BPLB2019-0027D� VOICE (760) 777-7125
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/13/2019
Permit Type/Subtype: PLUMBING/ Owner:
Application Number: BPLB2019-0027 NANCY SPURRIER
Property Address: 78208 SAN TIMOTEO ST ST 78208 SAN TINOTEO
APN: 646160019 LA QUINTA, CA 92253
Application Description: SPURRIER / INSTALLATION OF NEW SEPTIC SYSTEM
Property Zoning:
Application Valuation: $20,000.00
Applicant: Contractor:
ALMS UNDERGROUND CONSTRUCTION INC P
LLLiiI ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE 38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234 FEB 13 2019D CATHEDRAL CITY, CA 92234
CITY OF LAOUINTA (760)324-1911
DESIGN & DEVELOPMENT DEPARTMENT Llc. No.: 482180
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:
C21, C42 License No.: 482180
Dateoolll� Q 2,0. 19 Contractor
-I!, W-W 00
OWNER -BUILDER DEC— RION
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).:
(_) 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.).
(_) 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
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
Lender's
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 t e 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: ACE AMERICAN INSURANCE COMPANY Policy Number: RWCC65201240
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 t�hollse provisions.
Date: 73 rea-201,/gApplicantagor L�,.
Opp
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO ERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN 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
IMPORTANT: 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.
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 upon the
above -mentioned property for inspection purposes.
DW.-j4j�l9 Signature (Applicant orAg, ��Y.P_PM_
Application Number:
BPLB2019-0027
Property Address:
78208 SAN TIMOTEO ST ST
APN:
646160019
Application Description.
SPURRIER / INSTALLATION OF NEW SEPTIC SYSTEM
Property Zoning:
Application Valuation:
$20,000.00
Applicant:
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
Date: 2/13/2019
Owner:
NANCY SPURRIER
78208 SAN TINOTEO
LA QUINTA, CA 92253
Contractor:
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
(760)324-1911
Llc. No.: 482180
Detail: SEPTIC TANK MUST BE INSTALLED ON PROPERTY. 17.5 FEET NORTH FROM EDGE OF PAVEMENT PER 2016 CALIFORNIA BUILDING CODE.
FINANCIAL
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
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
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
0:
RIVERSIDE C WIN0I0 FACILITY
DEPT OF FNVIRilldMFNTAI WrAI TU
C
7i
CC
47950 ARABTA ST. STE# R
County of Riverside
EPARTMENT OF ENVIRONMENTAL HEALTH
,2/ 1 31/c 019 000001 www,rivcoeh.org
1107 10:46AN JOSIEO013 LAND USE APPLICATION
2060 $234- 00 OFFICE USE ONLY
034 00 • Riverside • CA • 92501- (951) 955-8980 PE CODE: -_�!'7" _L I FEE: 3'1 G u
742 A • Indio • CA 92201-(760) 863-7570 LAT: '3 3, Cq 2 L. LON.- _t { . 3coo
HECK $234. O0
❑WTS INFORMATION
TR/PM LOT # APN c
PRIMARY CONTACT Name E-mail
PROPERTY
Street Address 7i2 i�,
51+,^-'
-I t���;LO
Sr
City
L.�- CiV�aT,�
Zip Code 1, 2-2- 3
INFORMATION
Water Agency/Well
ivL b
Lot Size
Name
�-lA-L
itit
PROPERTY
OWNER
Street Address
MI City i L A
Zip Code e' Z
Phone
E-mail
Company Name �1
!"1
/ 1 /
lit n d G
f it r1 Jk
Contact A
� 0 �-�-
AGENT/
Mailing Street Address
�8703
f <3+
Zip Code S 2� 3�
CONTRACTOR
t5
rail
Phone
7KO zY 7 l
1
I E-mail
/ ll
G��,ns under r u( i
Owner/Representative Declaration: I certify that I have read the entire application and state that all the information is correct. I understand the
amount of fees paid is based an my declaration armatian on this form, and that incorrect information is grounds for denial of the project.
Signature (Applicant/Representative): _ Date: /3 Fe{ . 2-0 j 9
SUBMITAL CHECKLIST
required at applicant's expense:
❑ Soils Percolation Report/Detailed Contour Plot Plan
0 Floor Plan andfor Plumbing Layout
0 Certification of Existing OWTS (C-42/A)
❑ WQCB Clearance
0 Special Feasibility Boring Report
0 Well Final Evaluation
0 Water Will Serve Letter
❑ Sewer Will Serve Letter
Other:
PAYMENT INFORMATION
Receipt #
Check it
Credit Card ,Approval #
OFFICE USE ONLY
EPO-92 Wl/ 11/19)
For our office locations call us at (888) 722-4234 or visit our website at www.rivcoeh.org
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
® 47-950 Arabia Street - Suite A • Indio • CA 92201 - (760) 863-7570
Property Information: APN: 6 k G - (- p t ci Date of Inspection: / / F�_; ,6 , Z -0 / ?
