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12-0140 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:00000140 Property Address: 49787 COACHELLA DR APN: 646-240-009- - Application description: PLUMBING Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6800 T-4u4t 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: PRINCE ANNE M 49787 COACHELLA DRIVE LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/15/12 Applicant: Architect or Engineer: Contractor: t *t! _ ROTO ROOTER PLUMBERS ^• ,10), 2141 INDUSTRIAL COURT #" " �. I VISTA, CA 92081 (760) 598-4292 J - E Al2 I• Lic. No.. 4221557 1 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Pirplessionals Code, and my License is in full force and effect. _ .I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: A B C36 (74 License No.: 422155 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is 11_issued. ate--�s , tractor: 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of pe ry that I am exempt from the Contractor's State License Law for the Carrier GUARD INS Policy Number ROWCW234997 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of he work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to ecome subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should b ome subject to the workers' compensation provisions of Section License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the Labor Code, all forthwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: cant: Date: �� ��'��TO ( 1 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 and Professions Code: The WARNING: ,FAIL ECUORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN A DITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). 1 _ 1 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.). 1 _ 1 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: LQPERMIT APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 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 act or 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 statethat the abo information is correct. I agree to comply with all city and county ordinances and state laws relating to buildin ___.ruction, and hereby authorize representatives of .his county to enter upon the above-mentioned prope or inspection purposes. Date, f ignature (Applicant or Agentl: Application Number . . . . . 12-00000140 Permit . . . .PLUMBING Additional .desc . Permit Fee . . . . 37.50 Plan Check•Fee 9.38 Issue Date . . . . Valuation 0 Expiration Date 8/13/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 22.5000 EA PLB CESSPOOL 22.50. ---------------------------------------------------------------------------- Special Notes and Comments INSTALL 14'.X 6' SEEPAGE PIT. 2010 CODES. ----------------------------------------------------------------------=----- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ------------=---- Charged Paid Credited- Due. Permit Fee Total ----------------------=------------------ 37.50 00 .00 37.50 Plan Check Total 9.38 .'00 .00 9.38 Other Fee Total 1.00 .00 .00 1.00 Grand Total 47.88 .00 .00 47.88 LQPERMIT uacty 4 4�' LA �/ c� CITY OF QUINTA. �(�pPoS-�� 1`�� —• O 7 co �Q DIY?SBUILDING & SAFETY DEPT. Co 'c'. X C( q , n rc( cit APPROVED . nn ,..FORiG�NSTRUCTIGN 3 X C �° P I 1 DAT" �::7 I!`/-j,Y t .Fcp I F- 9'�,i c) r) �4 w o O O .a �. too —{ Li l-12 1 C5 0 r <'¢a Qq��' ��c)c of hoase C- `r ci y • ,I COUNTY OF RIVERSIDE - COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH I DEH -SAN -122 Rev: 11/07 Distribution: WHITE - Office file; YELLOW - Applicant; PINK - Bldg. Dept.; GOLDENROD - Plans/Records TR/PM Lot No. APN: ASSESSOR'S PARCEL NUMBER ).