7l
No on-siie regenerating wattzir softening devices rnay be discharged into the individual sewage disposal of d/T
system h .cvrilh approved without clearance from the Water Quality Control Board.
-( water supply sorv:n thi n,--tallation must be from an approved. sourceG",l'�jT (CVIc/!�
—.X_Ail sewage disp'Isr .t"aif'gon must conform twith requirements of current Uniform Plum Godo.
tiny cutting, grading or fillip, in eyc. ms of two(2) flet will nullify sewage disposal approval.
l�.prroval has been obtained from the Regional Water Quality Control Board for installation of the sewage
disposal system.
This is to conify thaat�_t`re,Riverside Cou`Aty Environmental Health Services approves}h'e �s,,u/bsurface savage
disposal plot plan Eo ebtai Ejuildii�g �:€�rmit for ins fallen, construction.C��Rlk o i �/f%D C�DiT �i(/E�✓/�f' ja art
,'_r_ 7-499- 92_V .-- v 0/ /
MAWTAIN 100% EXPANSION AREA. MIN. ISO' FRO ANY WELL he -J1,4-74-
MIN. 10' FROM ANY TREE OR WATER MAIN--;a>It
DEPARTMENTTHIS-APP OVA"RANTIE. -By-
�� � f p�
OF PUBLIC HEALT ee,,th oi,Rivereide PIMS byo�not relieve the
IS VALID FOR ONE (1) YEAR cer orlArchiteat of the reepopeibility for the Enainem
FROM DATE OF APPROVAL. `me or Arebitectural deaiea n
A4wr olfour-
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t P.O. BOX 1504 No. 110600
g 78-105 CALLE ESTADO .�
Building 5].-100 Navarro. ' s
Address ItLA QUINTA, CALIFORNIA 92253..
Owner
Phyllis -Holmes
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 51-100 Navarro
A.P. Number
City Zip
a Qui.ht TQI_13/45b
92253®6385 Legal Description
Contractor Project Description 1c�,?9`?"n epi
Hendrickson Construction' P... ._ _
Address Additional 9eepa ge 3 ii�
68315 Kip -ley Rd
City Zip - Tel.;
Capt City 92234 328-1747.
State Lic. City
& Classif. A 256184, tic. # 194 Sq. Ft.' No.. "No. Dw.
Arch.; Engr., 'Size- Stories :' Units "
..Designer - New ❑ Add ❑ Alter ❑ Repair ❑ Demolition.❑
'-Address Tel.
City . T-7
Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm that I am licensed under provisjonsof Chapter 9'(commencing with Section
7000) of Diiivvision�3'off the Business and Professions Code, and my license is Injfull fore and
effecti <' b�. V'^•$t- —7�i A i I i j
dS GN TU til - DATE .
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following �•� �� -
reason: (Sec. 7031.5,Business and , Professions Code: Any city or • county which 'requires a
Permit to the applicant for such permit to file a signed statement that he Is licensed, pursuant to PERMIT construct, alter, improve, demolish, or repair any structure, prior to its Issuance also AMOUNT
requires - -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of -
Division 3 of the Business and Professions Code, -or that: he 7s exempt therefrom, and the basis -
-. for the alleged exemption.' Any .violation of Section 7031.5 by 'any applicant for permlr .Plan Chk: Dep..
subjects the applicant to a civil penalty of not more than five hundred dollars.($500). - Plan Chk. Bal.
,
❑. 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, Buisness and'. – '
Professions Code: The Contractor's License Law does not apply to an owner of property who. 'Const.' '
builds or improves thereon and who does such work himself or through his own employees, Mech.
.provided that such 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 Electrical "
of proving that he did not build or improve for the purpose of sale.) - `
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- - Plumbing ., TO . Q�
struct the project. (Sec. 7044, Business and Professions Code: The, Contractor's License Law.
does not apply to an owner of property -who builds or improves, thereon, and who contracts for S.M.I. - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ..Grading
..
