05-5172 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,-CALIFORNIA 92253
Application Number:
Property Address:
APN: .
Application description
Property Zoning:
Application valuation:
Applicant:
r
05-00005172 .
77750 AVENUE 50
658-190-003- -
PLUMBING
GOLF COURSE
50000
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that am licensed.under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: �QA �B��rC9 C27 jfp� �LicenseNo.: 743112
Date: SZ J'�"> ontractor:,l/�' �(/y'�'
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 70001 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 ) 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.).
1 _ 1 1, 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. , BAP.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: -
Owner:
LA QUINTA COUNTRY CLUB
P O BOX 99
LA QUINTA, CA 92253
Contractor:
WALL CONSTRUCTION,
78450 AVENUE 41
INDIO, CA 92201
(760)772-8446
Lic. No.: 743112
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/23/.05
WORKER'S COMPENSATION DECLARATION
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 STATE FUND Policy Number 0460004815
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
�ff. 3700 of the. Labor. Code, I shall forthwith comply with those provisions.
Date: t H-3-0SApplicant: Oil.,, 'y t�/t►`�
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 ($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 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 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 county to enter upon the above -mentioned property for inspection purposes.
Date: 1� S Signature (Applicant or Agent):
I
LQPERMIT
Application Number . . . . . 05-00005172
Permit PLUMBING SEWER
Additional desc .
Permit. Fee . . . . 30.00 Plan Check Fee
.00
Issue Date Valuation
50000
Expiration Date 5/22/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA PLB BUILDING SEWER
---------------------- --------------------------------------------------------
15.00
Permit PLUMBING
Additional desc
Permit Fee . . 33.00 Plan Check Fee
8.25 J
Issue bate Valuation
0
Expiration Date 5/22/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 12.0000 EA PLB INTERCEPTOR
12.00
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
------------------ 7------------------------ -----------------------
Special Notes and Comments
EXTEND EXISTING SEWER, WATER, GAS FROM
EXISTING CLUBHOUSE TO MODULAR BUILDINGS
& CVWD APPROVED GREASE INTERCEPTOR PER
APPROVED PLANS..
Fee summary -Charged Paid Credited'
Due
Permit Fee Total' 63.00 .00. 00
63.00
Plan Check Total 8.25 .00 .00
8.25
Grand Total 71.25 .00 .00
71.25
LQPERMrr
Bin #
City of La Quinta
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
ds� S 1
Project Address: I Vt %, 14my*
Owner's Name:
A. P. Number:
Address: -7 7 - ` OV
Legal Description:
City, ST, Zip: R2�
Contractor: AW -Dou (� 1„,q (i -r". 4�.—
Telephone:
Address:
Project Description:
City, ST, Zip:
Telephone: n
State Lic. # : City Lic. #:
Arch., Engr., Designer: 0
�x� f.
Address: ' 7-0
e✓es
D
City, ST, Zip:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Telephone: , �? �'
State Lic. #: ' �J
_
Name of Contact Person: u
Sq. Ft.: 4? O
# Stories:
# Units:
Telephone # of Contact Person: Q- 4544-6151
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
b
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan"
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing O'tS
Grant Deed
Plans picked up
Seu
S.M.I.
to ..
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctio issue
1 f�
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
COACHELLA VALLEY WATER DISTRICT ASSESSOR'S PARCEL NUMBER
85-995-Avenue 52 --- - -- - -
Coachella, California 92236
(760) 398-2651
APPLICATION FOR WASTEWATER INTERCEPTOR/SEPARATOR APPROVAL
APPLICANT: Submit this form with a copy of a SCALED plot plan (1" = 20' to 1" = 40' SCALE) drawn io District specifications. A nonrefundable filing fee is required
when the application is submitted. Check must be made payable to the Coachella Valley Water District Approval of this application shall remain valid for a period
not to exceed one (1) year from date of payment
Plan Check No.
Agent,'Contractor, Contact Person $
Address City State Zip
Telephone
,ar%/
t7odc� emu. d
!moo' i3 ivU �S ��i17�3
7G�7728`f�f6
Owner — �f'��j=�� tit
Address _._.._City--- tate Zip
Telephone
Quk
7 -TS0 Avt' Sa Ls Quo'fn
%0 6 o r s
Job Property Address City Zip
A-(Jff 56 �� d���-1-�. c
Legal Description
11,iq0Vj1VT*
DBA
NODU)1L' CL ()8Hbusc
PLEASE COMPLETE THIS SECTION FOR REVIEW OF FOOD ESTABLISHMENTS
NOTE: PLANS WILL NOT BE ACCEPTED UNLESS THIS APPLICATION IS COMPLETE AND THE PLAN CHECK FEE IS PAID.