- 3 y L4G -2-10 - 6 U LAND USE APPLICATION ON# IN# LMS# EHS # AGENT, CONTRACTOR ADDRESSCITY / STATE / ZIP TELEPHONE # 1/11' 9 ( :r-Nclu S7A 1. T, U(5 TO C 9708 Q OWNER ADDRESS CITY / STATE / ZIP TELEPHONE # Z 2 - �SYJAW l4qW7 o c f c a y 3 -P I— JOB PROPERTY ADDRESS CITY / STATE / ZIP Thomas Brothers © Map # U co 7g n R S LOT SIZE WATER AGENCY/WELL USE O PERMIT rr L' P I T FINANCIAL RESPONSIBIL TY' NOTE: Pertaining to Deposit -Based fee Payments - Fees placed on deposit are intended to pay for System review including approval and installation. The project owner or applicant named in Section B will be subject to billing requests for additional monies should fees deposited to that point be insufficient. At final approval, the project owner or applicant named will receive a final statement and notice of any final fees due or refunds due (as applicable). CO ROP Fees: For Alternate Systems, renewable operating permit (ROP) fees will be due upon finalization of the proj1etd f0P. fletwillabe issue to- a project owner_or_ wr ` ' i 1,11_ Z applicant named in Section B. �`- y'-1 . O T. SEND ALL BILLING MATTERS TO THE CLIENT OR ENTITY LISTED BELOW: 0 RESPONS113LE CLIENT / ENTITY NAME N MAILING ADDRESS CITY / STATE / ZIP TELEPHONE # .s Applicant Signature: Date: Below — For Office Use Only CHECK BOX IF REQUIRED If any box is checked, this application shall be considered rejected until the information is provided and the fees paid. Re -submittals later than 90 days after date noted below may require repayment of fees. U ❑ Holding Tank Agreements Required ❑ Floor Plan and/or Plumbing Layout Required Z O ❑ Certificate of Existing OWTS Required ❑ Special Feasibility Boring Report Required F. ❑ WQCB Clearance Required ❑ Detailed Contour Plot Plan Required (1 to 5 foot intervals) W W .❑ Soils Percolation Report Required U) PRE SITE INSPECTION REMARKS INITIALS & DATES S`T, C n, joil 6 X 1 `( /k D/eh Ir'f X )T1rs! l°T .&v f h<-- 5 1, 11-1 "T (I is E jJorG N rf LC y V_ t I -X L -1 o i) Ile, r e'k IF a r C �1 g 7' C t -t `( L�4 Soils Percolation / Boring report by Project # Date Type of System: ❑ New ❑Replacement ❑Existing # Fixture units Septic tank Cap. Soil Rate ❑Pump ❑ Addition ❑ ATU ❑Connect to Sewer # Bdrms Sq. Ft. Bottom Area Total Linear Ft. Sidewall allowance ft Rock/ sq ft running foot. Tested Depth Maximum Trench Depth D Z O Install Lines) ft long ft wide with min. inches rock below drain line, or ❑ Plastic Chambers V • W N Leach Lines / bedspecial design for slope A licable ❑ N/A ❑ Overburden Factor: Pit Diameter No. Pits Pit below Inlet(BI)Pit Total Depth Max Allowable Depth , Well Review Approved by:' (Signature) CONSTRUCTION / INSTALLATION INITIALS & DATES This Application is O Approved ❑ Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth in Section D above. A building permit is necessary for the construction of the above designed system. W No construction Is permitted in the required reserved 100% Expansion area. Z (1) Septic tank must be 100' minimum from any wells. O (2) Leach lines must be 100' minimum from any wells including expansion area. I— V (3) Sewer lines must be 50' minimum from any wells. W to (4) Seepage pits must be 150' minimum from any wells including expansion areas. EHS Signal: e: Date: 1 S h Environmental Resources Management Office Locations E j nmental Health - ERM Division Environmental Health - ERM Division Environmental Health - ERM Division Gerside Permit Assistance Center Palm Desert Permit Assistance Center South County Permit Assistance Center 4080 Lemon Street, 2nO Floor 38686 EI Cerrito Road 39493 Los Alamos Riverside, CA 92501 Palm Desert, CA 92211 Murrieta, CA 92562 RIVERSIDE 951 955-8980 PALM DESERT 760 393-3390 MURRIETA 951 600-6180 I DEH -SAN -122 Rev: 11/07 Distribution: WHITE - Office file; YELLOW - Applicant; PINK - Bldg. Dept.; GOLDENROD - Plans/Records County of Riverside Community Health Agency Department of Environmental Health 4080 Lemon Street, 2nd Floor P.O. Box 1206 Riverside, CA 92502 (951) 955-8980 1. Certification of Existing Subsurface Sewage Disposal System. Date of Inspection: i u d 1{ i .lr ; 6 i a A4 (Property Address) (Owner's Name) (Legal Description and APN) FAILURE-TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT OWNER FROM OBTAINING ENVIRONMENTAL HEALTH SERVICES APPROVAL. 