❑ 1 am exempt under Sec. B. & P.C.C. for this reason
' Driveway Enc. -
_ Dare 'owner Infrastructure
.WORKERS' COMPENSATION DECLARATION '
hereby affirm that I;have'a certificate of consent to self -insure, or a certificate of
- Worker's. Compensation. Insurance,.or a certified copy thereof:. (Sec: 3800, Labor Code.).. - -
Pol icyi No. Company
❑•Copy. is filed with the city: ❑.Certified copy is hereby.furnished.
TOTAL 30. 0 0
CERTIFICATE I. OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit. is for one. hundred. dollars ($100) valuation.
or less.)
I certify that in the performance of thework for which this ermit is issued I h II t
employ any person in any manner so as to become subject to'the Workers' Compensation • '.
Laws of California.
'
Date • Owner'.
NOTICE TO APPLICANT. If, after making this Certificate of -Exemption you should become
ZONE:
BY:
subject' to the Workers' Comp'en'sation provisions of the -Labor Code; you :must forthwith
comply with such provisions or this permit shall be deemed_ revoked. - . _
Minimum Setback Distances: -
-.
Front Setback from Center Line
Rear Setback from Rear Prop: Line
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the .
Side Street Setback from Center Line '
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side. Setback from Property Llne
Lender's Name
-
-
Lender's Address =`
FINAL DATE
,
INSPECTOR "
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this •application and state that theabove information is correct.
Issued by:
Date Permit -
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 the above-.
mentioned property for inspection purposes. +
Validated by:
Signature of applicant Date
• Mailing Address
Validation,
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. S0. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
FINAL INSP.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR -
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SERV ePOTIR SEPTIC TANK
OUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE.
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
,n
G 4/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION nL
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
P!P,J
'7%.�-0
p
-5 Po '-f foN
ria
Z9
SA-,JTA
LSA Y- A !,'ITP'
(2zc 1 �16 la�
HENDRICKSON CONSTRUCTION, INC.
General Engineering'Contractor • Underground Specialists
Na
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Post Office Box U • Cathedral City, CA 92234' • (619) 328-1747
License #256184-A
,i.
A
RIVERSIDE COUNTY DEI:lPARTIYIENT OF PUBLIC HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
Food Establishment �Sewaage Disposal
Trailer Park Gal. septic Tank
Motel, Apt., HotelSq. Ft. of Leach Line
+� Dwelling 1-f
'fl 1�. _ x _i±�epage Pit
Commercial BuNfing Connoction to Sewer
swimmis % Pool
_ i No on-site revrgra4-19 mctftaris4r, dsvias3 may bo di7;hmrrd into the individual sewage disposal
system herewitO aop;rov.;:d with.%si :, y '.yea >iL; rra;,L-r Qu=ay Ganfrol Board.
_%G Water supply rr,ver: 0;_ sou�.
..j,, All sewage dispasai c, cw-r nt uniform Plumbing Code.
_ (- Any cutting g; aUF ;S, cr tea: 4% In cxc s ::,f (t) � Ni reud9i •g szaaZ9 disposal approval.
Approval hes boon ohtainad frwn the sgioaal Water QusR- Control Lard for installation of the sewage
disposai system.
This is to certify that the Riverside County Department of Public Health approves for occupancy, construction x
nstallation the item(s) checked above.
Wit• Z-/13 /6 2
MAINTAIN 100 6 EXpANSIONAREA.
MIN.
MIN. "0' FNSOM ANY LARGE TREE OR WATER FROM /kIVYV1iELL
Septic tank and sevpar Hpas must be 50 ft.
DEPARTM NT OF PUBLIC HEAL _ from aw ��EIs, in -c! udi-a� er n .m areas.
IS VALID FOR ONE (i; YEAR Leach Bemis Must b8 lk� ft. minim= and
FROM DATE OF APPROVAL. ps egBu150 tnamum >tr®m
any wells.
