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08-1557 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 08-00001557 Property Address: 49125 AVENIDA FERNANDO APN: 658-280-014- - Application description: PLUMBING Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5000 Tiht 4 4 Q" Applicant: Architect or Engineer: BUILDING& SAFETY DEPARTMENT BUILDING PERMIT �1A 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: B C36 C42 License No.: 793482 ate:7'rZ°4.1—Co o ONER-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 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).: (_) 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.). (_ 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 contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 1 I am exempt under Sec. , BAP.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I h6reby'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, Date: 9/12/08 Owner: AL BACKMAN C/O PO BOX 630 LA QUINTA, CA 92247 Contractor: t SO CAL & ASSOCIATES PLMBNG C j P.O. BOX 955 YUCCA VALLEY, CA 92286 0 t Cry (760)369-4104, t/ Lic. No.: 793482to �e�, y ,E �t e j It, F? �- - -- --- WORKER'S COMPENSATION DECLARA ION, 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' c mpe at,anra p vide for by Section 3700 of the Labor Code, for the performance of th work for w ich•tlis permit is issued. --a" I have and will maintain workers' compensation insurance, as required_ 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 STATE FUND Policy Number 1820769-2008 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 I should become subject to the workers' compensation provisions of Section i 3700o e Labor Code, I shall forthwith comply with those provisions.' to �` A WARNING: FAIL E TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS J$1 00,000). 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 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 relatin��� const anddaerebq-eutfiociaa,rEpLe_sentatives of thisgs county toe on the above-mentionedpection purposes. ure 1Applicant or Age Application Number ... . . . 08-00001557 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 82.50 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 3/11/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 22.5000 EA PLB CESSPOOL, 22.50 1.00 45.0000 EA PLB SEPTIC 45.00 -------------------------------7-------------------------------------------- Special Notes and Comments INSTALL NEW 2000 GALLON TANK AND RE -HOOK TO EXISTING PIT Fee summary Charged ----------------- ---------- Permit Fee Total 82.50 Plan Check Total .00 Grand Total 82.50 LQPERMIT Paid Credited Due ---------- ---------- ---------- .00 .00 82.50 .00 .00 .00 .00 .00 82.50 ;ppgpelpor�- I"%-1.-W-1I14W- - I - - ANAP PLIMPING, Inc. Lic #C42 855 851 760 328-7887 * 1-800-334-7255 FAX 760 328-6607 P.O. Box 2318 Cathedral City, CA 92235 Ts -c -Row, Q11 ORDERED _ / Ad 4T ORDER TAKEN By DATE PROMISED 0 AM. 0 P.M. BILL TO PHONE ADDRESS ? CITY HELPER JOB NAME AND LOCATION --3 6-9 4t ()q ❑0 DAY WORK DESCRIPTION OF WORK Rooter Service 0 CONTRACT 0 EXTRA Camera QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT 00 Pumping Fee per 1000 gal. Rooter Service Camera Labor .$75/HR Septic Inspection Locating/ Ope ng F $75/H After Hou Fee Out of rea Fee Comments: Fuel Charge A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. $25 IO TOTAL MATERIALS TOTAL LABOR TAX WAIVER: Not responsible for seconddamage such as water ary d cre-t- d�am�age,chi pe con mark on street or-a-n-veways-o.LZtees. SIGNAT UA� ETED TOTAL COUNTY OF RIVERSIDE • COMMUNITY HEALTH AGENCY 4 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 ON# IN# LMS# C ' -T•,, J � � � �1.� } � � � EHS # AGENT,CONTRACTOR ADDRESS CITY/STATE/ZIP TELEPHONE# L r , p j Ci Q , V- L t- - Q OWNER ADDRESS CITY / STATE / ZIP TELEPHONE # _o IaL/C�.z�� ��,�-���� ►�� 11- 'JOB PROPERTY ADDRESS CITY / STATE / ZIP Thomas Brothers © Map # C-oZ S r LOT SIZE WATER AGENCYIWELL USE OF PERMIT ��� �L {� �_ p C rn to * 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. H SEND ALL BILLING MATTERS TO THE CLIENT OR ENTITY LISTED BELOW: L V RESPONSIBLE CLIENT / ENTITY NAME W y MAILING ADDRESS CITY / STATE / ZIP TELEPHONE # PApplicant Signature: Date: 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 F. ❑ WQCB Clearance Required ❑ Detailed Contour Plot Plan Required (1 to 5 foot intervals) W❑ Soils Percolation Report RequiredL� << + n N PRE SITE INSPECTION REMARKS INITIALS & DATES Soils Percolation/ Boring report by { 5 1-L 4 ' Project #S2 r 4 Type of System: ❑ New AReplacemen Existing # Fixture units Septic tank Cap. FDate- ate t ❑Pump ❑ Addition ❑ ATU ❑Connect to Sewer # Bdrms LJ to f � Q 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 U) Leach Lines / bedspecial design for slope Applicable ❑ N/A ❑ Overburden Factor: Pit Diameterr No. Pits Pit below Inlet (BI) Pit Total Depth Max Allowable Depth Well Review Approved by: (Signature) CONSTRUCTION / INSTALLATION INITIALS & DATES This Application is�ITApproved ❑ 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. W No construction is permitted in the required reserved 100% Expansion area. 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. U(3) Sewer lines must be 50' minimum from any wells. W (4) Seepage pits must be 150' minimum from any wells including expansion areas. A EHSS'Siignature: //J� / Date: J� ��f-1 n 4�J. .I C .Y_7_ (%a Environmental Resources Management Office Locations Environmental Health - ERM Division Environmental Health - ERM Division Environmental Health - ERM Division Riverside Permit Assistance Center 4080 Lemon Street, 2nd Floor Palm Desert Permit Assistance Center 38686 EI Cerrito Road South County Permit Assistance Center 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 # Permit # �/� ` i Project Address: a. � City of La Quinta Building & Safety Division P.O. Box 1504,78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet e-r-Aj1- 6( Owner's Name: ! ' A. P. Number: ' Address: Legal Description: City, ST, Zip: Contractor: l� Telephone: Address: ��Z-x��- Project Description: City, ST, Zip: LIOCC,pqu'T-L l ia Telephone:,-? 60 -�W,31(f A� State Lic- # : -7q City Lic. #: .- �0 to Arch., Engr., Designer:�(� SQU Address: r4— -- [<71- kCf-O City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: � ` Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq- Ft.: #Stories: # Units:- Telephone # of Contact Person: -(( � Estimated Value of Project: 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 Energy Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'd Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval, Plans resubmitted Grading IN HOUSE:- ''d Review, ready for correctionstiisstie Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees