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13-1105 (PLBG)L�. P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00001105 Property Address: 78237 SAN TIMOTEO ST APN: 646 -160 -015 - Application description: PLUMBING Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 7000 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 fcommencing with Section 7000) of Division 3 of the Business and Professionals Code, and my.License is in full force and effect. License Class: C21 C42 y� License No.: 4822180 fDate: .-S ' Co� ctor. C O e� U T1 V OWNER -BUILDER DECLARATION 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 fo"r 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).: (_) 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 fSec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, avid 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.). (_ 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 contractorls) licensed pursuant to the Contractors' State License Law.l. (_) 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 !- VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: SUZIE BURK 78237 SAN TIMOTEO LA QUINTA,•CA 92253 Contractor: ALMS UNDERGROUND CONST, 38703.VISTA DRIVE CATHEDRAL CITY, CA 92234 (760)324-1911 Lic. No.: 482180 Date: 9/05/13 D r SEP 05 2013 CI'T'Y OF LA QUINTA _ FINANCE DEPT. .. WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1have 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 BARRET BUS SRVC Policy Number 2246 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 1 should become subject to the workers' compensation provisions of Section 37700 of the Labor Code, I shall forthwith comply with those provisions. ,Date:'Appl�i a 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. - 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 1 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 upon the above-mentioned property for inspection purposes. Da � Sigriature (Appilicant or Agent): ��l l J / //• Application Number . . . . . 13-00001105 Permit PLUMBING 2013 Additional desc . Permit Fee 23.84 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 3/04/14 : Qty Unit Charge Per Extension 2.00• 11.9200 EA PLBG SEPTIC SYSTEM 23.84 Special Notes ,and Comments SEPTIC DISPOSAL - INSTALL (2) 6 FT. X 16 FT. SEEPAGE PITS IN ACCORDANCE WITH ATTACHED COUNTY OF RIVERSIDE DEPARTMENT OF ENVIRONMENTAL HEALTH APPROVED LAND USE APPLICATION. 2010 CALIFORNIA BUILDING CODES. ---------------- -- -- Other Fees _. . BLDG STDS ADMIN (SB1473) '1.00 PERMIT ISSUANCE M/P/E 90.57 Fee summary. Charged. Paid Credited Due Permit Fee Total 23.84 .00 .00 23.84 - Plan Check Total .00 ..00 .00 .00 Other Fee Total 91.57 .00 .00 91.57 Grand Total 115.41 00 .00 -. 115.41 LQPERMIT Bin # City of La Quinta Building &r 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: A. P. Number: Address: 2 Legal Description: City, ST, Zip: A. AUL (:k4:iY:isv:C'^::';':;�{.ini:ijj:.i:;:: v. $ vjj::,.'•?'moi r i::' :.::::_: .`.!!:!. Contractor. © Telephone: :;>.;;::.;;;::;::>,:«:;:• Address: Project Description:pA0rp ' ` / `e_)Z City, ST, Zip: C E L('7'4y Telephone: r _> 4 e- � State Lic. #: L% aCity Lic. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone:iiii : ; :;;::,:;;;::.;;;•:e:.; : •>:.::..;v Consdvction Type: Occupancy: ..........::'��circle one : NewAdd n Alter Repair Demo State Lic. aine of Contact Person: Sq. Ft.:. # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: • Q APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd 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 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2". Review, ready for correclionsliissue Electrical Subcontactor List Called Contact Person Plumbing .Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- 'nd Review, ready for corrections(ssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees J aiFi+'.'.�,rYo r k1 ` ¢ tif. k �' ,� 'T a'�x�idd� i " !. , «•q�ii i 1' t �'.f� t Page 1 of 1 r � + � t f ;;r' t ' �,• { ,• � t r j ��M �r �! .lc,,� ��; Gt •F� 4�r� �, j# s.�1• e �%' � "" �.• ? ' ` � 9 r11 Qgti.r,� W TD11OTE0 g R 1 t tx 4 e • F �. •�;�'` iii f P.- � 5 �,� x h ,! � � �� �4 t �i _ • '� � i i+'• ♦ r. Nal' - M s • 7 i �J La� d 1 '�" rr a r r v k , e F verS"d Caurnt9.► TLMA iS s .. .1 ,.. ° Rf rYA f. ` .•i is `.ti ..�,'`t f r { f t•{,yQS' �, y, . x` + a _ �',-4 r ,.. } r^ ,ta k{7�. Zf�a Y, r'i. �'•Y + .4 d,r','. �•t . ` C. �� ., 3 13� •' fI 1 )4 ^S/ , �, +. .` � w j� � ,y. � '"� ,{� a � G.[ - �+�f I �.," ai♦f � i ya. '."� �.. �y ., r !r .�� ra � }w. 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F . • , fijaF, .. 3 - rP' "h. �! ..- e; +f li.. �X,! iJ';.'Gi°x ' k' '1 • •'• e • . {rf ' t f! .,. :f Y b 3 �+�' 7.1,.! { . y,., ' htti)://www3.tlma.6o.iiverside.cd.u§/outDut/rclis-bub arteinis5168121921080.JPG'�',k.- •• 9/4/2013-T`: COUNTY OF RIVERSIDE • COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH TR/PM Lot No. APN: ASSESSOR'S PARCEL NUMBER LAND USE APPLICATION oN# IN# LMS# EHS # 1DO 47 31 1 AGENT, CONTRACTOR ADDRESS CITY/STATE/ZIP TELEPHONE # At // llsUJJ tJ(a11J _3� 70i j1� �G -3 er .,,9:z73i% Q OWNER CITY / STATE./ ZIP ADDRESS CITY/ TELEPHONE # Z O ���2F C �:�^!� -- 1 -�R -% � 7 J.�11•, � •Ir�of!".> ,�.ul-1.1�1'1,e`.� �G . V JOB PROPERTY ADDRESS CITY % STATE / ZIP ` Thomas Brothers © Map # 78Z37,-78'233) cWn LOT SIZE WATER AGENCY/WELL USE OF PERMIT V W See (D:Xcc- i) t5 * FINANCIAL RESPONSIBILITY * • .J ) 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). ' m 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 Z applicant named. in Section B. t'; 0 4,•� :I`, SEND ALL BILLING MATTERS TO THE CLIENT OR ENTITY LISTED BELOW: })'; Vin' 7, dflpri RESPONSIBLE CLIENT / /ENTITY NAME / W MAILING ADDRESS y ((� CITY / 1STA{jTE / ZIP (� (� / I TEL:EPP'H�ON(�E # S 1, l � 1 �+:). . `` ..R I c. �/1 i'H.) ' `�. AZ �l7 Zw : 7u.U2... ! Applicant Si n lure: Date: Z 3- CHECK r' 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. C� ❑ Holding Tank Agreements Required ❑ Floor Plan and/or Plumbing Layout Required Z O El Certificate of Existing OWTS Required ❑ Special Feasibility Boring Report Required ❑ WQCB Clearance Required ❑ Detailed Contour Plot Plan Required (1 to 5 foot intervals) U W ❑ Soils Percolation Report Required U) PRE SITE INSPECTION REMARKS INITIALS & DATES /'huv� b rtAA pry -wc 1e /(rt 5 - > kr 5 w/ IiT hiE5 *-r .fsr T 'we VIti. ST .. - xr.0 trs P t7)-A.dL 1: 1C(c P 17 t -t r- C�rCl�t rt' C 1-1 % U F t DO Soils Percolation / Boring report by Project # . _T Date Type of System: ❑ New ❑Replacement ❑Existing # Fixture units Septic tank Cap. Soil Rate ❑Pump ® Addition ❑ ATU ❑Connect to Sewer # Bdrms G U1= xr ITIN( Sq. Ft. Bottom Area Total Linear Ft. Sidewall allowance ft Rock/ sq ft running foot. Tested Depth Maximum Trench Depth O Z O Install Lines ft long ft wide with min. inches rock below drain line, or ❑ Plastic Chambers U W Leach Lines / bedspecial design for slope A licable C1 N/A 13 Overburden Factor: Pit Diameter / 6 No. Pits Pit below Inlet (BI) Pit Total Depth Max Allowable Depth Well Review Approved by: (Signature) CONSTRUCTION / INSTALLATION INITIALS & DATES This Application is E Approved []Den led 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 11, Septic tank must be 100' minimum from any wells. O (2) Leach lines must be 100' minimum from any wells including expansion area. U(3) Sewer lines must be 50' minimum from any wells. W U) ) Seepage pits must be 150' minimum from any wells including expansion areas. EHS Sign1re: Date: Environmental Resources Management Office Locations ,5i onmental Health — ERM Division Environmental Health — ERM Division Environmental Health — ERM Division erside Permit Assistance Center Palm Desert Permit Assistance Center South County Permit Assistance Center 01 4080 Lemon Street, 2nd 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 -.,) V 'A I,'% - 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:' :Z 7 A iti 2013 7a237 (Property Address) (Owner's Name) L L_f-PlTef *I- LoT tS (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 requiredplotplan. 