2. Show design and location on a scale of 1" = 10' to 1" = 40' of the sewage disposal system and 100% expansion area in relation to attached dwellings, structures, wells, rocks, watercourses, etc. on required plot plan. 3. a. I examined the existing subsurface sewage disposal system at the above location on (date) date and determined that the septic tank capacity is gallons and that there is sq. ft. of leachline bottom area. There are bedrooms in the dwelling. There are fixture units. b. There are leachline(s), each ft. long. c. There are plastic chamber(s), each ft. long. d. There are J seepage pit(s), each 1. in diameter, C < ft. deep. e. The leach bed is ft. by ft., total sq. ft. of leachbed area. 4. ` a. Construction of septic tank (please check one of the following): `]'concrete ❑ fiberglass ❑ steel ❑ other: b. Internal dimensions ofseptic (length eft., width F:--> depth e ft.) c.. Condition of tank (please answer yes or°no for each question): Yes No Inlet Tee present?`❑ Outlet Tee present? ❑> ❑ Two compartments? U.- ❑ Tank structure deteriorated?* ❑ *If yes, briefly explain and indicate appropriate correction suggested: d. Condition of D-Box (if needed) Level ❑ Yes ❑ No replaced ❑ Yes ❑ No full of septic effluent ❑ Yes ❑ No 5. a. While pumping the tank, did effluent flow back into tank from the absorption system? ❑ Yes 0°°N"6 b. Prior to pumping, was the liquid level in the tank above the outlet tee? ❑ Yes ❑ No c. Was the area around the lids oxidized? ❑ Yes ❑---No d. Is design of system gravity feed? O�Yes ❑ No e. Were well(s) observed on this or adjacent property? ❑ Yes e �No If yes, indicate distance of well from: Septic Tank ft. Leachlines ft. Seepage Pits ft. f. Distance from springs, lakes Septic Tank ft. and natural drainage courses: Leachlines ft. (circle appropriate item) Seepage Pits ft. g. Sewer is within 200 ft. of system and abuts property line. ❑ Yes C3,No ADDITIONAL COMMENTS: h. How long has dwelling been vacant? (if applicable) months weeks N/A ❑ 6a. ❑ 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. 6b]_ It is my opinion that the system is not in good working order and will not function properly without the following repairs: d !j %i I certify, under penalty of perjury that the foregoing is true and correct: gnature C-42 State License Number Expiration Date i Print Name Name of Pumper Company and Receipt Number/Name of Company Holding C-42 License Address _ Phone Number The Department of Environmental Health has reviewed and approved this certification: Environmental Health SpecialistY Date DEH-SAN-18,.4" (Rev 6/04) Distribution: WHITE—Office; PINK—Contractor; YELLOW—Applicant Sin.# �1t}/ of'. Qg11�1tc�::: .. ' Building &r Safety. Division .' Box 1504, 78-495 Calle Tampico. ' La.Quinta, CA 92253 - (760) 777-7072 ! Building Permit Application and Tracking Sheet Permit #P.O. d . Project Address: N o Owner's Name:. a R t n A. P. Number. Address: o c Legal Description: Contractor. City; ST, Zip: . ^^ K C,K ^_ Telephone: r• !: Address:l Project Description: City, ST, Zip: v C S -7-4 el c, Telephone: City Lie. #; State Lic. # : Arch., Engr., Designer Address: City., ST, Zip: Telephoner r' : , .� ; ' ° State Lic. #:,rc Name of Contact Perso L22,S Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: 18,0 Q �— APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cale$. Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance. Title 24 COCO'. Pians picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan V Review, ready for correctionstiissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Pians picked up S.M.L. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- 3' Review, ready for eorrectionsfissue Developer Impact Fee Planning Approval. Called Contact Person A.LP.P. Pub. Wks. Appr ' Date of permit issue School Fees Total Permit Fees