1. Owner: 4 A L a- 'kL �, T 'pvA' tLr- Address: -7 2-0';.5 Ae. T ,>1c>%t C T City: L,¢ L iil T-, t
FAILURE TO PROVIDE ALL REQUIRED /NFORNIATION 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 outcroppings, drainage, watercourses, etc.
3. a. I examined existing subsurface sewage disposal system at the above location on // Rk 2019 and determined that
the tank capacity is/DDD 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 leach line(s), each ft. long Depth ft. ❑ Rock ❑ Plastic Chamber
c. There are / Seepage pit(s), each !C ft. in diameter, and z O ft. TD. /V ft. BI.
d. The leach bed is ft. by ft., total sq. ft. of leached area. Depth is ft.
4. a. ConstruCiDrt of septic tank (Please check one of the Following):
LrJ-✓Concrete ❑ Fiberglass ❑ Steel , ❑ Other:
b. Internal dimensions of septic: Length V ft. Width 6 ft. Depth lam_ ft.
c. Condition of tank (please check yes or no for each_question,: Inlet Tee present? ❑ Yes ❑ No
Tank Structure deteriorated? ❑ Yes ZNo Outlet Tee present? ❑ Yes ❑ No
Effluent Filter Present? ❑ Yes ❑ No Two compartments? ❑ Yes (J No
d. Condition of D-Box: Level? ❑ Yes ❑ No Replaced? ❑ Yes ❑ No IA/ A
5, a. While pumping the tank, did effluent flow back into tank from absorption system? ❑ Yes ❑ No
b. Prior to pumping, was the liquid level in the tank above the outlet tee? ❑ Yes ❑ No
c. Was the area around the lids oxidized? ❑ Yes OrNo
d. Is design of system gravity feed? aryes ❑ No
e. Were well(s) observed on this or adjacent property? ❑ Yes 2No
If yes, indicate distance of well from: Septic tank eft Leach lines Seepage Pits
f. Distance from springs, lakes, and natural water courses chr�k all that apply):
❑ Septic Tank �❑ Leach lines ft. ❑ Seepage Pits
g. Is sewer within 200 ft. of structure and abuts property line? ❑ Yes Ca No
Additional Comments: a f'r c '4an e4 5 _frnwit n 4 n a�a
h. How long has dwelling been vacant? (if applicable)
weeks ❑ N/A
ft.
ft.
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: S„c'l a-* . r.. ; 4-L - J - _ _ C _ A - - -
! certifj under malty of perjury that the foregoing is true and correct.
J
Signature: es+�- Print Name:
Contractor License No.: `� ($ Q -Expiration mate: ❑
Pumper Co.; Phone Number: 73 2
Address: 397 3 I/" City Ci4eafraf 424 Zip: 9
E?0-31 ;RO/93/16)
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
wtivw.rivcoeh.arg
....,.': LAND USE WORKSHEET
ON: I B&S: APN: S 4 c — ''
USE OF PERMIT: _ (�U �G i �[
`f } Z r�� c� .� r Tg1PM: 1�0 LF 9; �*res z LOT: i �r
LEACH LINES
❑ Rock below drain line: in. ❑ Plastic Chambers ❑Other:
Sidewall Allowancz: ftZ/LF
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: G # of Pits: ( Depth Below Inlet (BI): Total Depth: /c max Depth:
ATU
❑ Groundwater: bgs ❑ Impermeable: bgs ❑ Other:
Manufacturer: Model: Rated Capacity:
Tanks Required: ❑ Pretreatment ❑ Pump ❑ Other:
Dispersal Field: Cl Drip Dispersal ❑ Leach Lines ❑ Seepage Pits
Size: Emitters: Depth: (fill out above) (fill out above)
In addition to the above, provide the following prior to Final:
❑ Engineer Clearance Letter ❑ Service Agreement ❑ Recordation document ❑ ROP Permit
CONSTRUCTION/INSTALLATION REMARKS
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PROJECT STATUS
This application is M. Approved ❑ 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 s t forth in the Department's Local .Agency IVlana. ernent Program (LAMP) and any applicable codes.
REHS Signature:
Plan �4 Only
For our office locations call us at (888) 722-4234 or visit our website at www.rivcoeh.org
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Project Address: $' 2 a E T,'w.a�� p
APN #: 6 Y 6 ' / 40 • 0 /
Applicant Name:
Address:
City, ST, Zip:
Telephone:
Email:
PERMIT # 0027
PLAN LOCATION:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
ZT,v':600-n2w Sv s4,2, »-,
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Valuation of Project
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LA QU I NTA, CA 92253
760-777-7000
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BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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