BPLB2016-007578-495 CALLE TAMPICO D U a ' VO.IC\!760) 777-7125
LA QUINTA; CALIFORNIA 92253 4X (76 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT r INSPE °IONS (76 7-7153
BUILDING PERMIT
Cp�MU n'OF� r ?�,Da /31/2016
Application Number: BPLB2016-0075 Owner: ��E[pp QU�ryjA
Property Address: 80119 PALM CIRCLE DR HEINO NURMBERG �FNTQEPfRT
APN: 600080032 . 80119 PALM CIRCLE DR �9cryT
Application Description: NURMBERG / ABANDON OLD SEEPAGE PIT/INSTALL NEW PIT LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $5,000.00 j
Applicant: Contractor:
ROTOCO INC DBA ROTO ROOTER PLUMBERS ROTOCO INC DBA ROTO ROOTER PLUMBERS
2141 INDUSTRIAL COURT 2141 INDUSTRIAL COURT
STE B STE B
VISTA, CA 92081 VISTA; CA 92081
(760)598-4234
Llc. No.: 422155
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 Professions Code,
and my License is in full force and effect.
License Class: A. B. C36, C42 License No.: 422155
�Date:S
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 theN
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).:
(_J 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 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.).
(� 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 contractor(s) licensed pursuant to
the Contractors' State License Law.).
(� 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
Lender's
WORKER'S 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 forworkers'
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: ,Polity Number: _
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 a`s 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 forthwith .
comply with those provisions.
I ant
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 Building Official 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 city to enter upon the
above-mentioned property for inspection purposes.
Signature (�4-cant or A
Description: NURMBERG / ABANDON OLD SEEPAGE PIT/INSTALL NEW PIT
Type: PLUMBING Subtype: Status: ISSUED
Applied: 5/27/2016 SKH
Approved: 5/31/2016 JJO
Parcel No: 600080032 Site Address: 80119 PALM CIRCLE DR LA QUINTA,CA 92253
Subdivision: TR 4518 & INT IN COMMON AREA Block: Lot: 21
Issued: 5/31/2016 MFA
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $5,000.00 Occupancy Type:' Construction Type:
Expired: 11/27/2016 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: ABANDON OLD SEEPAGE PIT AND INSTALL NEW 14' SEEPAGE PIT PER 2013 CALIFORNIA BUILDING CODE
ABANDON OLD SEEPAGE PIT ONLY. CITY SEWER NOT AVAILABLE. REPLACE SEEPAGE PIT WITH NEW ONE PER HEALTH DEPT. PER 2013
CPC
0
flied to Approved }
5roved to Issued
FINANCIAL INFORMATION
Printed: Tuesday, May 31, 2016 12:50:35 PM 1 of 2 - r sys7EMs
INSPECTIONS
PARENT PROJECTS
BOND INFORMATION
. ... ..
ATTACHMENTS . ...... . . ..... ..
Printed: Tuesday, May 31, 2016 12:50:35 PM 2 of 2 c9?W1yS7rmS
777777
CLTV
DESCRIPTION
ACCOUNT:
QtY,
AMOUNT
PAID:
PAID DATE
'RECEIPT
:'REC
.,,CHECK
METHOD
PAI D BY
BY
ROTOCO INC DBAMFA
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00.
5/31/16
R15898
21512
CHECK
ROTO ROOTER PLU
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
ROTOCO INC DBA
PERMIT 1
ISSUANCE
101-0000-42404
0
$91.85
$91.85
5/31/16
R15898'
21512
CHECK
ROTO ROOTER PLU
MFA
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
.
ROTOCO INC DBA
SEPTIC SYSTEM
101-0000-42401
0
$12.09
$12.09
5/31/16
R15898
2151 2
CHECK
MFA
ROTO ROOTER PLU
ROTOCO INC DBAMFA
SEPTIC SYSTEM PC
101-0000-42600
0
$4.83
$4.83
5/31/16
R15898
21512
CHECK
ROTO ROOTER PLU
Total Paid for PLUMBING FEES: $16.92 $16.92
TOTALS: $109.77 $109.77
INSPECTIONS
PARENT PROJECTS
BOND INFORMATION
. ... ..
ATTACHMENTS . ...... . . ..... ..
Printed: Tuesday, May 31, 2016 12:50:35 PM 2 of 2 c9?W1yS7rmS
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
fi.
Certification of l st` g Su surface Sewage Disposal
/ . %.
Date of Inspection: T�-�
. r
(Owner's Name)
Property Address)
6dv-� 0-0-63 t
(Legal Description and APN)
FAILURE TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT' .
OWNER FROM OBTAINING ENVIRONMENTAL HEALTH SERVICES APPROVAL. jay
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 required'plot plan.
3.. a. I.examined•the existing subsurface sewage disposal system at the above location on (date) 9S"��'��- date
and determined that the septic tank capacity. is gallons and that there is /sq. ft. of leachline
bottom area. There are bedrooms in the dwelling. There are. fixture units.
b. There are leac lih ne(s), each ft. long.
c. There are plastic chamber(s), each ft. long.
y . d. There are / seepage pit(s), each �_in diameter,ft. deep.
