14-0255 (PLBG)t `P.O--90X 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
14-00000255
Property Address:
49796 COACHELLA DR
APN:
646-240-007- -
Application description:
PLUMBING ,
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
9800
Applica
Tii�v 4 4 Q"
Architect o Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
Owner:
TOM BRASFIELD
49796 COACHELLA
LA QUINTA, CA 9
(
Contractor:
HAMMER PUMPING
P.O. BOX 2448
CATHEDRAL CITY,
(760)321-7448
T4 No.: 661010
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/10/14
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ENS CONTRACTOR'S DECLARATION
y
r
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of jury that 1 am li 'under rovisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000 of Division 3 o he Business nd of ssionals C e, 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 lass• C42 C36 Lic se No.: 661018
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: c Contr tor:
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 perjury that I am exempt from the Contractor's State License Law for the
Carrier NATIONAL UNION Policy Nu ber 910606
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the orman a of the wor for which this permit is issued, 1 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 anner so as o ecom ubject to t orkers' 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
nd agree t t, if I should c e s ject to the wor 'compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 if t Labor Code, shy I hwith comply w' h thos visions.
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 1$5001.:
"Date f App cant:
(_ 1 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
WARNING: AILURE TO SE WOR RS' 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 CRIMINAL 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 ADDITION 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.).
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
of La Quinta, its officers, agents and employees for any act or o sion related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this ppplf-110-Tan,
anon comes null nd void if w .k'' not commenced
within 180 days from date of issu5nce of such pe lt, or ssatio work f r 180 days will subject
permit to cancellation.
I certify that I have read this application and/state that the ab ormation is correc . ree to comply with all
city andoun ordinances and state laws relating to buil in � struction, and her y autho representatives
of this c unt to enter upon the above-mentioned inspection purp s.
Date: �� Signature (Applicant or At�ewtT: A
t � S
LQPERMIT
Application Number . . . . . 14-00000255
Permit . . . PLUMBING 2013
Additional desc .
Permit Fee . . 11.92 Plan Check Fee .00
Issue Date Valuation . . . . 0
Expiration Date 9/06/14
Qty Unit Charge Per Extension
1.00 11.9200 EA PLBG SEPTIC SYSTEM 11.92
----------------------------------------------------------------------------
Special Notes and Comments
ADDING NEW SEEPAGE PIT ABADONING CURRENT
PIT THAT WAS MSDE OF BRICKS APPREOVED
PER A.J.2013 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
PERMIT ISSUANCE M/P/E 90.57
PLAN CHECK, PLUMBING 4.77
Fee summary Charged Paid Credited Due
Permit Fee Total 11.92 .00 .00 11.92
Plan Check Total .00 .00 .00 .00
Other Fee Total 96.34 .00 .00 96.34
Grand Total 108.26 .00 .00 108.26
Bin #
City Of La QUihta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name 1 — �C�.S-F't��'�
A. P. Number:
Address: L— --j j G C d p�{t,-�e-(rLA
Legal Description:
City, ST, Zip: �—A QU t , Az
Contractor:
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Telephone: ' ��
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Address: 0 _ '� LtO
Project Description:
City, ST, Zi A L Q 1 TL
Tele hone:
'�: •:f:
State Lie. # :
City Lie. #..
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Arch., Engr., Designer:
A��jQ��
Address:
City., ST, Zip:
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TelephonerConstru
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ti n Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
c�
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance, .
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan ,
Plans resubmitted
Mechanical
Grading plate
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Dccd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Sclio6l Fees
Total Permit Fees
r—
DUARTMENT OF ENVIRONMENTAL MALTH
Food l000 Gallon Septic Tok &--5-7
Park. — Sq. Ft. of Leach Line
-Y- Noy( .Dia --63l-93ni6—MD-L1—"
._.._.._.Connection to Sewer
P001 Connect to Existing S. S. D. S.
1L 1v,, w x1Cr sUIttlnrnt dt;-: es may be discharged into the individual sewage dispo*4'
W "tum the Water Quality Control Board.
SySter.,j jjerCW,Lk, W,..!IUUL Cll'al=C
st, 11 -requiremems of current Uniform Plumbing Coda
.wlip alsp�,
Mon must conform with
in arca ot, It"hing system may nullify sewage disposal approval.
Quality Control Board for installation of the
_,._Approves:1 has 'Goof. obtwl -C tj om the Regional Water
fiewup &pvad; �Ystcm.-
L4
DAM
r
P,
120 WA
7:>
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AL 17j
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D
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DUARTMENT OF ENVIRONMENTAL MALTH
Food l000 Gallon Septic Tok &--5-7
Park. — Sq. Ft. of Leach Line
-Y- Noy( .Dia --63l-93ni6—MD-L1—"
._.._.._.Connection to Sewer
P001 Connect to Existing S. S. D. S.
