0408 (PLBG)PERMIT A?PLICATION
�- City of _a Ouinta
Department of B/ilding and Safety
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This permit becomes void if work not commenced within 180 days from date of ssuance. OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED 'CONTRACTORS DECLARATION:] hereby affirm 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 lull force
and effect.
License Class Lic. Number
�.
Date. .Contractor
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt liom the Contractor's License Law for the..
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
construct, -alter. improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he 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):
O I, as owner of the property. or my employees with wages as their sole compensation, will dothe work, and the :
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner -of property who builds, or improves thereon, and who does such work himself or - •-
through his own employees, provided that such improvements are not intendedor-offered for sale. If, however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
0 I, as owner of the property, am exculsively contracting with.licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who,
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).,
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date ' Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of'consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy. thereof (Sec. 3800. -Lab: C:). u
Policy. No; Company -
0 Certified•copyis hereby furnished, ;
O Certified 'copy i filed with the City Building Inspection Department or City Department..
! / % / .ice
Date? i Applicant
APPLICANT "p" numbing Company, Inc.
Bell
,Ado:RE 0• Box 4582
Pa°!ni uSprings, CA 92263
C00
vESinging Palms'
CITY/ G QuiNITjY•1/STIP CA 92253' -
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TRACT NAME '•
OWNER.NAME (L MI)
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CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
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ARC/ENG FIRM NAME
ADDRESS '
CITY/COMMUNITY/STATE/ZIP
PHONE 4
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USE OF PERMIT Septic . System
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END
SIDE.
CERTIFICATE OF EXEMPTION FROM WORKERSCOMPENSATION INSURANCE:. This section neednot be completed if
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permt. is
issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Law. of
California.
Date Applicant .
NOTICE TO APPLICANT: It, after making this Certificate.of Exemption„you should become subject to the Work•.rs' . .
Compensation provisions of the Labor Code; you.must forthwith comply,with such provisions or this permit shall -
be deemed revoked. '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no extavation five (5) or morefeet in depth into which a person is required to descend, wil. be
made in connection with work authorized by this -permit, and that no building structure; scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36)-teet high.,(Chap 3.2, Grp 2, Art 2, Sec341, Ti1L8.
C.A.C.)
O -As owner -builder, I will not employ anyone to do work which would require a permit from the Divisioe of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division oflndustrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performaice.
of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct. I agree to comply wiIN all ,
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of.this county to enter upon the above-mentioned properly for inspection purposes.•
Signature of Applicant or Agent Date'
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state :hat
the information given is correct. I•agree to comply with all state laws and'county ordinances,relating to buicling
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to Etter
upon the property forlwhich I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPUPRMT
- 008 f/ 8 1 2—T13_83 Plumbing
Permit
to install Septic System
Permit
Fee $ 4.00
Septic
System 10.50
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TOTAL
•
FEE50
I .
$ 4
BLDG. DEPT.
'VALUATION 1 $1000.00
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts
'2A
Slab Grade
35 Furnace Compart.
3
Steel.
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck
39 Appl. Clearance
7 '
Framing
40 Fire Damper
8
Vents
41 Smoke Detection Device
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace P.L. y ❑
43 Final
10A
fireplace T.O. ❑
NON ADDITIONAL INFOR N
/
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
—1
2C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18' ' Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit. L. Line
ELECTRIC APPROVALS
-REAR OF PROPERTY. LINE
PSL P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance'
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
Bete Peamlin# Co., Vve.
LIC. 11310813
P. 0. BOX 4582 ..
PALM SPRINGS, CALIFORNIA 92263 -
(714) 327-4860 - 346-6916
F.FI, til
pPROVED
City of La Quinta
Community DevaiopmentiSidg..,Dept.
Date
THIS APPROVAL GhANTLD BY 1H_` -
DEPARTMENT
H_` -DEPARTMENT OF d UKIC HEALTH
IS VALID `0*� 0; (l ) �'Q A{
F..APPROVAL.
RIVERSIDE COUNTY DEPARTMENT OF PUBLIC HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
Food Establishment. '' Sewage Disposal Ex,c <�w�
Trailer -Park Gal. Septic Tank
Motel, Apt., Hotel/ Sq. Ft of Leach Line
_lLDwelling /awl x /l� Seepage Pit –
Commercial Building Connection to Sewer
Swimming Pool
No on-site regenerating water softening devices may be discharged into the individual sewage disposal
system herewith approved without �laa ance frorn the. Water Quality Control Board.
4'WatOr Supply serving this•ins`allation must.be from an approv^d source.
Allsewage disposal installation must conform with requirements of current Uniform Plumbing Code.
Any cutting, grading, or f;:;ing in excess .of four (4) feet will nullify sewige disposal approval
— Approval has been obtainid from the. Regional Water Qua�ity Control Board for installation of the sew-
ape disposal system. 1
This is to certify that the Riverside County Department of Public Health approves for cel eonstrgctlon
or installation the item(s) checked above.
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RIVERSIDE COUNTY DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scalEd plot plan drawn to county specifications required on the
attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be
made payable to County of Riverside.
Name
Mailing Address
City_
State
Zip Code
Phone
'Property Address
'City or Community
'Legal Description of Property (Lot, Parcel Map, Tract)
'Assessors Parcel No.'
Water Serving Property From
Lot size
'' �, � �r / � ? ��
�- -mit-•�"—� i f / -S
Signature of Applicant Date
'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initial Date
WQCB Clearance required Yes ❑ No ' / 1 _ 3 — S3
Soils feasibility report required Yes ❑ No
Detailed boring report required Yes ❑ No Q
Detailed contour plot required Yes ❑ Nob
Comments:
Soils or boring report by Date
Approved by Date
Soils Map Page Soil Type Tract File No. �� """ �rr, (Other
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required
Type of System
l
New Addition Replacement:
*
Leach line sq. ft. of bottom area trench
Leach bed (sq. ft. of bottom area bed)
Seepage Pit Diameter
Number of Pits
Seepage.Pit Depth B.I.
Total Depth of Pit
5' 0 61--
,- L) r
` '' / /_ '
Location of System
Additional Requirements e:7., A7 2 TQ s, %f 0 ,—, af. y k�l / f
A permit i pprove6/denied for the design of a subsurface disposal system as indicated on the accompanied plot plan
using the requirements set forth in Section B above. A building permit is necessary for the installation of the above
designed system:
r1lrw,_. T P.. / / 7 — , 7 —
Signature of Health Official Date
Receipt No. t1 X11 6
District: Riverside ❑ Indio El' Hemet ElDISTRIBUTION: WHITE - Office File YELLOW - Applicant
DOH SAN 122 (Rev 10/82)
Issued By f
D
ate
PINK - Building Dept. GOLDENROD - Pending File