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11-0523 (PLBG)P.O.-,BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 1-1-00000523.___�� Property Address: 80130 PALM CIRCLE DR APN: 649-090-022-11 -4518 - Application description: PLUMBING Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 4200 BUILDING & SAFETY -DEPARTMENT BUILDING PERMIT Owner: GROUNDWORKS OF PALM BEACH CTY 8140 93RD `LA S � BOYNTON BEACH, FL 72 . /r''`1 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 MAY 20 2011 Date: 5/19/11 ' LQPERMIT Contractor: I' 1 Applicant: Architect or Engineer: ROTO ROOTER PLUMBE S CITY AF 3.A QUINTA 2141 INDUSTRIAL CO RT #D - FI;�If�A;.^,r t°�pT. VISTA, CA 92081• (760) 598-4292 Ip11- Lio. No.: 422155,. ------------------------------------------------------------------------------------------------- - LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that 1 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 Professionals Code, and my License is in full force and'effecf._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: A B C36 C4 License No.: 422155 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is _ /ate• ntractor• 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 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 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 the 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 become 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 become 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, 1 shall 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).: ate: Applicant, 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: FAILURE TO SECURE WORKERS' 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 contractor(s) 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 _ 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 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. Date: Owner: - 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 CONSTRUCTION LENDING AGENCY . permit to cancellation. ' I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the 1 certify that I have read this application and state that the above information is correct. I agree to comply with all, work for which this permit is issued (Sec. 3097, Civ. C.): - 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 i ection pur ;poses. Lender's Name: ! I , A_ -ate: C�-11 Si um ('Applicant or Agent): Lender's Address: ' LQPERMIT Application Number . . . 11-00000523 Permit PLUMBING Additional desc . - Permit Fee 60.00 Plan Check Fee 15.00 Issue Date . . . Valuation 0 - Expiration Date 11/15/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00• -45.0000 EA PLB.SEPTIC 45.00. -------- Special Notes and Comments ABANDON OLD SEEPAGE.PIT & INSTALL NEW 14' SEEPAGE PIT. 2010 CODES. ----------------.------------------------------------------------------------ Other Fees -.BLDG STDS ADMIN.(SB14,73) '1.00 Fee summary Charged Paid Credited Due Permit Fee Total 60.00 .00 .00 60.00 Plan Check Total- 15.00 .00 .00 15.00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 76.00 .00 .00 76.00 LQPERMIT Cl t i .®F LA QUINTB'1 .BUILDING & SAFETYDEPT. APPROVED FOR CONSTRUCTION DATF� " I BY G A 1 t `p� u c 1 t 01IR AGEt`�`: or, Rfi r r N ALT..i ... ASL j{F RLTH T .rik ye S r c N (UVU ' �lry 5�1C a ;4 l 1'? " _ �.r D S • ..,,..,._.,�.:C1.rh o•tt:'%! f- ,7, ,i. i, T'tilSfi+a?..5. sl r 1 t BY `��� COUNTY OF RIVERSIDE • COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH 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 LAND USE APPLICATION N5 I UD ON# IN# LMS# EHS # t ! t l AGENT, CONTRACTOR ADDRESS CITY / STATE / ZIP �'! TELEPHONE # sC �'C`n �.a'ir� ✓. ,c,i, - f cjr M (i Ta ,� n �3 1.0 - Q ' O�WNER ADDRESS CITY / STATE-/ ZIP ' TELEPHONE # F- -JOB PROPERTY ADDRESS ' CITY / STATE-/ ZIP Thomas Brothers © Map # fW LOT SIZE WATER AGENCY/WELL USE OF PERMIT r * 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 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. O SEND ALL BILLING MATTERS TO THE CLIENT OR ENTITY LISTED BELOW: (~j RESPONSIBLE CLIENT / ENTITY NAME LU V, MAILING +ADDRESS '''� CITY / STATTEE�/ ZIP /_� TELEPHONE # Applicant'Sigriature: ` Date: s� 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. V ❑ Holding Tank Agreements Required ❑ Floor Plan and/or Plumbing Layout Required Z O ❑ Certificate of Existing OWTS Required ❑ Special Feasibility Boring Report Required ❑ WQCB Clearance Required ❑ Detailed Contour Plot Plan Required (1 to 5 foot intervals) W❑ Soils.Percolation Report Required PRE SITE INSPECTION REMARKS INITIALS & DATES A(pt Ar 'I, /Z' fAt,. 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. x Tested Depth Maximum Trench Depth - O Z O H Install Lines ft long ft wide with min. inches rock below drain line, or ❑ Plastic Chambers U W fn Leach Lines / bed s ecial des!2n for slope Ap 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 UXb 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. No construction is permitted in the required reserved 100% Expansion area. IJJ 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. V(3) Sewer lines must be 50' minimum from any wells. W (4) Seepage pits must be 150' minimum from any wells including expansion areas. EHS S' "t Date; % XIV Environmental Resources Management Off ice,Locations /Environmental Health - ERM Division Environmental Health - ERM Division' -..`• Environmental Health - ERM Division ( ,Riverside Permit Assistance Center Palm Desert Permit Assistance Center. South County Permit Assistance Center V 4080 Lemon Street, 2"' 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 DEH -SAN -122 Rev: 11/07 Distribution: WHITE - Office File; YELLOW -Applicant; PINK - Bldg. Dept.; GOLDENROD-.Plans/Records Bin # Qt/ ofla Quanta Building 8T Safety Division . P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # G,�✓ 11' Project Address: Owner's Nam j A. P. Number: boo _ 0 O _ 0 Z Address: o Legal Description: City, ST, Zip: Contractor: ;��•\�pgJil{vri ui� : vi:Gn:Ci>i\{:��' Teleph \^ "M `\:izti<.zz';fi D �b Address: r e3 Project Description: r� City, ST, Zip: Telephon / 0/ �11� 2� State Lic. # : L City Lic. Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lic. # <:::' �•. ;;,:r:y!<:>:.;:;;:'» .<.::<:. :.,..:•:<::: ;�:;+.v+v v'{':h f•.iµ:4.iv:;'.:'�ii.%�>ih:Y ti"��':v:'+K: w:;:',a��?s::r::<.:>: s,>.:•<:>>, "`'>..< Construction Type: Occupancy: Project type (circle one): New Add'n Alter ep Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: ' Telephone # of Contact Person: 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 plan god Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed 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 School Fees Total Permit Fees