1L 1v,, w x1Cr sUIttlnrnt dt;-: es may be discharged into the individual sewage dispo*4'
W "tum the Water Quality Control Board.
SySter.,j jjerCW,Lk, W,..!IUUL Cll'al=C
st, 11 -requiremems of current Uniform Plumbing Coda
.wlip alsp�,
Mon must conform with
in arca ot, It"hing system may nullify sewage disposal approval.
Quality Control Board for installation of the
_,._Approves:1 has 'Goof. obtwl -C tj om the Regional Water
fiewup &pvad; �Ystcm.-
L4
DAM
r
P,
120 WA
7:>
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RIVERSPEA-7PY-MDIO FACILITY "7
DEPT OF ENYIROHMENTAL',HEALTH .,COUNTY. OF RIVERSIDE -COMMUNITY -HEALTH AGENCY
47950; ARABIA'. ST','.STE#.A
EPARTMENT'.OF ENVIRONMENTAL HEALTH
C
7;
T
C
C
TR/PM Lot No. APN: S OR'S PARCEL NUMBER
1. 4q 3
-LIGATION 14 7 1. 41-(o ?4q -00 4
3/10/2014 000001 ON# IN#
816 2:43.PM ERIKA0003 EHS # -)7
C) 105
20801i;-� $600-00 R_116g�va�m�
N
2210 $12.00 ADDR[;.qS TELEPHONE #
-
#
1ANGE $0.00 49_796 Q *C ( 6LLA 'DZ-
LrArCLOlf-4-ot' CITY Thomas Brothers Map #
/( (/1 .,Co �xz. L LAajtVJ �
LOT SIZE
WATER AGENCY/WELL USE OF PERMIT
_.w frK✓ ,v
FINANCIAL RESPONSIBILITY
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
-subject
applic6nt ',named ih'Section B will be 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).
ROP Fees: For Alternate Systems, renewable operating permit (ROP) fees will be due upon finalization of the project. ROP fees will be issued to the project owner or applicant
named in Section B.
SEND ALL BILLING MATTERS TO THE CLIENT OR ENTITY LISTED BELOW:
RES 0N LE CLIENP/ ENTITY NAME
AILING ADDRESS CITY/STATE -ZIP
TELEPHONE #
Qk
:3 (ov Lq L4
pplicant ig atur
Date:
A 6/ 44
Below - For Office Use Only
CHECK BOX IF REQUIRED
If any box is checked, this application be considered rejected until the information is provided and the fees paid. Re -submittals later than 90 days
-shall
after date noted below may require repayment of fees.
El Holding Tank Agreements Required
0 Floor Plan and/or Plumbing Layout Required
El Certificate of Existing OWTS Required
0 Special Feasibility Boring Report Required
El WQCB Clearance Required
El Detailed Contour Plot Plan Required (1 to 5 foot intervals)
0 Soils Percolation Report Required
PRE SITE INSPECTION REMARKS. INITIALS & DATES
10/* 2 0 4
P. 0 le k LT A GA /_T 44-1 f I T 00-/V 0 Y A 4-W
Pt -64-, Fft-L / 11- W11 CGrAr olo-,oq-71: 11 (,A- L, riA-ISTI*" A"e- I,, G 5e IT.
r 1-i N4 0 ,ilk 4 4 4- d. I K.5 0e C4 I d' K 171,
Soils Percolation/Boring report by
Project #
Date : 4111101-;xL 6 1
Type of System: 0 NewZeplacement El Existing
NR
# Fixture units
Septic tank Cgp*.11�'-�_"
..
I Soil Rate
0 Pump 0 Addition 0 ATU C1 Connect to Sewer
# Bdrms
1.-Hg4Crr
000
Sq. Ft. Bottom Area
Total Linear Ft.
Sidewall allowance ft Rock/ Sq ft running foot.
Tested Depth
Maximum Trench Depth
Install Lines ft long ft wide with min. inches rock below drain line, or El Plastic Chambers
Leach Lines/bed special design for slope Applicable 0 N/A 0 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
S E&ION 1 E I Pm. t; ��z
This Appl'icati6n is KApproved 0 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.
No construction is permitted in the required reserved 100% Expansion area.
(1) 'Septic tank must be 160' minimum from any wells.
Leach lines must be 100' minimum from any wells including expansion area.
(3) .'Sew6r lines must be 60'minimum from any wells.
<ZD Seepage pits must be 159' minimum from any wells including expansion areas.
EHS S' natur -Tate:
Environmental Resources Ma agement Office Locations
Environmental Health - ERM Division
Environmental Health - ERM Division
Riverside Permit Assistance Center
Palm Desert Permit Assistance Center
4080 Lemon Street, 2nd Floor
38686 El Cerrito Road
Riverside, CA 92501
fPALM
Palm Desert, CA 92211
RIVERSIDE (951) 955.8980
DESERT (760) 393-3390 1
nrw.qAm.1,2,) P.,,. lino