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13-1332 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00001332 Property Address: 48885 AVENIDA EL NIDO APN: 658-310-013- - Application description: PLUMBING Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6100 Applicant: T-ihf 4 4 Qulk& BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: DENISE M. NOBE 48885 AVENIDA EL NIDO LA QUINTA, CA 92253 ( Contractor: Architect or Engineer: GSEWER & SEPTIC PROS INC. TSIDE CITY LIMITS 18 6-315 AVENIDA RAMADA ?013 ESERT HOT SPRINGS, CA 92240 Lic. No.: EXEMPT --------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class:p986954 _ License No.: EXEMPT Date/0 O—/ Contractor: OWNE -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).: 1 _ 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 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.). (_ ) 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 Date: 10/18/13 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 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 7600 Policy Number EXEMPT 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 3700 of the Labor Code- hall forthwith comIn those provisions. Date /U �' �-� Applicant: WARNING: FAILURE TO SEgjJK WORKERS' COMPENSA ON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001 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 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 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 build' g construction, and hereb horize representatives of this county to enter upon the above-mentioned property f r inspection purposes Date -/Q — /0 /3 Signature (Applicant or Agentl• 4 LQPERMIT Application Number . . . . . 13-00001332 Permit . . . PLUMBING 2013 Additional desc . . Permit Fee 11.92 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/16/14 Qty Unit Charge Per Extension 1.00 11.9200 EA PLBG SEPTIC SYSTEM 11.92 ---------------------------------------------------------------------------- Special Notes and Comments INSTALLATION OF 16 X 16 SEEPAGE PIT OLD ONE COLLAPSED 2010 CODES. INSPECTOR TO VERIFY SEWER IS 200 FEET FROM PROPERTY INSPECTOR TO VERIFY.APPROVED S.T. & J.J. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PERMIT ISSUANCE M/P/E 90.57 Fee summary Charged Paid Credited ----------=------------------- Due --------------------------- Permit Fee Total 11.92 .00 .00 11.92 Plan Check Total .00 .00 .00 .00 Other Fee Total 91.57 .00 .00 91.57 Grand Total 103.49 .00 .00 103.49 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 # I "Project Address: Z716 _g 1ch Owner's Name: A. P. Numbei: Address:— Legal Description: City, ST, Zip: ' C 2 2 S 3 Contractor: Telephone: Address: _ SISA—V-e-22,'-64 yyKcla- Project Description: S �/ City, ST, Zip: ' e�aA C'42 Z 2 LIQ17 Telephone: _5 2 State Lic. # : B City Lic. #; Arch., Engr., Designer:�v l Address: l City, ST, Zip: Telephone::»»:«:;;»::«:>:><:<:>:»:>:•<::::. l �'f,.•:y+ii:4i ii'•:y is j;:j4i )iiiiiy;:jC:)j{'.;;: ;� K. Y�Y':i:i':•:i:�:9iliYrik%2:ii{iii t: y'!. ii:'iY.N.{:.:i•Y:+,Gyf :l: n'L:•'i:' ;{:;iGfj: Construction Type:. O upancy: Project type (circle one): New Add'n Alter Repair Demo State Lic. #: ::;;: ; ::c :» ;:>.: Name of Contact Person: QS Cir �,Q�1-� Sq. Ft.: #Stories: # Units: Telephone #,of Contact Person: Estimated Value of Project: 4. / 04C> APPLICANT: DO NOT WRITE BELOW THIS LINE it 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 2°' Review, ready for corrections/issue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Reyiew, 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 Sewer & Septic Pros Inc.PtOpOSAt Proposal 110. toa(Oct 16315 Avenida Ramada, Desert Hot Springs, CA 92240 Sheet No. Tel : (760) 272-3410 Email: sewerandsepticpros@gmeil.com Ca. Lic.986954 Date I LI •2013 Proposal Submitted To Work To Be