" ... � 1 ., r ,... .. . .. r • . 'der(. .'rF�.-^o :^.^t,r�1.�. tj[�.� :f.y..l'(' .Yw._ iI1 x-'.x'."x. aSw.ya . -'i' 'i . ._ ) � � -.
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8O"l,�' DEPARTMENT OF HEALTH Assessors Parcel No.
NTY OF RIVERSIDE
%�
RVVIRONMENTAL SERVICES DIVISION 07 03 - O
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Appllcant 'Submit this fob with four copies of a SCALED plot plan (1-20 SCALE) drawn to County speculations as indicated on the attached check list.
A nbh-refundab a filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside.
AppTval ofthis application shall remain valid for a period not to exceed one year from date of approval.
ttt
LOG # ° • VERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING & SAFETY (goldenrod) APPLICATION
Agent, Contractor,•Cbntact PeRpn
Phone
Address City State Zip
X4 d�ke�., r_, 0
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Owner r? . r L.
Phone',O r3
Addresses,/_/®p City tate Zip
'P I
o..o Ahcn'. CQ.
Job Property Add ess
City
State
Zip
Legal Description o��p. (PM, Tract, Lot)
Yr OSB • +,
p
Lot Size
Water Agency/Well
Use of Permit P/P, CU, etc.
Other .4
Wk IZZ.
Dwelling, MH Site Prep, etc.
ljg-,lD
I
Date
Signature of Applicant
CATEGORY' REV CODE FEE
CATEGORY REV CODE FEE
SUBSURFACE DISPOSAL (per system) 1238 $153.00
❑ SITE EVALUATION UPON REQUEST 7349 $120.00
❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION ;;
(NO PLOT PLAN)
❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00
a. 1st 4 Parcels (Each) 1238 $153.00
❑ PRELIMINARY ELECTIVE EVALUATION
b. Each Parcel after 4 7344 $ 55.00
(Attach DOH -SAN -53) 7352 $ 69.00
❑ REREVIEW (2nd review same parcel) 7344 $ 55.00
❑ HOLDING TANK 7351 $119.00
❑ SITE EVALUATION In Conjuction with Critical Area' 7346 $197.00
❑ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00
❑ GRADING PLAN REVIEW DETAILED 1238 $104.00
❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00
❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00
❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00
❑ COPIES (LAND USE) 7786.81 $ .50
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes I( No
Certification of Existing S.D. System Required ❑ Yes I No
WOCB Clearance Required ❑ Yes I No
(Attach Form DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required ❑ Yes D No
Special Feasibility Boring Report Required ❑ Yes No
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes No
Grading Handout Provided ❑ Yes No
Staff Specialist Lot Inspection Required ❑ Yes No
Maintenance Booklet Provided ❑ Yes No Lot Inspection Date Initials
M1
C/42 / Soils Percolation Boring Report by Ir / P up/Project # Date
Soils Map Page Soil Type Approved By ( t Date
No. of Systems
Type of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
❑ Holding Tank WReplacement
❑ New ❑ Addition
Bedrooms, Fixture UnitsGreaselntcp/Lint
2 S� ��Ossl
f
❑ Existing
4hr �r //
Gal.
Gal.
Sq. Ft.
Total Line
,.--- Sidewall Allowance
Leach Bed sq. ft.
Bottom Area
Ft -
ft. rocW sq. ft. mg ft.
Install Line(s) ft. long ft. wide with
rea
Inlet Tested Depth ❑ NA
min. inches rock benGnes-o
Propose .Bottom Tested Depth
,
LeachlinesJbed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
l
Seepage Pit TotaDepth
�
1+3
Other:
Inlet (BI)
(TD)
Applicable
N/A Overburden Factor
❑ 5 X6
I
f o
Max. Allows 9pth
Well Review Approved: Signature Date Well Drilling Permit #
Grading Plan Ap roved: � Signature Date
`
REMARKS: En r e ie ol, a & e^
C u re,,+II 1041dlh15 ou /=/i ,- 3 bdr,
A �i)>"k.
