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05-1288 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: [05-00001288 ✓t Property Address: 80820 VISTA BONITA TR APN: 772-280-006- - Application description: ADDITION - RESIDENTIAL Property Zoning: VERY LOW DENSITY RES Appliootion %,aluationl 10000 (f4tit - 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT D MAY i'i zoos Owner: GELLER 80820 VISTA BONITA TR LA QUINTA, CA 92253 CITYContractor: ANl.LA DURKTON, MARK Applicant: Architect or Engine r: FINANCEDEpy 69683 PLEASANT GROVE CATHEDRAL CITY, CA 92234 (760)328-7276 Lic. No.: 505442 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 Professionals Code, and m1 Licen ise is in full force and effect. License Class: 13 License 5 5442 r D'aie: contractor: M (MV— 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 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, 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. , 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: 5/13/05 ----------------------------------------------- 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 EXEMPT 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 '-'�Q�J3377,0000 of the Labor Code,, II shall forthwith comply with (those p�rowsi ns. -- Dater , Applicant: ) 1{✓ 1 i 1\!i'� Y V IGr f��l V 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 15100,0001. 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 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 inform is cor ct. I agree to comply with all city and county ordinances and state laws relating to building constru ' a her y au rize representatives of this county to enter upon the above-mentioned property oris n p rpo Date: RtTpignature (Applicant or Agent): Application Number . . . . . 05-00001288 ------ Structure Information 26 SQ. FT..ADD, AND BBQ ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC FLOOD ZONE NO 1ST FLOOR SQUARE FOOTAGE 26.00 ---------------=------------------------------------------------------------ Pa_rmi t RTTTT.nTMr, PFRMTT Additional desc . . Permit Fee . . . . 117.00 Plan Check Fee 76.05 Issue Date Valuation . . . 10000 Expiration Date 11/13/05 Qty Unit Charge Per Extension BASE FEE 45.00 8.00 9.0000 THOU BLDG 2,001-25,000 72.00 ---------------------------------------------------------------------------- Permit . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 15.91 Plan Check Fee 3.98 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/13/05. Qty Unit Charge Per Extension BASE FEE 15.00 26.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY .91 ---------------------------------------------------------------------------- Permit . . . MECHANICAL Additional desc . Permit Fee 21.50 Plan Check Fee 5.38 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 10%13/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.5000 EA MECH VENT FAN 6.50 ---------------------------------------------------------------------------- Permit . . . PLUMBING Additional desc . . Permit Fee . . . . 39.00 Issue Date . . . . Expiration Date . . 11/13/05 Qty Unit Charge Per LQPERMIT Plan Check Fee . Valuation . . 9.75 0 Extension ry Application Number . . . . . 05-00001288 Permit . . . . . . PLUMBING Qty Unit Charge Per Extension BASE FEE 15.00 3.00 6.0000 EA PLB FIXTURE 18.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments 26 SQ. FT. BATH ADDITION AND EXT. BBQ4/6 /05 10:32:59 AM jjohnson ------------------------------------------------------------------ Other Fees . . . . . . . . . ENERGY REVIEW FEE =--------- 7.61 STRONG MOTION (SMI) - RES 1.00 Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 193.41 .00 .00 193.41 Plan Check Total 95.16 .00 .00 95.16 Other Fee Total 8.61 .00 .00 8.61 Grand Total 297.18 .00. .00 297.18 LQPERMIT oachella Valley Unified School District 83-733 Avenue 55, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224_ This Box For District Use Only DEVELOPER FEES PAID AREA: '; - AMOUNT LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMMAND. AMOUNT: DATE, RF.r.F.IPT- CHFr..K N- INITIAL- CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: 1Zesidence is at the Polo Estates Date: May 11, 2005 Owner's Name: M/M Geller Phone No. 310-600-0698 Project Address: 80-820 Vista Bonita Trail La Quinta, CA Project Description: addition ATN: 772-280-006 Tract #: Type of Development: Residential XX! Commercial Total Square Feet of Building Area 26 sq. ft. Certification of Applicant/Owners: The person signing certifies that the above in penalty of perjury and further represents that he/she is authorized to sign o f the Dated: May 11, 2005 Signature: Lot #'s: Industrial is corr:ct and makes this statement under *********************************************************************** SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code 17620 Number of Sq.Ft. Amount per Sq.Ft. Amount Collected Gov. Code 65995 26 $ 0.00 $ 0.00 Building Permit Application Completed: Yes/No Project Agreement Existing Not Subject to Fee Approval Prior to 1/1/87 Requirement Note: By: Carey M. Carlson, Asst. Supt., Business Services Note: any addition to iirest ence.$oo sq. ft or under is exempt from developer fees �-� Certificate issued by: Elvira Mattson, Office Technician Signature: NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this Cistrict provide (1) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -da} period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other- applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not beer_ issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. 1lv �;ill;.iocsRietfce h rt.ificatc ofcompliance form W)IC lO 1.: (i.ililC 1/16/03 T COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY _ASSESSOR'S PARCEL NUMBER % v DEPARTMENT OF ENVIRONMENTAL HEALTH — =� _d APPLICATION FOR WASTE WATER DISPOSAL APPROVAL APPLICANT: Submit this form with four copies of a SCALED plot plan (1"=20' to 1"=40' 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 application shall remain valid for a period not to exceed one year from date of payment. LMS # Agent, Contractor, Contact Person Address 7.,?_/: J cALCC.- �_s,—q� �jtY �T` J4 State Zip T lephone �, Civ 5/7 L � r 41 1? Owner Address City State Zip Telephone Q (// Sid► !�'aNi%/t T%' LA C (1,-,1i cA Z Job Property Address City ' Zip %/1, 2 a i 1/JT c A IU Lot Size Water Agency/Well Use of er it P/P, SUP, PUP, etc. Legal Description DBA U) c, vwo Ad 6[12 ^ Dwelling, MHSite Prep., etc. Signature of Applicant � „�% / % Cate - '�Y U S FOR OFFICE USE ONLY CHECK BOX IF REQUIRED If any box is checked, this application shall be considered rejected until the ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) information is provided and the fee paid. Resubmittals later than 90 days after date noted below may require repayment of fees. ❑ Other C3Staff Specialist Lot Inspection Required 00 C3Holding Tank Agreements Completed 0 ❑ Certification of Existing S.D. System Required Thomas Bros. Page Grid W C]WQCB Clearance Required ❑ Date Lot Inspection Completed: Initials U) (Attach for DOH -SAN -007, Santa Ana Region Only) Remarks: ❑ Soils Percolation Report Required ❑ Maintenance Booklet Provided ❑ Special Feasibility Boring Report Required ❑ Final Inspection by Department of Environmental Health is required. ❑ Rereview Required Initials Date Please call 24 hours PRIOR to inspection. C/42 / Soils Percolation Boring Report By Lic/Project # y Date Soils Map Page Soil Type Approved By .z. Date No. of Systems Type of System(s) No. Dwelling Units (1) Septic TankSoil Rate Grease/Sand ❑ Holding Tank ❑ Replacement Bedrooms, Fixture Unit,17r /..t 5 Q Grease Intcp/Lint Trap ,2 ❑ New ❑ Addition55 1fkJfIe,W±JFfA r� 1 d 0 Existing ❑ Connect to Sewer 7 Gal. Gal. Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. Bottom Area Ft. 100 1- ft. rock/ sq. ft. running ft. Install Line(s) ft. long ft. wide of Bottom Area z— Inlet Tested Depth ❑ N/A with min. inches rock below drainlines U Pj /� Proposed Bottom Tested Depth or ---- Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (B1) Seepage Pit Maximum Other: 0 Applicable Total Depth Allowable Depth U N/A Overburden Factor ❑ 5' ❑ 6' TD W U) Well Review Approved: Date: Well Drilling Permit# SIGNATURE Grading Plan Approved: Date: SIGNATURE Plan Check Only Approved:: Date - G REMARKS: 611111 �n (/ T® i /�ii� �/'� �/1 /C iP(�✓iM�°r UU � ThisPROVED ENIED for the category checked in application i<AcIF- SECTION B abovedesign of a disposal system as indicated 'on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above- Revenue Code Fee $ designed system. No construction is permitted in the required reserved 100% expansion area. Check # (1) eptic Tank must be 100' minimum from any wells. Z2) each lines must be 100' minimum from any wells, including expansion Date Initial 0 area. (~j (3) Sewer lines must be 50' minimum from any wells. W C0 (4) Seepage pits must be 150' minimum from any wells, including expansion RIVERSIDE: 951-955-8980 area. I N DI O: 760-863-7000 SOUTHWEST: 951-600-6180 6 S' ure .. * •SDa� � S « ���• o », uibmuuuon: vvnl I r—mice rne; YtLLUW—Applicant; FINK-13ldg. Dept.; GOLDENROD—Plans/Records 41 � County of Riverside Community Health Agency Department of Environmental Health 4080 Lemon Street, 2nd Floor P.O. Box 1206 Riverside, CA 92502 �,.• (909) 955-8980 g 1. Certification of Existing Subsurface Sewage Disposal System. Date of Inspection: (Property Address) (Owner's Name) (Legal Description and APN) FAILURE TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT OWNER FROM OBTAINING ENVIRONMENTAL HEALTH SERVICES AFPROVAL. 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) 47 '"'" -0 'u date and determined that the septic tank capacity is / S -DQ gallons and that there is _1-4o g-5 sq. ft. of leachline bottom area. There are Sbedrooms in the dwelling. There are aS6 fixture units. b. There are leachline(s), each *400 ft. long. c. There are 0- plastic chamber(s), each e:► ft. long. d. There are -40— seepage pit(s), each ' in diameter, 'a" ft. deep. e. The leach bed is eft. by 700 ft., total sq. ft. of leachbed area. 4. a. Construction of septic tank (please check one of the following): F _concrete ❑ fiberglass ❑ steel ❑ other: b. Internal dimensions of septic (length ft., width, depth ft.) c. Condition of tank (please answer yes or no for each question): Yes No Inlet Tee present? X ❑ Outlet Tee present? Q ❑ Two compartments?] ❑ Tank structure deteriorated?* ❑ `Ia *If yes, briefly explain and indicate appropriate correction suggested: Condition of D -Box (if needed) Level (J Yes (JNo replaced (J Yes ❑ No full of septic effluent ❑ Yes ❑ No 5. a. While pumping the tank, did effluent flow back into tank from the absorption system' ❑ Yeses] No b. Prior to pumping, was the liquid level in the tank above the outlet tee? ❑ Yes D;IYo a c. Was the area around the lids oxidized? ❑ Yes @ No d. Is design of system gravity feed? Q'Yes ❑ No e. Were wells observed on this or adjacentproperty? r () f ❑ Yes No If yes, indicate distance of well from: Septic Tank_ ft. Leachlines / ft. Seepage Pits / ft. f. Distance from springs, lakes Septic Tank ft. and natural drainage courses: Leachlines ft. (circle appropriate item) Seepage Pits ft. g. Sewer is within 200 ft. of system and abuts property line. ❑ Yes ANo ADDITIONAL COMMENTS: h. How long has dwelling been vacant? (if applicable) months weeks N/A Or 6a. It is my opinion that the system appears to be in good working order and can be expected to function properly with r\proper maintenance. No repairs are necessary at this time. 6b. ❑ It is my opinion that the system is not in good working order and will not function properly without the following repairs: I certify under penalty of perjury that the foregoing is true and correct: Signature C/-42 State License Number Expiration Date W .s4' /'!1 ✓Y1 �7' 7"7 xYl rY1 f_ �, ` 1�eo'�t 5^ —[� t, Print Name Name of Pumper Company and Ffeceipt Number/Name of Company Holding C-42 License Address �` Phone Number The Department of Enviro mental Health has reviewed and approved this certification: Enviroafiia tal Health Specialist # • / Date DE4-SAM184 (Rev 10/03) �.: Distribution: WHITE—Office; PINK—Contractor; YELLOW—Applicant A;1W ., County of Riverside Community Health Agency Department of Environmental Health 4080 Lemon Street, 2nd Floor P.O. Box 1206 Riverside, CA 92502 (909) 955-8980 1. Certification of Existing Subsurface Sewage Disposal System. Date of Inspection: A 'S -c> s7 (Property Address) (Owner's Name) (Legal Description and APN) FAILURE TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT OWNER FROM OBTAINING ENVIRONMENTAL HEALTH SERVICES APPROVAL. 