12919 (PLBG)4
P.O. BOX 1504 N O . 12919 I
Building 46••-080 Jefferson Street 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Indian Springs Country Club
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address Same '
A.P. Number 4
-r
City
La Quinta,,,CAI
Zip
92253
Ir MAR\O\, 11994
Legal Description
Project Description
e
Install 6' X 201 se E3 e it
� � :�
Contractor
A-1 Cesspool Service, Inc.
ddress
P.O. BOX 193'
City
Desert Hot Spy
Zip
sings 92240
Tel.'
329-6875
State Lic.
& Classif. C-42 2+65214
City
Lic. # 386.
Sq. F.
Size
No. No. Dw.
Stories Units
Arch., Engr., -
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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 full force and
ffect.i` `, g
1GNATURE DATE
S OWNER -BUILDER DECLARATION
I hereby affirm that 11am exempt from 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 rile 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 (S500).
❑ 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, Buisness 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 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 did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct 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.) -
O I am exempt under Sec. B. 8 P.C. for this reason
Estimated Valuation
$1,000.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
1�. {�
Mech.
-
Electrical
-
Plumbing
22.50
S. M. 1.
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. --`' Company
C%C py is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) `
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
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 the above-.
mentioned property for inspection purposes.
Signature of applicant_ Date
Mailing Address
City, State, Zip
TOTAL :37.50
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE I INSPECTOR
Issued by: Dat
Validated by:
Validation:
ermit
ul
Ir MAR\O\, 11994
By �-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBNG FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P: t SQ. FT. p
GAS (ROUGH)
METER LOOP
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
REINF. STEEL
URINAL
ESTIMATED CON�(RUCTION VALUATION $
WATER PIPING .
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
LUMBER GR.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
VENTILATION
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/e c
SEWAGE DISPOSAL
FIREPLACE
SQ.FT.GAR ® 3/ac
IHOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE -
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
CU. yd.
plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
�Ile)
�- y
`
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
IAIDIAAI S-11-1/ e4
isr. -
44 17A-
RIVEMME COUNrl� SAI OF MIMLEC HEALTH
DIV1810H OF UNWROMMILlivITAL Fdf—M i
Foad Establishment
Trailer Park
Motel, Apt., Motel
DwaIiing
Commerc+ari Building
S•wic.Pa"i.ig Foal
aabiasa DiEwszI
Gal. S"l-' G T?nh
5'.4. R. of i.e;xh Line
it — — _ 3capagra Pit
Conlep. ioc? to Sevier
No on -sato regarersting wma c.r coftonit
n dsvi� mny ba diF swreod into tha individual 50-welge di po a1
Sy;�iPe� herewith approved c:ftirua6$ Ci�s?ra.�+S eis?aEa w24Cc Zii�l'G;! s"d£aoI '{3:::rd.
Water supply sarying r,his =jet aW fAcn crpmvej ZZLITC0.
All m -wage di5p l lnslw &tip:? m2ul or.no.7a3 vAlh of currzn� Umf rm Plumbing Code.
Any cuttiRg Grading, or fi l n in Gf Barr (4) f=Ll•eK VMM nul jf 9 V!*n .3 aaia f^ jai apvraaval.
Approval has been eb2aioaed from tNo Fps: w? _=l %`Ziar QuaRy cordmi owd for in"AD edosa of kine swage
disposal system.
This is to certify that the Riverside County Department of Public 13e-Zltaa approves for o� ^sPancy, construction ar
nstallation the itenW checi:^,d sbava.
aha
MAINTAIN 100% EXPANSION AREA. MIN. a FROM ANY WGLL
MIN. JW FROM MY LARGE TREE OR, WATER MAIN.
DEPARTMENT OF PUBLIC HEA1.1
IS VALID FOR ONE (1) WOR;
:FROM DATE OF APPROVAL.
a
' as ASSESSOR'S PARCEL NUMBER
COUNTAOF RIVERSIDE HEALTH SERVICES AGENCY
6 `Y - 0119 -
DEPARTMENT OF ENVIRONMENTAL HEALTH
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
APPLICANT: Submit this form with four copies of a SCALED plot plan (1-20 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 applica-
tion shall remain valid for a period not to exceed one year from date of payment.
LOG #
Agent, Con ` ctor, ontact Person
Address City State Zip
Telephone
4-1 It
o 43 r .22410
ti*- 6175 -
Q
Owner
o .
Address • City . State Zip
(290 .Tcfft A? 5, . 144.
Telephone
Z
Job Property Address
City
Zip
f
-Z2 -
U
Lot Size 102WLater Agenc I
Use of Permit, PIP, SUP, PUP, etc.
Legal Description
s U
lF/�IACE CL'.aC/! �i:✓f W SEEDA6�
CI a�j A<2�J d r/t /it/�/?. �Gd %j% fFC. o?� 773 f /� 9, —
SI , ature of Applicant
Date
/lA
CHECK BOX IF REOVIRED
❑ Holding Tank A reements Completed °
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval)
❑ Certification of Existing S.D. System Required
❑ Grading Handout Provided
m
❑ WQCB Clearance Required
❑ Staff Specialist Lot Inspection Required
Z
O
(Attach For DOH -SAN -007, Santa Ana Region Only
❑ Lot Inspection
U❑
Soils Percolation Report Required
W
CO
❑ Special Feasibility Boring Report Required
❑ Date Lot Inspection Completed: Initials
Remarks:
❑ Maintenance Booklet Provided
Initials Date
❑ Final Inspection by Department of Environmental Health is required.
CI421 Soils Percolation Boring Report by UcJProject # Date
Soils Map Page Soil Type 19 Approved By Date
No of Systems
Type.of System(s)No.Owdtiri"nits
(1) Septic Tank
Soil Rate
GreasR4/S nd
F X I S7%Aj 4
O Holding Tank Replacement
New
O0Addition
Fixture niUnits
EXIST;"M4/Nf, (D�,
E'x / S T!�%�
���
Grease Intcp'/W Trap
�
(f)
O Existing
0V Gala
�1
Gal.
/ PAIA I
Sq. Ft.
otal unear
Sidewall Allowance
Leach Bed sq. ft. of
Bdt,K Area
F
tt. rock/ sq. h. running ft.
Install Line(s) tt. long ___jt. wide with
Bottom Area
Inlet Tested Depth L+l'NA
min. in ook below drainlines or
U
Proposed Bottom Tested Depth
Z
Leach lines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below Inlet (BI)
Seepage Pit
Maximum
Other:
O
7
Total Depth
Allowable
P:
Applicable
O
/
Depth
!
NNIA
Overburden Factor'
LxJ 6'
TD °�
V
Well Review Approved: Date: Well Drilling Permit #
SIGNATURE -
Grading Plan Approved: Date:
SIGNATURE
Sewer Verification Approved: Date:
REMARKS:
1
This application i 'PPROVEO ENIED-for the category checked In SECTION B
FOR OFFICE USE ONLY
above, regarding the es gn o a subsurface disposal system as Indicated on the
acompanied plot plan, using the requirements set forth in SECTION C above A build-
Ing permit is necessary for the Installation of the above designed system. No construe-
p /
Revenue S 30 60
code ee $_ [
tion is Permitted In the required reserved 100% expansion area.
(1) Septic.Tank must be 100' minimum from any wells.
Check #
(2) Leach lines must be 101)' minimum from any wells, including expansion area.
Date i Initial vim,
.r
13
(3) Sewer lines must be 50' minimum from any wells.
Z
O
4) Seepage pits must be 150' minimum from any wells, Including expansion area.
Cn
ignature of Health .Official
C
os
fy
Date
0 G
wn-SAN ,ZZ tnev n/yai ulsmoutron: vvml I t—urnce rue; TtLLOW—Applcant; VINK—slag.w_ept.; (bVI—WENROL—Pians/Hecwrds
oer.4
:Cao - s,p eqv P,4
FxQSIT!Nta (sax, :cam..
Qr r ABa�DO�i' F- T11
-rAILF- D
LE:wua Lc u e s
1uSw-c .601/1 Fit -
10 t- . C
r r
/.vDiAV :SP.41e44
_ x/6.-080. �EF�E�� •fir , , .
Food Establishmont _,�— s ^rG6,;a Dispc4-9
Trailer Park a2k– cv. s-!:-Vtic Tank (IT60c 4c)[TU l%E.1-w/.✓7
Motel, Apt., Hotel s:;, Ft. ?i P_€adh UnoCQe e?iul
Dtaellin� % x 2 rQ`� a?ue �i!
Commz7cU BuRdins EXiS'r. Mai%✓T 006, cow.r.Von to $vvmr
swiminft F=!
No on-siti, regenoratiig ere:''r,'-,r &°. r2v?lin'; &v"i ed;Sd TrpQd irft tate ii ti@l?dual s9 R�F ga disposal
sy.-Ae ri. ti^rQwith appr34&j vijhiLia fro -a $ CW,'K7-W '3' -aa -rd.
Water su;plf SC i - 4hly"•.?,dsl 'st ' ' V"' leCi`.d c 7➢ € Y " � "e f l r /' (-VWd,)
�$ rw �1 w,rce. fTAll 3'^.rvage dia. ;'e � ` sig CTi:fa �1 ,£1: m k41110 i�^,yl e�y e� �e �'nrcnt U1.1itran f7 a^si!;rs Coda.
pA, p!'y cut&'&. v�.F' r� Gr �'�:.,,�jg,iis e7j�z -S r" fart: ���� Z=1' ..:tt; s'iu'Nf b; '.^m v? dlzir�lzel ap bro""a'l.
Aprroval hay e -^C19 F}7.� aj+ jW;,7 ftorbj it,.@ i F" C bF yl.m.r / i siy V`m:fm
disposal fl �.C••W7 �e.'s r i•Y,,�.9.s aajP od's3 as 131 Ce .'�a'� ��r !'1s���E:ed�a;Ii 3t t(:'3 v��i>�E^.
5ybi�a34.
Th(s is ,o certify that the Riu;imide County Depai'tmdlit Of PAUblir_t; in-appr7vat torggrsiructie"I
nstal!at.ion the itamt.) cftclti ;i au?ja. L+rWslobl -
MAINTAIN 1000/ EXPANSION AREA. MIN. AR / FROM A NY WILL)1�
MIN. 19' FROM ANY b1ftE TREE OR WATER MAAIN;;&
ru e
4aer�w �lie.
`vp�n1 L
1'r;�E��T ®� P LIC tAT{ j'
i_�Ay
9 f.
1S VALID FOR ONE (1) YEAR
:FROM DATE OF APPROVAL_