04-3735 (PLBG)49350 Avenida Anselmo
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BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . .04-00003735 Date 4/28/04
Property Address . . . . . . 49350 AVENIDA ANSELMO
APN: 658-280-001-139 -000000-
Application description PLUMBING
Property Zoning . . . . LOW DENSITY RESIDENTIAL
Application valuation 2000
Owner
------------------------
PIERRE COSSETT
49350 AVENIDA ANSELMO
LA QUINTA CA 92253
Contractor
------------------------
ALMS UNDERGROUND CONST, INC.
38703 VISTA DRIVE
CATHEDRAL CITY CA 92234
Qty Unit Charge Per
BASE FEE Q
1.00 45.0000 EA PLB SEPTIC $
----------------------------------------------
Special
_____Special Notes and Comments"µ Q
NEW SEPTIC SYSTEM PER HEALTH DEPT-
APPROVED PLANS.
Fee summary Charged
Permit Fee Total 60.00
Plan Check Total 15.00
Grand Total 75.00
Paid Cr6dited
00 .00
.00 .00
.00 .00
Extension
15.00
-------45_00-
Due
60.00
15.00
75.00
WCC:
VIRGINIA INC
WC:
00500016007
01/01/05
CSLB:
482180
11/30/05
CCC:
C42-C2i
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Permit . . . . . . PLUMBING
Additional desc
Permit Fee . . . . 60.00
Plan
Check Fee
15.00
Issue Date . . . .
Valuation
0
Expiration Date 10/28/04
Qty Unit Charge Per
BASE FEE Q
1.00 45.0000 EA PLB SEPTIC $
----------------------------------------------
Special
_____Special Notes and Comments"µ Q
NEW SEPTIC SYSTEM PER HEALTH DEPT-
APPROVED PLANS.
Fee summary Charged
Permit Fee Total 60.00
Plan Check Total 15.00
Grand Total 75.00
Paid Cr6dited
00 .00
.00 .00
.00 .00
Extension
15.00
-------45_00-
Due
60.00
15.00
75.00
P.O. Box 1504 • VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: e9-4 Date:
Applicant: Architect oreer:
Applicant's ailing Address Architect or E gineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 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 Liceryse i in full fo e an effect.
License Classss ) C_ License No.
Date (�.0 � G% Contractor -4� fli7, 2
/ OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
yssed. My workers' co pensation insurance carrier and policy number are:
Carrier l/ (nl.� - Policy Number
I certify that, in the performance of the work for whichh th emit is issued, I shall not employ any perkon 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, 1 shall
forthwith comply with those provisions.
Date• Y^� rUy APPlicant�/t'J2l�'%
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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of *ththerea 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
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is herector 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 Ouinta, 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
construction, and hereby authorize representatives of this county to enter upon the above agree to coniwithall city and county ordinances and state laws relating to building
-mentioned pperty for inspection purposes.
r! �
Date Signature (Applicant or Agent):
ASSESSOR'S PARCEL NUMBER
COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY / �,- _ rd _ 0 0 1
(�
DEPARTMENT OF ENVIRONMENTAL HEALTH
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 City State Zip
Telephone
Owner r
Address City State Zip
Telephone
Q
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I'e.'r� .,��.r/ �t ,��
-t1i e`er � I o ..1h e _fl.,u
OJob
Property Address
City
Zip
Lot Size
Water Agency/Well
Use Permit, P/P, SUP, PUP, etc.
Legal Description
DBA
U-1
C
Dwelling, MH Site Prep., etc.
wf!�
Signature of Applicant 1
Date
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
Z[JHolding
Tank Agreements Completed
❑ Staff Specialist Lot Inspection Required
❑ Certification of Existing S.D. System Required
Thomas Bros. Page Grid
W
❑ WQCB Clearance Required
C3Date Lot Inspection Completed: Initials
(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 # Date
Soils Map Page Soil Type Approved By Date
No. of Systems
Type of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
❑ Holding Tank ❑ Replacement
Bedrooms, Fixture UnitsS-�
Grease Intcp/Lint Trap
New ❑ Addition
�❑
i r�
NYh�I d.
f h`�.�
00OGal.
100
Existing ❑ Connect to Sewer
1
Gal.
Sq. Ft.
Total Linear
Sidewall Allowance
Leach Bed sq. ft.
Bottom Area
Ft.
ft. rock/ sq. ft. running ft.
Install Line(s) ft. long ft. wide
of Bottom Area
Inlet Tested Depth ❑ N/A
with min. inches rock below drainlines
U
Proposed Bottom Tested Depth
or
Z
Leach lines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below Inlet (131)
Seepage Pit
Maximum
Other:
P:Applicable
0
Total Depth
tj 0
Allowable
Depth
W
N/A Overburden Factor
❑ 5' �) (6'
t
TD
Li t�
U)
Well Review Approved: Date: Well Drilling Permit#
SIGNATURE
Grading Plan Approved: Date:
SIGNATURE
Plan Check Only Approved: Date:
j
ly,1JCtv-A,C j �, G+aj�% +. t',!F
REMARKS: ,k 7o Irrv, Wa4tAS -%4 t-M
VII0I4 bfawri IVIS Vt Is. MCI, Jai
'At 1,I„k. -So`,
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This application is(APPROVED%DENIED for the category checked in
SECTION B above, 11 er�garrding�the design of a disposal indicated
system as
on the accompanied plot plan, using the requirements set forth in SECTION
3S
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.
�� t
Check # �r
(1) Septic Tank must be 100' minimum from any wells.
Ll ) Z' 10 L4
Z
(2) Leach lines must be 100' minimum from any wells, including expansion
Date Initial
O
area.
(~j
(3) Sewer lines must be 50' minimum from any wells.
W
U)
(4) Seepage pits must be 150' minimum from any wells, including expansion
RIVERSIDE: 909-955-8980
area.
INDIO: 760-863-7000
SOUTHWEST: 909-600-6180
Signature
`-1 >� 1
Date
Utr1-5AN-Tzz (Kev aiUi) ulstrlbution: WHITE—Office File; YELLOW—Applicant; PINK—Bldg. Dept.; GOLDENROD—Plans/Records
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ALMS UNDERGROUND CONSTRUCTION
38703 Vista Drive, Cathedral City, Ca. 92234
760-324-1911, FAX: 760-324-9541
CITY OF IA QUINTA
BUILDING & SAFETYPT-
Ap CONSTRUCTIONO N
FOR
TF =1=Z Oy BY
rVTa;n .400 se.
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AP1:1 IT'llCAR? 'WTI ffh
EPARTMENT OF PU I RM
IS VALID FOR ONE (1) YEAR
F DATE Of APPRO .
COUNTY OE RNERSIDE
DEPARTMENT OF EIMRONMENTAL HEALTH
Sewage Disposal
M-0 Gal. Septic Tank
. Dwelling_ FL of Leacin Line
` •
commercial S _ Dia — 9) D
e Pits e \
.. Seepag I No
_Connect to Eldsting System ....
Connect to Sewer
devices shelf be discharged into the septic system withoa E clearance
PIo on-site water softening Control Board.
r ' the. Calif Regional Water Quality
airs a new approval by this I ept-
All sewage disposal installation shall
conform lea h 1iheh 3hk1reqnt e c P
Any grading. -in the l;i ea o th p p
Oate:gF' r
u:.
TN s p ut
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LA QUH
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BUILDING &SAFETY.' D RTMENT:
Sf
ACCEPTe-0 FORC009W.-M-1.
a .0—TION
SUBJECTS'® INSTALLATIM, k' ,) PER
AND ALL APPLICABLE CODES
DAT E BY
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