3. a. I examined the existing subsurface sewage disposal system at the above location on (date) 2 -7 Au :Z Q V3 date and determined that the septic tank capacity is L500 gallons and that there is Q sq. ft. of leachline bottom area. There are Al 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 seepage pit(s), each 41 in diameter, 1/0 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): aconcrete ❑ fiberglass ❑ steel C] other: b. Internal dimensions ofseptic (length ft., width depth s ft.) c. Condition of tank (please answer yes or no for each question): Yes No Inlet Tee present? Outlet Tee p1re-sent?.' 4. Two compartments? Tank structure' deteri6r6a t&d?*' *If yes, briefly explain and indicate appropriate correction suggested: d. Condition of D -Box (if needed) Level 0 Yes (j No replaced Lj Yes a No full of septic,effluent (j Yes Q No IVA 5. a. While pumping the tank, did effluent flow back into tank from the absorption system? ❑ Yes @/No b. Prior to pumping, was the liquid level in the tank above the outlet tee? Q -Yes ErNo c. Was the area around the lids oxidized? (j Yes 0-N'o d. li'design of system gravity feed? Ca`Yes (j No e. Were well(s) observed on this or adjacent property? El Yes @'No If yes, indicate distance of well from: Septic Tank Leachlines Seepage Pits ft. f. Distance from springs, lakes Septic Tank ft. and natural drainage courses: Leachlines (circle appropriate item) Seepage Pits g. Sewer is within 200 ft. of system and abuts property line. EJ Yes Cq/No ADDITIONAL COMMENTS: . Ir -�TZ: h. How long has dwelling been vacant? (3 applicable) 2 months - weeks N/A Q 6a. Q It is my opinion.that the system appears to be in good working order and,ca'n be expected to function properly with proper maintenance. No repairs are necessary'at this time. 6b. Ii is, my opinion thiat the system.is not in good working order and will not function properly without.the following repairs: 7 L I certify under penalty of,0erjury that .thp foregoingis'true,ard correct Z Igo" 0 J� Tignature C42 State License Number- Expir 3, fto a, Print Name. Name of Pumper Company and'Receipt.Nuimber/Name p - f Company H61ding C-42 License 3 Addres ,�Phone Number 'Ma.1- The De aArt rn of t f Eir on en I Health has reviewed and approved 'this, tertifidati6n-.7. Enviro ntal Health Special Date F DEH- 884 (Rev 6/04) Distribution: WHITEL04ice; PINK-dontractor;-YELLOW-Applicant t y v rr. i i v r na v QIWJIJ= raa+na+a a -a e y DEPARTMENT OF ENVIRONMENTAL HMM. Food 15: IV Gallon Septic Tok>✓ s -r s Trailer Park Sq. Ft. of Leach Line - e Dwelling X Commercial Connection to Sewer Swimming Pool Connect to Existing S. S. D. S. �c No on-site'regenerating water softening devices may be discharged into the individual sewage dispo"i system herewith approved without clearance from the Water Quality Control Board T All sewage disposal installation must conform with requirements of current Uniform Plumbing Coda �Apy cutting, grading or filling in area of leaching system may nullify sewage disposal approval Approval has been obtained from the Regional Water Quality Control Board for installation of the sewage disposal system. 1,4 �<o J . OV I C ILL Q M �. \ M LL! z cc . C7ww \ • \` _j LL Zpa• XwLL, Q LL CL Q W co a< c Ll! 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