BPLB2019-001778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
PLUMBING/
BPLB2019-0017
78480 CALLE REMO
646182004
SIEGEL / SEPTIC SEJ$PAGE REPAIR
$6,000.00
Applicant:
SEWER & SEPTIC PROS INC
16315 AVENIDA RAMADA
DESERT HOT SPRINGS, CA 92240
DP
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JAN 3 0 2019
CITY OF LA QUINTA
DESIGN & DEVELOPMENT DEPARTMENT
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 Professions Code, and
my License is in full force and effect.
License Class: C42 License No.: 986954
Date: 1-5 &—( q Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
Llcense 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 byany applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_)1, as owneraf 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 oneyear 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, as owner ofthe property, am exclusively contracting with licensed contractors to
construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State
License Law does notapply 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 Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/30/2019
Owner:
JACK SIEGEL
78480 CALLE REMO
LA QUINTA, CA 92253
Contractor:
SEWER & SEPTIC PROS INC
16315 AVENIDA RAMADA
DESERT HOT SPRINGS, CA 92240
(760)329-7600
Llc. No.: 986954
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.
0 & 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 fnsurance carrier and policy number are:
Carrier: Policy Number: C65204769
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, I shall forthwith
comply with those provisions.
Date:- — 36 '( Cl Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). 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
IMPORTANTr Application is hereby made to the Building Official 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.
agree to comply with all city and county ordinances and state laws relating to building
:onstruction, and hereby authorize representatives of this city to enter upon the above -
mentioned property for inspection purposes.
]ate: --3u —12 Signature (Applicant or Agent)
Date: 1/30/2019
Application Number:
BPLB2019-0017
Property Address:
78480 CALLE REMO
APN:
646182004
Application Description:
SIEGEL / SEPTIC SEAPAGE REPAIR
Property Zoning:
Application Valuation:
$6,000.00
Applicant:
SEWER & SEPTIC PROS INC
16315 AVENIDA RAMADA
DESERT HOT SPRINGS, CA 92240
Detail: INSTALL A NEW 6X14 SEAPAGE PIT VIA D-BOX.
Owner:
JACK SIEGEL
78480 CALLE REMO
LA QUINTA, CA 92253
Contractor:
SEWER & SEPTIC PROS INC
16315 AVENIDA RAMADA
DESERT HOT SPRINGS, CA 92240
(760)329-7600
Llc. No.: 986954
DESCRIPTION
ACCOUNT QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404 0
$101.40
Total Paid for PERMIT ISSUANCE:
$101.40
DESCRIPTION
ACCOUNT QTY
AMOUNT
SEPTIC SYSTEM
101-0000-42401 0
$13.34
DESCRIPTION
ACCOUNT QTY
AMOUNT
SEPTIC SYSTEM PC
101-0000-42600 0
$13.34
Total Paid for PLUMBING FEES:
$26.68
DESCRIPTION
ACCOUNT CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416 0
$10.00
Total Paid for RECORDS MANAGEMENT FEE:
$10.00
DESCRIPTION
ACCOUNT QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611 0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00
RIY£u-JE L11,11NDtf FACILITY
ftm OF ENVIRONMENTAL HEALTH
47950 ARABIA ST. STE# A
01 /30/2019 000001
#1853 3:44PM JOSIE0013
722080 $234.00
CRD. CARD $234. 00
RU ENV HLTH"INDIO FE
47950 ARABIA ST
STE A
INDIO, CA. 92201
678-731-55I6
Sale
zzzzzzzzzzzz6391
MI Entry Method; Chip
Total: $ 5.55
01/30/19 18:38:50
Inv #; 000000003 Rppr Code; 015207
Apprvd; Online
The above Service Fee charge
is for the convenience of th•
payment method and is a
separate transaction payabir
in addition to the amount due.
Your signature indicates
acceptance of this Service Fee
and Your payment to the card
issuer according to their
Payment terms.
Customer Copy
THANK YOU!