'`e. The leach bed is ft. by ft., total sq. ft. of Ieach bed' area.
41..::a: 'Construction of septic tank (please check one of the following): "
concrete
❑ fiberglass C] steel
other:
'.Internal dimensions of septic, (length ft., width_, depth I�
Condition of tank (please answer yes or no for each .question):
1 Yes No
Inlet Tee present? 0® ❑
Outlet Tee present? ❑
Two .compartments?
b Tank structure deteriorated?' ❑ 0�°°"
*If yes, briefly explain and indicate appropriate correction suggested:..
d Condition of D-Box'(if needed) Level C3 Yes Q-Mp replaced (J Yes El
of
of>septic_effl.ue.nt_0 Yes:❑_No_.,.
5. a iNhile pumping the tank; did effluent flow back into tank from the absorption stem"? es ❑;;No.
b. Prior to pumping; ;was the liquid -level in the, tank above the outlet tee? []ayes ❑ No
c. Was the area around the lids oxidized? C] Yes
d. 'Is design of system .gravity feed? [ ' es ❑ No
e. Were well(s) observed on this or adjacent property? ❑ Yes &WO ,
If yes, indicate distance of well from: Septic Tank ft.
Leachlines ft.
Seepage..eits ft.
f. Distance from springs, lakes Septic Tank ft.
and natural drainage courses: Leachlines 1/ ft.
(circle appropriate item). Seepage Pits ft.
g. Sewer is within. 200 ft. of system and abuts property line. ❑Yes'
ADDITIONAL COMMENTS:
h.. How long has dwelling been.vacant?_(if applicable) months weeks. N/A
6a. ❑ It is my opinion that the system appears to be in good working, order and can be expected to function properly with
proper maintenance. No repairs are necessary -at this time. .
6b. ❑4 isopmy opinion that the system is not in good working order and will not function properly without the:following repairs:
I certify under penalty,gf perjury that the foregoing is true and correct:
C-42 State License Number
iawre v
Expiration Date
Print Name Name oMmper Company -and Receipt NNumber./Nrafie of Company Holding G-42 license
:�/ 5/f r/S ! da �:' ✓ ✓LT A ;)r C -.t+ �Mow-24-Z2—�Z� '
Address Phone Number
The Dart ent of nviron en al Health has reviewed and approved this, certification:
7f14, .�1J 7a
yipiental Health Specialist
84 (Rev 6/04)
- uare
Distribution: WHITE—Office; PINK7.Contracti
COUNTY OFRIVERSIDE
DEPARTME--NT f OF ENVIRONMENTAL - .HEALTH
DEH -SAN -122 Rey:6114 ` a . Distribution: WHITE —Office File; YELLOW —.Applicant,, PINK — Bldg'Depl.; GOLDENROD . Plans/Records
Lot No.
ASSESSOR'S PARCEL NUMBER
LAND USE APPLICATIONti.. '(-(
_ �"
a -i
TUU
-
-
•A "I
rS,ECTI;ONAt? �p.;3i. +rs��+�r��'+t`o-r� °.r?'§t`'w'�w' ..Y,�y41?» "':::�s�;�`# `}'k*('a,''s
OWNER; ' ti AGENT/CONTRACTOR: f 7� -
ADDRESS . 100,
CITY
ADDRESS
21 tq I �� , t �✓&-F— .
CITY
l
"PHONE',. ,
EMAIL ."
PHONE
EMAIL ..
JOB PROPERTY ADDR SS ; • CITY "
f /
LOT SIZE ` WATER AGENCYNVELL
USE OF PERMIT .
,�• µ... elf 3r�4,?"' 1vs se'
SECTIONi6'�n'�"�t�Ma�`PaI-ItiW:
- * 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,tnat point be insufficient. At final approval, the project owner. or
applicant named will receive a final statement andnotice of any final fees due or refunds due (es applicable).'
ROP Fees: For AlternateSystems, 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:
RESPONSIBLE CLIENT / ENTITY NAME
AILING ADDRESS: CITY%STATE ZIP •,
PHONE
Applicant Signature::Date:
Below - For Office Use Only
w.. i+'i9 23 .• 'F i'A} ,L'R. 'i'},} L�x.!�'g -N"� 'S�"t t.�+MT�,y�4 ''�'�'+c, NAY, WiN." ,? , ,fig +#".t±.-.t�•J.L: T �'
,SECTIO,NC.�.s :?.1 S#:,:5.' SD.Fc{ y^�r.WR`iv.72,*^ j hn._JS1+r{ �'ssli? br•Yk�wLxYn+.zT� W; ..