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) `i — *T • © 4V date and determined that the septic tank capacity is / 1 000 gallons and that there is at0 sq. ft. of leachline bottom area. There are 6 bedrooms in the dwelling. There are �"'' fixture units. b. There are / leachline(s), each kPQ ' ft. long. c. There are .A-- plastic chamber(s), each c+ ft. long. d. There are 4X seepage pit(s), each 4110- in diameter, ft. deep. e. The leach bed is eft. by ft., total 2 sq. ft. of leachbed area. 4. a. Construction of septic tank (please check one of the following): 0 concrete L) fiberglass C3 steel C3 other: b. Internal dimensions of septic (length _�ft., width $ depth ft.) c. Condition of tank (please answer yes or no for each question): Yes No Inlet Tee present? ,4. ❑ Outlet Tee present? R) ❑ Two compartments? `@ ❑ Tank structure deteriorated?' ❑ .0 "If yes, briefly explain and indicate appropriate correction suggested: _a_ fid''Condition of D -Box (if needed) Level ❑ Yes ❑ No replaced ❑ Yes ❑ No full of septic effluent ❑ Yes ❑ No ' +,5. a. While pumping the tank, did effluent flow back into tank from the absorption system? ❑ Yes F[4, No b. Prior to pumping, was the liquid level in the tank above the outlet tee? ❑ Yes No g c. Was the area around the lids oxidized? ❑ Yest No d. Is design of system gravity feed?��j Yes ❑ No e. Were well(s) observed on this or adjacent property? 0 Yesx,No If yes, indicate distance of well from: Septic Tank Leachlines % ft. Seepage Pits ft. f. Distance from springs, lakes Septic Tank ft. and natural drainage courses: Leachlines ft. (circle appropriate item) Seepage Pits ft. g. Sewer is within 200 ft. of system and abuts property line. ❑ Yes No ADDITIONAL COMMENTS: h. How long has dwelling been vacant? (if applicable) months weeks N/A `0- 6a. f 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. ❑ It is my opinion that the system is not in good working order and will not function properly without the following repairs: I certify under penalty of perjury that the foregoing is true and correct: / !" Signature / �C-42 State License Number Expiration Date V%iC.jC' a!"Z s moi• T se -Pi'%�...- sof . ✓Y1 s/Y7 44y- /z4P4.411" -K-- �i'i� C.. Print Name Name of Pumper Company and Receipt Number/Name of Company Holding C-42 LiAnse I- (?-t7-a /G 0 .7 - Address 4 Phone Number The Department of Environmental Health has reviewed and approved this certification: Environ men I Mli'Specialis(W Datef DEH 3_i Rev 10/03) Distribution: WHITE—Office; PINK—Contractor; YELLOW—Applicant (E) FRE51DENCE Q (WITH 8 EXISTING TOILETS) (N) BA (E) GA lw OUT- %C3E /• .0000 . / Sy5k4v, COUN1Y OF RITERSID9 DEPARTMENT OF ENVIRONMENTAL HEALTH L9,CisT aA( Sewage Disposal t/ Dwelling $-f � F_q l Aa l. Septic Tank • Commer ial _206Qq. Ya t. of Leach Line • Seepage Pits i No.—DIla _ E TD_MD IConnect to Sewer —Connect to Existing System tl'�No on-site water softening deAces shall be discharged into the septic system without clearance m the Calif. Region -.l �Zter QualLity C,aAtrw 15afdo Ali sewage disposal L*talWion sial! con='m:n to the cuff -Mt UPC Any lea iia in the Prea of the roposed.1, ach lines sh 1 ree� ire anew approval by this Dept ,, pfte�3 O Ei � z . rlIt Af • EPARTMENT Of PUKiC .: . W I 1S AID FOR o . FRO RATE % A� _ , . r, �I V. I M+ . 1N f01' �A sit, .s�® 0 U` 4- V+ V" -�- 2 CK if r foH I KUFT 1E] 7-q L � G 1� �G. a s ;TE PHEJ N R. ' NIE T Progressive Arehileclurul Design 82-72 ! Dr. Carreon Blvd. Indio, California 02201 (619) ;142-55)r