,RC ENV HU14 INDIO
4f950 ARABIA ST
STE A
INDIO. CA. 92201
760-863-8287
Sale
zzzzzzzzzzzz6391
VISA Entry Method; Chip
Total: $ 234.00
01/30/19 15:39:07
Inv a: 000000003 APpr Code: 022619
Apprvd: Online
Customer Copy
nJeuv Vn-
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County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
PLC- Ctl"rc h
LAND USE APPLICATION &'_L'r
OFFICE USE ONLY
❑ 3880 Lemon Street • Suite 200 • Riverside • CA • 92501- (951) 955-8980 PE CODE: '7 c[ Z I FEE: :23Lt. G, r
W,47-950 Arabia Street • Suite A • Indio • CA 92201- (760) 863-7570 LAT: 3 3 , b- 6t l LON: - t l >S-,9
Use of Permit: A00171n.A,A`- PST ON:
OWTS INFORMATION
TR/PM -3 L L( i' LOT # ` APN
PRIMARY CONTACT Name b E-mail
PROPERTY
Street Address I 2- .L �
City
1
J ��'tc,
Zip Code
Water Agency/Well C
Lot Size v Z
INFORMATION
Name
PROPERTY
OWNER
Street Address I1
� � Z{�C C'.cllZ (esl/-e:
City��
.v.�q
Zip Code
Phone -3 jO C z-t0 q x E-mail
Company Name i
Contact
AGENT/
CONTRACTOR
Mailing Street Address
City
Zip Code
Phone 3 7c0 2y ,
�6GC�
Email
Owner/Representative Declaration: I certify that / have read the entire application and state that all the information is correct. I understand the
amount of fees paid is based on my declaration of information on this form, and that incorrect information is grounds for denial of the project.
Signature (Applicant/Representative); Date: U
C _ OFFICE USE ONLY T
_ _ _ . _
t22 F
PAYMENT INFORMATION
Receipt #
Check #
Credit Card Approval #
ADDITIONAL
For our office locations call us at (888) 722-4234 or visit our website at www.rivcoeh.org
EPO-92 (REV 11/18)
k� County of Riverside
DEPARTMENT OF ENVIRONMENTA
L HEALTH
www.rivcoeh.org
^-��-�--- LAND USE WORKSHEET
ON: B&S:
USE OF PERMIT: 4- ��9 IT(o,�A C 9 lT -M In A.
OWTS DESIGN
❑ New U Repair/Replacement ❑ Modification ❑ Connect to Existing OWTS Fixture Units:
❑ ATU ❑ Pump ❑ Connect to Sewer ❑ Septic Verification
Soils Percolation/Boring Report By: Date: Project:
C-42Certification: s�u�w SLIC j'2R�5 Date: (Irk License #; c
Septic Tank Capacity: I &C,Gv 7(r6 Soil Rate: Tested Depth:
LEACH LINES
LOT:
Bedrooms:
3
sd q 5- `i
❑ Rock below drain line: ���i
n. ❑Plastic Chambers �Lother:
Sidewall Allowance:
Sq. Ft. Bottom Area: Total Linear Ft.: # of Line(s): Length:
Special Design: ❑ Yes ❑ No Slope: ❑ N/A ❑ Overburden Max Trench Depth:
SEEPAGE PITS
Pit Diameter: # of Pits: l Depth Below Inlet (BI): i cl Total Depth: Max Depth:
ATU
❑ Groundwater: bgs ❑ Impermeable: bgs ❑ Other:
Manufacturer: Model: Rated Capacity:
Tanks Required: ❑ Pretreatment ❑ Pump ❑ Other:
Dispersal Field: ❑ Drip Dispersal ❑ Leach Lines ❑ Seepage Pits
Size: Emitters: Depth: (fill out above) (fill out abov
In addition to the above, provide the following prior to Final:
❑ Engineer Clearance Letter ❑ Service Agreement ❑ Recordation document ❑ ROP Permit
PROJECT STATUS
This application is WAPProved ❑ Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the
requirements set forth above. No construction is permitted in the required, reserved 100% expansion area. System must meet
requirements set forth in the Department's Local Agency Management Program (LAMP) and any applicable codes.