This application is(APPROVED ENIED/for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied -plot -pt n, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed
syste No conc_tniction is permitted in the required reserved 100% expansinn area
(1 Septic tank must be 100' minimum from any wells
D
Leach lines must be 100' minimum from any wells, including expansion area
(3) Seepage pits must -be 150' minimum from any wells, including expansion area
Signature Health 3,6
of Official Date -24/
=j
❑ CASH N[CHECK NO. 12!% 7
RECEIPT NO. 6 Issued By �` L&}� Date 2-�/ 3 �� 2
DISTRICT ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
I
DOH -SAN -122 (Rev 6/91) DISTRIBUTION: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records
44
G -'I OFTN%78-105 CALLE ESTADO" LA QUINTA, CALIFORNIA 92253 (619) 564-2246
June 13, 1986
John Kulander
P.O. Box,70415
Sunnyvale, CA .94086
SUBJECT: 51-100 Avenida Navarro
Dear Mr. Kulander:
This letter is to inform"you that al,l of t:he substandard conditions
outlined in my letters,of March 6th thru,April 1st, 1986,have been
rectified and no subsequent problems have arisen.
As a matter of clarification it,should be noted that the electrical
problems outlined in my letters were minor in nature and at no time was
this department suggesting that the premises required rewiring.
I would lite to thank you for your cooperation in,,this matter and if you
have any further questions, please feel free to contact me.
Very -truly yours,
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Tom Hartung
Chief Building Inspector
TH': psn
MAILING ADDRESS P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
April 31 1986
4'
78-105 CALLE ESTADO LA,:QUINTA, CALIFORNIA 92253 (619) 564-2246
NOTICE OF INTENT TO ISSUE PERMITS
Christopher M. Hayden and Glenn R. Travis
17332 Irvine Blvd., Suite 105 1200 Arizona St., #A-12
Tustin, California 92680 Redlands, CA. 92373
RE: NOTICE OF INTENT TO ISSUE CITY PERMITS FOR BUILDING .'AND
HOUSING CODE COMPLIANCE REPAIRS AT 51-100 AVENIDA
NAVARRO, CITY OF LA QUINTA.:
WHEREAS,,on March 6, 1986, and at times -prior thereto, the Chief
Building.I,nspector of the City has notified Christopher Hayden,
ns)owner of the above described property, of various items of
..substandard construction and safety hazards to occupants of the
above described building and ordered the repair thereof; and
WHEREAS, said required repairs and reconstruction have not been
commenced by the_ owner thereof to this date; and
WHEREAS, City has received a request from John L. Kulander and
Karen E. Kulander, as mortgagees in possession of said property,
through their attorney, Philip S. Klatchko, for. -the issuance of
required City permits to commence the required repairs and
reconstruction to said real property.
NOW, THEREFORE, YOU ARE HEAEBY'ADVISED:
1. Unless valid objections are received in writing on or
before April 15, 1986, it is the intent of the City of
La Quinta to issue necessary permits to John L. and
Karen E. Kulander, as mortgagees in possession, for
the purpose of commencing construction of the
required repairs and reconstruction of the building
located at 51-100 Avenida Navarro, City of La Quinta.
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
Christopher M. Hayden and
Glenn R. Travis
April 3, 1986
Page 2.
2. 'Any objections thereto -must be inwriting'and
addressed to James Longtin, City Attorney ,-
P.O. Box 1504, La Quinta, California, 92253, and
be postmarked no later than April 14, 1986.
Very t my yours,
Longtin
ty Attorney
cc: Philip S. Klatchko
Attorney -at Law
Professional Park, Suite 3
177 South Civic Drive
Palm Springs, California 92262