04-7514 (PLBG)r
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BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760).777-7012
78-495 CALLE TAMPICO • FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . . t04-00-0.0_7.5.14% Date 12/01/04
Property Address . . . . . . 78430 CAMEO DUNES PL
APN: 643-181-017-15 -2043 -
Application description . . . PLUMBING
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 2350
Owner
DUPREE GERALD W
"INGT epe Fib• *18'430 CAIrVD :DuaFs Pc.
I_z1K.AT0 LA leu/A)7, CA IL ��
--------------------------
Permit . . . . .
Additional desc
Permit Fee . . . .
Issue Date . . .
Contractor
----------------- - - - - - -
MAPLE LEAF PLBG HEAT/AIR COND'
P.O. BOX 3563
-?ALM DESERT -CA 92261
�(_� 60) 346-6758
W NC : STATE FUND
046001349204 11/06/05.
uC'SLB: 48139.3 10/21/05
CCC:----C20_C36
--
-�" --- -----------------
18.00 Plan Check Fee 4.50
Valuation 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00
--------------------------------- ---= --------`---------'------'------------
Special Notes and Comments.
RUN 3/4 GAS LINE OFF METER THROUGH
GARAGE TO STOVE TOP IN KITCHEN_
Fee summary Charged Paid. Credited Due "
---------------------------------------------------------
Permit Fee Total 18.00 .00 .00 18.00
Plan Check Total 4.50 ..00 .00 4.50
Grand Total 22.50 .00 .00 22.50
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P.O. Box 1504• �� VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: D *7-5 14 Date: 1.2-1-04
Applicant:
Applicant's Mailing Address: .
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S 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
de, and my License is in full force and effect.
License Class C� GU — G ^. �, 1� tcense No. T
OWNER -BUILDER DECLARATIONr
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License�Law for the follovtidng 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 ttie applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' 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 exerhotibn? 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).):
U 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 safe (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 or 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.).
U 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 contractors) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
WORKERS' 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.
1 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. Myworkers' compensation nce carrier and policy number are:
arrier ST4% F—V-1 , olicy Number AV 4 2 00/ -?* 204/
I cerfify that, in the performance of the work for which this permit issued, I shalinot 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
forthwithcomplywith those provisions. l 1
ate L �� `� plicanl �— l� -0J-X-4'1t -
WARNING:. FAILURE TO SECURE WORKERS' COMPENSATION 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.
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 !�
T'
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 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 county to enter pie above mentioned property for inspection purposes.
Dategnature (Applicant or Agent):
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COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES
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 speculations as indicated on the attached checklist.
A non-refundable filing fee (see below) 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 approval.
%J
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # E �/1�r iP\G 1. Lle"t v
A ent, Contractor, Contact P/erson�-
Phone
Address & Phone
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Phone
•MMailing Addre ss
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State
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Zip
Job Property Address
4`'/30 La,.••o'�JN�es �%
Legal Description Prop. (PM, Tract, Lot)
Lal' /S Hct s��0
Lot Size
A enc"' -11
Use of Permit P/P, CU, etc. '{"� �` ` `-`
Other
/6SXi3zx AN '
f�)
%ge.11inQAH Site Prep, etc. yST pt
Signature of Applicant
Date
CATEGORY: REV CODE FEE
'� CATEGORY: REV CODE FEE
•'b
SUBSURFACE DISPOSAL 1238 "s 4�0
a
" SITE EVALUATION UPON REQUEST 7349 $42.00'
4,
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 st 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
INITIAL DATE [y
Holding Tank Yes Nocf � / L " G " a
Agreements Completed ❑
Certification of Existing S.D. System Required ❑ Yes &ONN�o�
ON
WQCB Clearance required. (Attach Form ❑ Yes M-
DOH SAN 007, Santa Ana Region Only)
r
Soils Percolation Report Required. _ ❑ Yes d
Special Feasibility Boring Report Required. ❑ Yes A d/
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes °
o�
Other ❑ YesPNo
Staff Specialist Lot Inspection Required ❑ Yes
Lot Inspection Date
/� 9 w
4
Soils boring report by . ` • te
Project # DaVZ
Soils Map Page Soil Type Approved by Date
_
No. of Systems
Type of System(s)
No. Dwelling Units( 1) 1
(1) Septic Tank
Soil Rate/Sand
k 1 S7'
/
❑ Holding Tank ❑ Existing
N ❑ Replacement
Bedrooms, Fixture Units
�• 36&L, , 3941-71
G ase Intcp
L I
t
Leach Line Sq. Ft.
Sidewall allowance
Install_ Line(s) ft long ft wide with
Leach d sq. ft.
Bott trench area
ft rock/ sq. ft
min. inches�oc. below drainlines or
of bottom area
per running ft.
NA
Leachlines/bed special design for slope:
(3) Pit Diameter
ADO
No. Pits
Pit Below
Seepages it0 0 Depth
en
Applicable/
/6'
.j¢^
Inlet (BI)
N/A Overburden factor
931`B
�
.r SE P/F.
�/� XI ST.
/
(li
Max. Allowable I� epth
�( D
No. 2 System N11
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This applicatio PPROVED Eg11�D'for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
(1) Septic tank and sewer lines must be 50' minimum from any wells
Leach lines must be 100' minimum from any wells, including expansion area
Seepage be 1.50' from including F ✓'@� �G��P lis-�L.�a�
(3 pits must minimum an -wells, expansion area
Signature of Health Official_��f.wG� K /ro/d Date-/9O'o7'
RECEIPT NO. Issued By " Date
DISTRICT: ❑ Riverside, C9eo Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
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Coffam lal BuRdins connection to Sa►Mer
a�vltru=�fng Peal J
NO 0*09 regmw a#tt.3lMtY ing wa±fr Wftizlrsa dtvi"- r ;y t-,e (A5Cftrdr:d into the lnd:viduai Ww� diapcaaf
aw,e A here'mb #ptlrrrw�i L'-ifc:uC!" C':'+ ' {:C `':_ :ti "r;: ! :aiR: O11tr�7i
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�C— Any cuMap, liradd� or V17n,1 in fcor. j»} i<yi ►ttE r i+'; �►'! .� :!I .^�taf.■
d rposbE Approvaihass reta� s isbtafn td tron: ii a a n,►al 4�-�i ,9: t o+SU'Jii_pw1rd 'y[the
This is to Csrtiiy that':tt*il ►imFda County DwrtUMt 0 PUM; 1�!M '
Installation the it atwre. 3 «. � � °��°^"`ss�for'+ ; pn;!clQn, )r
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IR}111YTnIf i IW/7f"r SUFr*w"Y :;iri1� M�`i . ?L !ii! N. FRGM MY .WULL-
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DE RTMEN f • Or. PUBLIC HEA , HadW of Blverai[tg �Oun oes nat relieve the TOx :.
ct AmUteai tb6 7respdjWb q for thv•aes1mru
IS VALID FOR •ONE-(�)
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