Performed At Name U e r i J" ` �".e� h t✓ Street Street LI St S' T S' A• V d n,' �a .e A v, ; dc,City State Gty State c 2 -3 Tel: Fax: Email: We hereby propose to furnish all the moterials. and perform all the labor necessary for the completion of ccss ( 1 a~S-I G 6 l a: S c .e p `yam �- �.o O. �y a C Lc Q v. •. -r s J �. c cA s I.uc aro U_ t r,-r= Ln /c+,, ; ti v zC rK 44 (�v•r WQ,- r was c 7 . C) �Ov 3 ✓��senr V 4; V- 27 60 c� L o r,S a L s o w. e• V%_ . In the event of any oction arising out of this agreement, the prevailing party will-be entitlled to reasonable attorney's fees. All material is guaranteed to be as specified, and the above work. to be performed in accordance with the drawings and specifications submitted for-above work and completed in a substantial workmanlike manner for the sum of Dollars (S 6 with payment :to be made as follows: (d �y to o h cZ Ge,c.,� •-�-c..,� .. � c �U tee,. � ' ti- �, � o H Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon. strikes, accidents or deibys,b.eey_ond our control. Owner to_. carry fire, tornado and. other necessary insurance upon above work« "NOTICE TO OWNER" (Section 7019--Contractor ticeese taw) Under the Mechanics' lien law, any contractor, subcontractor, laborer, materialman or other person who .Kelps to improve your property and is not paid for his labor, serfuss vices or material, a Respectfully submifted right to enforce his•daim against your property. Under the law, you may protect yournif against such claims -by filing, before commencing such work or improvement, an original Pers c-5 12 "d S contract for the work of improvement or a' modification thereof,. in the office of the county recorder of the county where ft property is situated and requiring that a conbaetoes payment bond be recorded in• such office. Said bond shall be in an amount not ten'Uhan frfty State License No : 986954-C42 percent (50%) of the contract price and shall, in addition to any conditions for the performance .of the contract, be conditioned for the payment in full of the deims of ail persons furnishing labor, sen. All bills not paid within 30 days of invoice date are ices, equipment a materials for the work described in said codtraet subject to V/2% per month interest'.' Note — This proposal may be.withdrown by us if not accepted within JJO days . ACCEPTANCE OF PROPOSAL The above prices, specifications and .conditions are satisfactory .and7aepted, You area riz to do the work os specified. ent will be made as outlined above. Accepted I ,Vc/ �Sig Date W Signature Contractors are required by low to be 'licensed and regulated by the Contractor's State license Board. Any questions concerning a contractor may be referred to the Registrar, Contractors State License Board, 13132 Bradshaw Road,] Sacramento, Colifomia..1mailing. Address: P.O. `Box 26000, Sacramento, California 95826.1 I Oscar Zarate, Owner of Sewer N Septic Pros, Inc. authorize Jayme Lynsky to pull Business Licenses and Permits for my Company. Date Signature CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County Of Riverside On September 30, 2013 before me, Kenton R Heiser, Notary Public (Here insert name and title of the officer) personally appeared Oscar Zarate who proved to me on the basis of satisfactory evidence to be the person(s) whose name(a)g subscribed to the within instrument and acknowledged to me thateOhe%key executed the same in is . authorized capacity(ies-, and that by is ' signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS y hand and official seal. Signature of Notary Public KENTON R. HELSER UU �, Commission No. 2011828 z . ' NOTARY PUBLIC -CALIFORNIA RIVERSIDE COUNTY ". t1Ay Comm. Expires MARCH 14, 2017 (Notary Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages 2 Document Date 9/30/2013 (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee (s) ❑ Other 2008 Version CAPA v 12.10.07 800-873-9865 www.NotaryClasses.corn INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, anv alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signet). Please check the document carefully for proper notarial wording and attach this form if required. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/they- is /ere ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO. Secretary). • Securely attach this document to the signed document .A .�..,v.., - _. --11� r_Y.•.-_. �.,�.. ./ t� xr ,7�'.-rw•-•:._. '•`f-: �__-.1�wa -- -�. �:- .-�q,r'v+.��.-..-'. :.�,, .... , ao ._.. ._-..-i+"NY'i r-+- .-.. COUNTY OF RIVERSIDE • COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH fr R/P�M� AA A 4f, tt Lot No. APN: ASSESSOR'S PARCEL NUMBER 1 LAND USE APPLICATION { ;1,�rt J t S G.S L ;S# , EHS # AGENT, CONTRACTOR ADDRESS CITY / STATE / ZIP TELEPHONE # ttD 'Is �ttlrt�ltl�, {�1a-�,. (�l Z7L 2-72',*;(4)U ,,)oT .�wc:)Aa�'. s - lm-.��,, � /U) Q OWNER + ADDRESS CITY' STATE/ ZIP Y TELEPHONE # Z0 brig Rtilon(4 -f,.o L) � h hl a -(_n13 P I (d, JJIO�6 U JOB PROPERTY ADDRESS CITY / STATE / ZIP V Thomas Brothers © Map M W S A trn� LOT SIZE WATER AGENCY/WELL USE OF PERMIT * 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. F_ H SEND ALL BILLING MATTERS TO THE CLIENT OR ENTITY LISTED BELOW: () W RESPONSIBLE CLIENT / ENTITY•,NAME . `10 I 1 ) 0 C" � f C?i-1('. �7Ct �� 1 � � (_ , N MAILING ADDRESS, CITY / STATE / ZIP +(P - �S htv!? r ii S rc. 5122.1-A) TELEPHONE # ,A.ppliccaan'tSignature: Date:,.- t ;!� ` `` i `~ za ?C9 0' Below — For Office USe'Onl '' CHECK BOX IF REQUIRED + }� i �"" t "{ '0,4 17 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 -pp == days after date noted below may require repayment of fees. ronnnrs,� V ❑ Holding Tank Agreements Required ❑ Floor Plan and/or Plumbing Layqequut Required i Z O Elfica Certificate Existing OWTS Required e oequ peceasr ❑ Sial Feasibility Boring Repot Rired H ❑ WQCB Clearance Required ❑ Detailed Contour Plot Plan Required (1 to 5 foot interv_ als)'PRV . . U W ❑ Soils Percolation Report Required PRE SITE INSPECTION REMARKS INITIALS & DATES L• Ye z. 4 (� �( tl U t. - .` , y, r f it f "I P VW Y r}- - r t l tra. 1-7 ,f r t ir- it r- ,.4 ? r '- ,A 4 , z_# .A, 57,41 t- Ali. 1i- Ca X It,/ 0 ?l ,V-0 Al A "L v -r ;PcA lk Cf V.0 5 _,x rAire rcrvNt-r t,-lLk 01, p„r'rtrr . c l � y Gt LX awl. r14 `1� �G f �.�-etc �� �s�r,r, 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 1 # Bdrms (�'✓� t vt S trot �.G Sq. Ft. Bottom Area Total Linear Ft. Sidewall allowance ft Rock/ sq ft running foot. !! Tested Depth Maximum Trench Depth t] Z O H Install Lines ft long ft wide with min. inches rock below drain line, or ElPlastic Chambers U W Cn Leach Lines / bedspecial design for slope Applicable ❑ N/A ❑ Overburden Factor: Pit Diameter No. PitsPit below Inlet (BI) Pit Total Dept Max p lowable Depth 4 ' c� U Well Review Approved by: (Signature) T _U CONSTRUCTION / INSTALLATION 'INITIALS Ei^tF/t0i'— -e/t 6(4E,fT A -+fAll' OG FtL-T- ct./L--`J td_11WU ;. This Application is IYApproved ❑ 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. F- U (3) Sewer lines must be 50' minimum from any wells. • � , W (4)111 Seepage pits must be 1.50' minimum from any wells including expansion areas. 1 EHS Si Aaturev Date: f A3 t 5y Environmental Resources Management Office Locations Health - ERM Division Environmental Health - ERM Division Environmental Health - ERM Division CEnvironmental Mverside Permit Assistance Center Palm Desert Permit Assistance Center South County Permit Assistance Center 4080 Lemon Street, 2ntl 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 C-10 0 `4 DEH -SAN -122 Rev: 11/07 Distribution: WHITE -Office File; YELLOW -Applicant; PINK- Bldg. Dept.; GOLDENROD - Plans/Records