04-4187 (PLBG)BUILDING-& SAFETY DEPARTMENT
c - .O. Box 1504 (760).777-7012
-495. CALLS TAMPICO FAX (760) 777-701.1
A QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)'777-7153
BUILDING PERMIT
ion Number " C04=0-0-0-04"187 Date 5/13/04
Pr erty Address . . . . . 80-124--PALM-CIRCLE DR
N: .649-090-021-10 -4518 -
Application description PLUMBING
t Property Zoning LOW DENSITY RESIDENTIAL
Application valuation 4625
1 -
Owner Contractor,
------------------------ -------.---- ---- ---
MYLL BETTY BAIRD TRI STAR CONTRACTING, INC.
80131 PALM CIR P:O. BOX 542
LA QUINTA CA 92253 CATHEDRAL CITY CA 92234
(760) 321-0898
WCC: STATE FUND
'WC: 197982003 10/01/04
•CSLB: 475515 01/31/05
• CCC: A-B
--------------------------------------------------------
---------------
Permit . . .'. PLUMBING
Additional'desc
Permit Fee 37.50 Plan Check Fee 9.38
Issue Date Valuation . . . 0
Qty-,. Unit Charge Per, Extension
BASE FEE 15.00
1.00 22.5000 EA `PLB CESSPOOL '-22.50
----------------------------------------------------------------Special Notes and Comments.-
ABANDON EXISTING SEEPAGE PIT AND INSTALL
A NEW 10' PIT PER REALTH DEPT APPROVED
PLAN.
Fee summary Charged Paid Credited. Due
Permit Fee'Total 37.50 0.0 .00 37.50
Plan Check.Total' 9.38 .00 .00 9.38
Grand Total 46.88 .00 00 46.88
-
P.O. BOX 1504
78-495 CALLE TAM PICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Applicant: /
0
Applicant's Mailing Address:
BUILDING & SAFETY DEPARTMENT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: S— 13— 04
Architect or En In r:
Architect o Engineer's Address:
Lic. No..
OUIL.UING 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
Code, and myUcens n fI, oree and effect. fy
icense_Class 1� \.
CLLicense No. `J
-Data Contractor :�g � L
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 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 exemption. Any violation of Section 7031.5 by any applicant fora permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 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.).
UI, 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.).
U I am exempt under Sec. , B.8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
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.
_ I have and lywill maintain workers' compensation insurance, as required by Section 3700 f the Labor Code, for the performance of the work for which this permit is
Carrier l4 ce ico pensation insurance cartieyanAgcYrt�Rtber�a(�' —1/� �%
(� Policy Number _ 11 `'1`'�' W �' l
I certify that, in the perforfnante 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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall
forthwith comply with those provisions.
Date Applicant
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 penafty of perjury that here 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
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 Ouinta, 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 pernit, 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. 1 agree
of to ce with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives this co ty to nter upon the above menti props for inspection purposes.
(Date 6 Signature (Applicant or Ag
TI-iIS APPROVAL GRANTED BY THE
P DEPARTMENT OF ENViRONiVIE►yTAL {�
IS VALID FOR ONE
1 �� vl (1) YEAR FROM
E
(. �,� OF APPROVAL
COUNTY OFRWERSWE tr
l . DEPARD4ENT-OF ENVIRONMENTAL HFA
TH
Sewage Disposal
Dwelling " 715�0
Gal. Septic Tank
'iCmMmercia➢ Sq, Ft. of Leach Line
-,�-- Seep Pits Fits _
No- f Dial Q BI ?-T.D— M[D
3.
�nect''tp Sever -ACornect to Existing System
N O:E-Sii� :�i4 tn1 'F(i ti'➢fli£Ig Lievices
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12be discharged intothe septic
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TI-iIS APPROVAL GRANTED BY THE
P DEPARTMENT OF ENViRONiVIE►yTAL {�
IS VALID FOR ONE
1 �� vl (1) YEAR FROM
E
(. �,� OF APPROVAL
COUNTY OFRWERSWE tr
l . DEPARD4ENT-OF ENVIRONMENTAL HFA
TH
Sewage Disposal
Dwelling " 715�0
Gal. Septic Tank
'iCmMmercia➢ Sq, Ft. of Leach Line
-,�-- Seep Pits Fits _
No- f Dial Q BI ?-T.D— M[D
3.
