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05464 (SFD)`j Building Address 53-655 Villa. Owner C. KmIlffmann Mailing Address 71-851 Bleanora City Zip Rancho Hirage 92270 Address Alex G. Torres 53-980 Avenida Obre U.'Quinta g State Lic. & Classif. 5so498 B -i Arch., Engr., Designer. Address P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No. 11LDING: TYPE CONST. & OCC: GRP.. P. Number 774-133--020 'el. 61.13/3346-84.03 Legal, Description List 8 Project Description SM Tela 619/774"0767 06464 ally Lic. # Sq. Ft. 1530 No. No. Dw. Size Stories- Units Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm 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 aneffectd 'f!FZ SIGNATURE DATE OWNEWBUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and PrWessions Code: Any city or county which requires a permit to construct, alter, Improve, demolish. or repair any structure, prior to its issuance also requires the applicant for such permit to tae a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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 ova penally of not more than five hundred dollars ($500). O 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, Suisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such Improvements are not Intended or offered for safe. ff, however, the building or improvement is sold within one year of cortptetion, the owner -budder will have the burden of proving that he did not build or improve for the purpose of sale.) O 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's license Law.) ❑ 1 am exempt under Sec. R_ & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consentito self -insure, or a certificate of Worker's Compensation Insurance, or a cert -copy. thereof. (Sec. 3800, Labor Code.) Policy No. .Company ❑ Copy is filed with the city. ❑ Certified copy is hereby fumished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the permit is for one hundred dollars ($100) valuation or less.) 1 certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: 8, after makig Oris Certificate of Exemption you should become subject to the Workers' Compensation pmvsions of Ore Labor Code, you must forthwith comply with such provisions or Otis permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lenders Address This is a building permit when property filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. ' 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 the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ stimated valuation $82,960.00 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. 133.19 Const. 553.1,1V Mech. :)3.57U— •3UElectrical Electrical Plumbing.5 . S.M.I. T.151 Grading L .Hilt Driveway Enc. 20.U0 Infrastructure TOTAL REMARKS .f1 ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date 3/9/89 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES UNDERGROUND A.C. UNIT r. 1ST FL SO. FT. ® = UNITS ROUGH PLUMB. BONDING HEATING (ROUGH) YARD SPKLR SYSTEM 2ND FL SO. FT. ® ER OR SE✓M ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) GAR. SO. FT. ® POWER OUTLET ROOF DRAINS REINF. STEEL DRAINAGE PIPING CAR P. SO. FT. WALL SO. FT. ® DRINKING FOUNTAIN SERVICE FINAL INSP. URINAL SO FT ® WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. $ -Plus-X$-=$ WATER PIPING NOTE Not to be used as property tax valuation FINAL INSP. �` y� FLOOR DRAIN MECHANICAL FEES 00FING WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vi c SEWAGE DISPOSAL SO.FT.GAR ® Vbo HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE tL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK �LGROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA /J 6/LAB GRADE �- (� ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS ER OR SE✓M ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE S// ' GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ -Plus-X$-=$ LUMBER GR. FINAL INSP. �` y� FRAMING FINAL INSP. 00FING � v /6 `` c REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL �n Iti i'�. V' �W�"'�i'+'t•7' •�'1~Er"M' i�'"''t��i1}i' Pitt7jt 1 i ��r, �� ,�`.i�'asT".i�'r6. COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assemrs Pa's No. ENVIRONMENTAL HEALTH SERVICES / NT- 0_3 PERMIT APPLICATION FORA SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit thitform with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached check list A non-refundable filing fee (see below) is required when the application is submitted. Check rust be made payable to ihe County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval. i VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOWi I Agent, Contractor, Contact Person A 16 ne 3 Add +t'''eas & Phone. ' Mai Owner / Phone , Mailing Address ` 7 o vow 7 74\, City ` State Zip ` J Property Add LegalDescription Prop. (PM, Tract,' L/ot) ) 610c'L 7.41Z41� .Lot Size ell. Use of Perrntt`P/P C►U;1 dt 'Other r �a»=A,gency. V %i �b� p P , el i HaSit ep, etc. .� Sig .' re of Applicant a Data CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE 13_S BSURFACE DISPOSAL 1238$45.00 ❑ SITE EVALUATION UPON 13EQUEST 7349. $42.00 O MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DMSION ❑ SEWER/SEPTIC VERII=IOATION 7348 $11.00 a. lot 4;Parcels (Each) 1238 $45.00 i (Less thran 1 year b. Each Parcel after 4 7344 $16.00 * ❑ PRELIMINARY ELECTIVE 7352 $45.00 ❑ Rerevlew (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 '$45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 513200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq-Tt.. 7347 $66.00 !, AL DATE Holding Tank Agreements Completed �. O Yes p N� o .: ' • Certifik�ldon of Existing S.D. System�Requyired, 0 Yes p. No . . 'yes WC)CB Clearance required.. (Attach Form 0_140e DOH SAN 007, Santa Ana Region Only) Sills Percolation Report Required. ❑ Yes © No Special Feasibility Boring Report Required. p Yes l � ft ,. Detailed Contour!Plot Plans -Required • (1 to 5 interval)' - \ 'Yes Other ` ' 6 Yes J9rNa -Staff Specialist Lot inspectlon Required y ❑ Yes Lot Inspection Date Solis boring report by' # Date Sills Map Page / SoA Type Approved Y �// —' Date 3— p- by of Systems Type Systeme) No Dwelling Unks(/ (1).Septic Tank Grease/Sand❑Ing Tank ❑Existing ❑ Exi tingrner►t Bedrooms Fbdare�t9ntls ;S.11�R;.le Intcp3New Gal t 2) Leach Line Sq. Ft Bollorritrench Sidewall allowance ,' :Instal� Lrrta(s) It long ft wide with leach Bed sq ft area R rock/ sq- It .per running R :min. Inches IiZdretnlines or of area Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total, Depth Other: Applicable , Inlet (BI) / N/A Overburden factor C11/6 " /(� Allowagle Depth No. 2 System /14 REMARK: /h 1. f% z jThis application is APPROVED/g_ENIED"fbr,the category checked in SECTION B above, regarding the design of F.. subsurface 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 -designed system. No,construction is permitted in the required 'reserved 100% expansion area. Septic tank and sewer lines must be 50' minimum from any wens (0Leach lines must be 100' minimum from any wells, including expansrea $3, Seepage pits must be 150' minimum from any wells, including expans n ar �0 7` -�1-Y Signature of Heafth Official LAIL, f.14q Date 0 RECEIPT NO. -,Issued By S� Daae j DISTRICT: ❑ Riverside, C9 fndio ❑ 'Hemet Q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: 'WHITE - Office file YELLOW - Applicant PINK - dIdg. Dept "GOLDENROD Plans/Records Gag