GENERAL CONSTRUCTION:
Type of Construction:
New Food Facility >4 Remodel of Existing Food Establishment Hours of Operation 12 Seating Capacity: Internal 30t� External
External Seating with Misters or Heaters Bar with Food Service Bar Nonfood Service Water Softener
Serviee:
Multiservice (reusable) Single Service (disposable)
OWNER/REPRESENTATIVE DECLARATION: I certify that I have read the entire application and state that all information is correct. I understand that the amount of fee
paid is based on my declaration of information on this form and that incorrect information is grounds for denial of the submitted plans. I also understand that plans will be
discarded if not picked up within sixty (60) days of approval or denial and that no inspection of my establishment will be conducted, or approval granted to operate, until all
proper information requested has been received and plans have been approved and retumed:
Signature \XM� �� Date l� 'L2 O.T-
-�...'lr
s" .ate•;,.
.:5� xPs ,.y Fr' �x,, O,�tDISTR�CT IiSE�e ON3X�.�.r` ������,�.-����,�,��.u�a�;���-<{x��>����
�'°tom y� x az:�.iyx3 5}hr`v�
4���H��i:� .
No. of Systems
Type of System(s)
No. Dwelling Units
❑ Sand/Oil ❑ Grease Interceptor Waived
hfNe'w ❑ Existing
Fixture Units
MGrease Interceptor
❑ Lint Trap
❑ Replacement ❑ Addition
❑ Clarifier
❑ Connect to Sewer
�c�DO Gal.
REMARKS:
OZI
ZV�-�
This application is:
O_Approved❑ Denied ❑ Conditional Approval*
Fee S
Check No. %QM
*See Remarks
Date
Initial
Sign
CVWD-921
1 •� 1 r
COACHI�LLA VALLEY WATER DISTRICT, POST OFFICE BOX 1058
COACHELLA, CALIFORNIA 92236 Phone (619)• 398-2651
' INTERCEPTOR/SEPARATOR APPLICATION
SECTION -A: GENERAL INFORMATION' .
BUSINESS OWNER NAME: f �:U „^1 �'!Q G� lV * (Z� r-L-V (j
BUSINESS OWNER ADDRESS: "Z'/ %S-y PVC �U (�yy,rj� Cl4' PHONE: (69 `Jloy-.L•t•�S
PROPERTY OWNER NAME: \ S',A ML AS J �'
PROPERTY OWNER ADDRESS: PHONE:
BUSINESS NAME: LG► A�,�...�y Mod�t�r' L� Qt{s�
ADDRESS: a S a.M G PCs �} (� �J� i
PHONE: --y �t
PERSON TO CONTACT FOR SERVICING P_ LtJ l PHONE: /vV �I. 1 y IJ
SECTION B:. SERVICE INFORMATION 1
CHECK ONE: EXISTING DISCHARGE [ ]-PROPOSED DISCHARGE
IF PROPOSED DISCHARGE, ANTICIPATED DATE OF DISCHARGE vs- — of '
1. CHECK ALL ACTIVITIES WHICH ARE PRESENT.AT YOUR FACILITY:
( ] OFFICE. [ ] MANUFACTURING, [ ] PRINTING/PHOTO FINISHING .
( } RETAIL/WHOLESALE [ ] ELECTROPLATING [ ]•CHEMICAL BULK STORAGE
( l WAREHOUSE [ ]' FLAMMABLES
' ( ] - ASSEMBLY ( 1. CAR WASH _
• ( ] OTHER
( ] LAUNDRY �< FOOD PROCESSING [ ] OTHER
( ] HOSPITAL [ ] REPAIR SHOP/GARAGE ( ] OTHER
2. IF RESTAURANT NO. OF SEATS_ �p
3• IF LAUNDROMAT NO. OF WASHERS
4.' IF GAS STATION NO. OF PUMPS
WATER SOURCE: . [>-p CVWD [ ] Other.