�nect''tp Sever -ACornect to Existing System
N O:E-Sii� :�i4 tn1 'F(i ti'➢fli£Ig Lievices
'I W ;a.a.
s .;2a
12be discharged intothe septic
�Tot SEZ QlLn� system rritlo:t clearance
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ASSESSOR'S PARCEL NUMBER
COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
APPLICATION FOR WASTE WATER DISPOSAL APPROVAL �-
APPLICANT: Submit this form with four copies of a SCALED plot plan (1"=20' to 1"=40' SCALE) drawn to County specifications as indicated on the attached
check list. A non-refundable filing fee 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 payment.
LMS #
Agent,( Contractor, Contact Person
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Address City State Zip
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Telephone
1?5 / -.54W
Owner /
Address r,s ,City /�) State // Zipt
CA
Te/l�ey�phone/
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Job Property Address
City
Zip..
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Lot Size
Water Agency/Well
Use of Permit, P/P, SUP, PUP, etc.
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LeLU aI De(s�cription Q
rk T 5Ill
DBA
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(
024
Dwelling,)MH Site Prep., etc.
Signature of Applicant f
�� t `sem r_ ^� // ,ra.� L✓,`7 • f�
Date �j,�
c I
`J FOR OFFICE
USE ONLY
CHECK BOX IF REQUIRED
If any box is checked, this application shall be considered rejected until the
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) i
information is provided and the fee paid. Resubmittals later than 90 days
after date noted below may require repayment of fees.
❑ Other
LIStaff Specialist Lot Inspection Required
Z❑
Holding Tank Agreements Completed
O
Certification of Existing S.D. System RequiredSY' A
Thomas Bros. Page Grid
0❑
WQCB Clearance Required
❑ Date Lot Inspection Completed: Initials
(Attach for DOH -SAN -007, Santa Ana Region Only)
Remarks:
❑ . Soils Percolation Report Required
❑ Maintenance Booklet Provided
❑ Special Feasibility Boring Report Required
j
❑ Final Inspection -by Department of Environmental Health is required.
❑ Rereview* Required Initials Date
Please call 24 hours PRIOR to inspection.
C/42 / Soils Percolation Boring Report By Lic/Project # Date
Soils Map Page Soil Type Approved By Date
No. of Systems
Type of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
`
❑ Holding Tank ❑ Replacement
Bedrooms, Fixture Units
Grease Intcp/Lint Trap
11
❑ New ❑ Addition
2 Q (►
QJ
Existing ❑ Connect to Sewer
A' cQi-ni, O
Gal.
Gal.
Sq. Ft.
Total Linear
Sidewall Allowance
Leach Bed sq. ft.
Bottom Area
Ft.
ft. rock/ sq. ft. running ft.
Install Line(s) ft. long ft. wide
of Bottom Area
Inlet Tested Depth ❑ N/A
with min. inches rock below drainlines
U
Proposed Bottom Tested Depth
or
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Leach lines/bed special design for slope:
(3) Pit, Diameter
No. Pits
Pit Below Inlet (61)
Seepage Pit
Maximum
Other:
O
Applicable
AAA
Depth
Allowable
F—
WN/A
Overburden Factor
❑ 5' 6'
{Total
` 0
TDI L
Depth
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Well Review Approved: Date: Well Drilling Permit#
SIGNATURE
Grading Plan Approved: Date:
SIGNATURE
Plan Check Only Approved:Date:
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REMARKS: " \r ca, `♦-(( 1a.i U Q c—.,4 � 1 S� ► v� S 1, S �l 4e h-1
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10,
This application is APPROVED/DENIED for the category checked in
SECTION B above, regt'arding®the design of a disposal system as indicated
on the accompanied plot plan, using the requirements set forth in SECTION
S 2-4 +
C above. A building permit is necessary for the installation of the above-
Revenue Code Fee $
designed system. No construction is permitted in the required reserved
-
100% expansion area.
32.1 U
Check #
(1) Septic Tank must be 100' minimum from any wells.
Z
(2) Leach lines must be 100' minimum from any wells, including expansion
�� J� `I
Date —initial
O
area.
H
iJ
(3) Sewer lines must be 50' minimum from any wells.
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(4) Seepage pits must be 150' minimum from any wells, including expansion
RIVERSIDE: 909-955-8980
area.
�_..�
INDIO: 760-863-7000
SOUTHWEST: 909-600-6180
Signature
n L1
Date r
%^_• 1 ; Disulouuon: wr i I L—Office rile; YLLLUW—Applicant; PINK—Bldg. Dept.; GOLDENROD—Plans/Records