REHS Si atur
L, Date:
❑ 'Check Only
For our office locations call us at (888) 722-4234 or visit our website at www.rivcoeh.org
EPO-91 (REV 11/18(
_ County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM
❑ 3880 Lemon Street • Suite 200 - Riverside • CA - 92501 —(951) 955-8980
CR 47-950 Arabia Street - Suite A - Indio • CA 92201 — (760) 863-7570
Property Information: APN: -- 0 0 Ll Date of Inspection: (- 2 cf / 9
1. Owner: ys a Address: Sr e-1 fro Co t 1,
City:
FAILURE TO PROVIDE ALL REQUIRED INFORMA TION SHALL PREVENT OWNER FROM OBTAINING
ENVIRONMENTAL HEALTH APPROVAL
2 Show design and location on a scale of 1:20 or 1:40 of the sewage disposal system and 100% expansion area in relation to
dwellings, structures, wells, rock outcropp(ngs, drainage, watercourses, etc.
3. a. I examined existing subsurface sewage disposal system at the above location on f,&-epI-I y
and determined that
the tank capacity is t nv o gallons and that there is — sq. ft. of leach line bottom area. There are • .3
bedrooms in the dwelling and there are — fixture units.
b. There are r2 leach line(s), each ft. long Depth .—ft. ❑ Rock ❑ Plastic Chamber
c. There are __/_ Seel)age pit(s), each ft, in diameter, and
/ ft. TD. ft. BI.
d. The leach bed is ^— ft. by #., total sq. ft. of leached area. Depth is _ ft.
4. a. Construction of septic tank (Phase check one of the following):
concrete ❑ Fiberglass ❑ Steel a ❑ Other: _
b. Internal dimensions of septic: Length %- ft. Width ft. Depth
c. Condition of tank (please check yes or no for each question): Inlet Tee present? ❑ Yes U-No
Tank Structure deteriorated? ❑ Yes B'No Outlet Tee present? des ❑ No
Effluent Filter Present? ❑ Yes ❑ No Two compartments? 2-Fes ❑ No
d. Condition of D-Box: Level? ❑ Yes ❑ No Replaced? ❑ Yes O-No
5. a. While pumping the tank, did effluent flow back into tank from absorption system? Q-Tes ❑ No
b. Prior to pumping, was the liquid level in the tank above the outlet tee? 2-Yes ❑ No
c. Was the area around the lids oxidized? ❑ Yes O'No
d. Is design of system gravity feed? Q Yes ❑ No
e. Were well(s) observed on this or adjacent property? ❑ Yes Q No
If yes, indicate distance of well from: Septic tank ft. Leach lines Seepage Pits ft.
f. Distance from springs, lakes, and natural wets rc661Fa11 H3et-p}yplgr
F"eplic Tank ft. ❑ Leach lines ft. ❑ Seepage Pits ft,
g. Is sewer within 200 ft. of structure and abuts property line? ❑ Yes 5-kKo
Additional Comments:
h. How long has dwelling been vacant? (if applicable) months weeks ❑ N/A
6. a. ❑ 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.
b. It is my opinion that the system is not in good working order and will not function properly without the following
repairs: JL -c cc& a-Ot�
I certify under penalty of perjury that the foregoing is true and correct.
7
Signature: Print Name: in -I
Cyr w✓� .
Contractor License No.: R e- S' c/ Expiration Date: C/— 3 ep
Pumper Co.: Se-t-L- 5 JVo-ric ^I ��
CGS Phone Number: ��, �2i .�� o 0
Address: 1 3 i 5' d G � '�d�n Y : CNq - City: Zip: r7 C7
tru-91 (KEV 03116)
Contractor Name: S
Address: 16 3 t S
City, St, Zip p ��
Telephone:
Email: S
State Lie: Cog G9 City Bus Lie:
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lie:
City Bus Lie:
Property Owner's Name: � d
Address: L`�t Sr- LI kc> `fo Ie
City, ST, Zip A �
Telephone:
Email:
New SFD Construction:
Conditioned Space
Garage
Patio/Porch
/ Fire Sprinklers
YHu.I 1 c.iK
Construction Type:
Grading:
Bedrooms: I Stories:
SF
SF
SF
SF
Occupancy
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
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COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMEW OF FJ+i+ RONMFNTAl, HEALTH
A � VE
A--_ DAM . i I a �r 9
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED r
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