IS WATER SUPPLIED BY LANDLORD? [ ] YES NO
WHICH BUSINESS NAME APPEARS ON WATER BILL_ L, A- &J n rq C O N/L'E-/y (• LV
NOTE: EACH INTERCEPTOR/SEPARATOR REQUIRES ITS OWN SEWER LATERAL', SEPARATE FROM THE*REST
OF THE BUILDING'S PLUMING, CONNECTED -DIRECTLY TO THE DISTRICT.'S SEWER SYSTEM.
EXCEPTION: THE USER OF AN INTERCEPTOR/SEPARATOR.MAY CONNECT THEIR DOMESTIC WASTE
LINE DOWNSTREAM OF THE SAMPLE BOX ON THE INTERCEPTOR/SEPARATOR LATERAL.
SECTION C: 'WASTE GENERATION
1. LIST DISCHARGE FLOWS, IF KNOWN:
CONNECTION NO. TYPE OR
SEWER SIZE AVG. FLOW (GPD) STRENGTH
1
2
3
f% '2: ATTACH COPY OF THE PLUMBING PLAN INCLUDING ISOMETRIC DRAWINGS.
=E NOTE NO. 2 J
E NOTE NO. 3
A
T-6
PLAN VIEW
ALL DIMENSIONS IN .INCHES
MODEL
A I
B
C
, D
E
• F
I G
H-
PC G-5000
50
48
65
74
74
24 3/4
4 1/2
41 1/2
PC G-6250
59
57
74
74
74
29 3/4
4 1/2
50 1/2
PC G-7500
62 1/2
60 1/2
77 1/2
85
85
30 3/4
5
53 1/2
EXCAVATION SPECIFlCATIONS
MODEL
G-5000
G-6250
G-7500
LENGTH
47'-0"
47.'-0"
47'-0"
WIDTH
10'-0"
10'-0"
11'-0"
BELOW INLET
4'-2"
4'-11"
5-2 1/2"
TANK HEIGHT
5'-5"
6'-2"
6'-5 1/2"
vent. 2-way cleanout
OUTLET
sanitary tee
running, outlet
] nning, trap•
"-CAP
e°
w /
` E
I 1 VARIABLE TO
GRADE IN
1 I 6" INCREMENTS
8"
3 1 4" TYPICAL
1 I I - E . SIDE
J WALLS
TIN
C 1 I RECESS
I I
4 3/4" TYPICAL
END h SIDE
WALLS
D •
2"4"
WOOD SLEEPERS
OUTLET
ND VIEI
` Interceptors/Separators: (i.e.,.grease, oil,.sand, and lint)
Interceptors/Separators shall be provided when, in the opinion of the
General Manager, they are necessary for the proper handling of liquid
wastes containing grease in excessive amounts, or any flammable wastes,
sand or other harmful ingredients; except that such
Interceptor/Separators shall not be required for Dwelling Units. All
Interceptors/Separators shall be of a type and capacity approved by the
General Manager, and shall be located.as to be readily accessible
for cleaning and.inspection. Interceptors/Separators shall be
maintained in continuously efficient operation at all times by the User
and at the Users expense.
Requirements
1) Size and location of Interceptor/Separator to be approved'prior.to
installation.
2)•Interceptor/Separator to have:
a) Sample Box
b) Sanitary Tee on discharge side of sample box.
c) Running Trap
d) Two Way Cleanout prior to sewer connection.
e) vent line after Sample Box, vent to be routed'to building internal
plumbing.
f) Manholes required at inlet, outlet baffle -tubes, and over each
battery opening.
g) To provide cleaning access all areas of an interceptor; a minimum
of one manhole one (1) per ten (10) feet of interceptor length.
Manhole covers shall.be gastight in construction having a minimum
opening demension of twenty (20) inches.
3) Inspection of Interceptor/Separator:
a) Interior examination required by District Source Control
Inspectors prior to filling Interceptor/Separator with water.
b) All external inlet and outlet plumbing to be inspected by Source
Control Inspectors prior to backfilling.
C) All manholes and sample boxes must be installed a minimum of one
(1) inch above finish grade/pavement with a concrete collar a
minimum of eighteen (18) inches around the manhole and sample box
frames, with a minimum depth of eighteen (18) inches.
D) Examination by inspectors required prior to pouring concrete
collars to verify depth.
yf