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
after date noted below may require repayment of fees. -
❑ Holding Tank Agreements Required
❑ Floor Plan and/or Plumbing' -L-ayout`: equired d i%>
❑-Certificate of Existing OWTS Required
❑ Special Feasibility BoringRep6rt4Required
❑ WQCB Clearan a Required ,
0 -Detailed Contour Plot Plan Requirr,ed (1 to 5 foot intervals)
❑ Soils Percolation -Re orYRe wired
PRE SITE INSPECTION REMARKS
INITIALS '& DATES .-
�. _f-1e,� ..• IGC e! L ��c G� j"ANK v r71- G Y r`./ /�!—r. ati���-t t_ k '.ilr3Ar��•�. `� kffT'[r(.
,fT. A� p°v/k✓--I •0 7.. ILE-r �' �4,-ACc F{A Le—,,: 134-Cez r=eLt, t,-f-rFf cCtfti
G"r1 Cv+/kvL.-jc
:SECTI.ON4D:,�"
Soils Percolation/Boring. reportby Project # Date'
Type of System: ❑ New 8, Replacement ❑ Existing ,
# Fixture units Septic tank Cap. Soil Rate
# Bdrms •• (GAG k f r�r 5
❑ Pump. ❑ Addition ❑ ATU ❑Connect to Sewer-
Sq. Ft. Bottom Area . Total Linear Ft.
'
Sidewall.allowance ft Rock/ sq ft running foot.
Tested Depth
Maximum Trench Depth
r
Install: Lines ft Ion ft wide with min: u" � inches rock below drain line, or ❑ Plastic Chambers
Leach Lines/bedspecial design for slope Applicable' " ❑ N/A ❑ Overburden Factor:
Pit DiameterNo.
PItS
Pit below Inlet (BI)
Pit Total Depth - .
Max Allowable Depth
Well Approval Date`..:
.CONSTRUCTION / INSTALLATION
INITIALS & DATES ..
_ .. •. .
Tc -
S E C_TI O *''f;'���°�
This Application. is•d 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,tlie construction of;the above designed system.
No construction is permitted in _the required reserved 100% Expansion are a. f
(1) • Septic tank must bo::1 Q0'fminimuin from any wells. = j
area.
'..(2) Leach lines must be6:00' minimum from any wells including expansion ;
-(3) Sewer lines must be 50' minimum from any. wells. f'
(4) Seepage pits must tie.150'�minimum frorri•ari wells including expansion areas.
EHS Signature,
Date:
Environmental Resources Management Office Locations ”
Environmental Health - ERM Division _ _
Riverside_ Permit Asslstance Center -
Environmental Health — ERM Division
Indio Permit Assistance Center 4 '
3880 Lemon Street, Suite -'200,
r 47-950 Arabia Street; Suite A
Riverside, CA 92501.. ' .- r _
Indio, CA 92201
•"RIVERSIDE 957 955-8980 "
INDIO 760 863-7570 t
DEH -SAN -122 Rey:6114 ` a . Distribution: WHITE —Office File; YELLOW —.Applicant,, PINK — Bldg'Depl.; GOLDENROD . Plans/Records
Building 8t Safety, Division
r
.,
P.O. Box 1504, 78-495 Calle.Tamplco
Permit>tY,
La Quinta, CA 92253 -. (760) •777.7012
Building Permit Application and Tracking Sheet
t project Address _
Owner s Name ` N •
A. P Number • .:
,.
Address:
Legal Description:
City, ST, Zip:
1
Contractor
Telephone • r s
,
Address: ;
f
Project Description: 401
• City, ST, Zip:
2Q��ki
"
"< Telephone:
i
ty,
Arch., Engr., Designer:
.
Address:
'•
City,, ST, Zip:
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Telephone
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. Construction Type:' Occupancy
.: State.Lic #"
J
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Project type (circle one): New Add'n Alter Repair Demo `
Name of Contact Person:Sq.
1?t : #Stories
# nits:
t4 °
' Telephone #,of Contact Person: `
. -
Estimated Value of Project:. D Do..ry
APPLICANT.
DO. NOT WRITE BELOW THIS LINE
N
Submittal
RegM
Recd
'TRACKING
PERMIT FEES
Plan Sets r
Plan Check submitted _:
Item
, Amount,
i
Structural Cates.
.... ....
Reviewed, ready for corrections
_. _..
Plan Check Deposit
.. ..
S,
-t
.., 4
Truss Calcs.
....._ .... .............._ .. ....:.,. ...... _ __.....
:.Called Contact Person
..
..
Plan Check Balance
-
-Title V Cates.
Plans picked up . ,.:
Construction
Flood plain plan
Plansrresubmitted
Mechanical
Grading plan
,2�a Review, ready for corrections/issue
Electrical
Subcontactor List
'Called Contact Person
!
Plumbing
.Grant Deed
Plans picked up
S.M.I.
.
H.O.A. A roval
PP
Plans resubmitted "
...
Grading
,•:
'.
fN HOUSE:-
_
'rd Review, ready for correctians/[ssue ',
Developer Impaet Fee -
�.
_ ...
analn _Approynl
_ ..
.Called C.ontattPCrS _ -
A I P P -
.
Pub Wks Appr
Date of •omit issue _
,.
_ __-
•
School Fees
:
.
................
..
Total Permit Fees..:
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ar
_ .. . _. _