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0010-126 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9.(cornmencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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 & Professionals Code). (,) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain arcertificate 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 & policy no. are: Carrier Policy No. y 9TATF FUND -01 (This section need not be completed if the permit valuation is for $100.00 or less). (; ) 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. 1/ Date:, N' Applicant— Warning.,. pplicant k _ r Wa ning.?Failure in'sec`ure 1Nork'ers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $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., IMPORTANT Application is hereby,made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 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 applicaton agrees to, & shall, inclemnify­ & hold harmless the City of La Quinta, its officers, agents and employe 2. Any permit issued as a result of this application becomes null and VO i 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 State laws relating to the building construction, and hereby authorize representatives of this City to enter upon rj the above-mentioned property.fo� inspection purposes. Mf ' ^ Signature (Ow=ne /Agent) `��•' Date BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT 004AM2QU JOB SITE APN ADDRESS •.7&3•ta A1N'iLs DA.'V3LLA 7744,74-0249 OWNER CONTRACTOR/DESIGNER/EN (NEER THOMAS R THORN`t O s A. a TORM t"omm2t:.rolom P -I'D B0011,78 81-900 AM`tM? 52, $at 0 %&QUC°Pi'JA CA 92253 .INLY10 C.h. 92201 (760,P72 -U48 03L -k 1411 USE OF PERMIT 3r 2�N2r.F iii l' IOO S NOT INCLUM, ii.UXiMIAi LN1,001A i RIVEW11Y r . TRACT C0N3TRtrCM01C ,- -< ;Z240.00 SF PORCTV'PATIO 3.M.00 S GA AMdM}zt3RT ('") lf1,l9�. yi, wom n14CE iEtfJ,ilfb %.n .i"�°AT�:f3 'COST 011,iri��7SAR�Ei� �C�k+� CONST-RUCIT ION REQ PI,Ai.N € HM'Cf r'. 101 0©Q- E 9 3l8 ba c. 9 Fft DEPOSIT 1101 -WO -439.318 •n5t`xo F MF=V,.'X'IC L APEX 101-000-421-0011 i0.s SUCTRICAL FEE 101.000.4 000 �'C.U��7%�€a� • 4Q1-�JU:S+�:�•�i?CO .`�34.3.f?i3 U'i'RC+-90 Mdf TOM FUk =811) 101mtitli -241.000 $13,82 s3p=1' o d; 101-000413-000 $20.00 PV;�E :IS?:PiAN 101-000-44.1-345 $1o�3.uzi R 0 5 200 -� ���'� :eat. C�,r�,��.9�C�;lc��r.��aD �=�..A�tca,ECT: � . LEW YnnPATO.+ M 4250M fir a� "$c'1Ab ply -a ".R i I +x 14 DUE NOW t; RECEIPT DATE/.% BY DATE FINALED INSPECTOR r INSPECTION -RECORD OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Slab Grade g � � O Underground Ducts Ducts Return Air Steel Combustion Air Roof Deck O.K. to Wrap t�_6 . p / Q� Exhaust Fans F.A.U. Framing Insulation '7 =�p� ( Compressor ' Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior ath Drywall LnInt. Lath _ (t a� Final 9// - ST Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping ' PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping % �l 310- ' S— Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: -. Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Finals Utility Notice (Perm) —� Qj --.. rt.. m, e:_r' ;•ti♦i >�.< x •r r' v r Yt,.. �i �. v. _ :. s� _ TTi _ fi 'r" `jly v ..� s o 4�c f0 ItP s21, j� p % �y P.O. BOX 1504 APPLICATION ONLY Addrdess " d �- i/ I L- lr p -t LA QUINTA78-495 CCALIFORNIA ALLE 92253 r " Owner- - � ���.4s c1 / .�. Mailing r BUILDING: TYPE�CONST� OCC. GRP. Address (� �( -7 A.P. Number 2 7 4-/. City Zip Tel. Tel. i- 4 1) IJi efrid I *2.2.:r3 7-4 0 �~` y� 5 0ciD Legal Description ZO 7' %Jl. iC .21-o Address } City lZip I Tel.. State Lic. City . & Classif. Lic, Arch., Engr.,-•w• Desjaaer L—EA)e:} De,5,6� Gpzop Address Te _ City( Zip ( State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 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 and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5.Business and Professions 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 file 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 civil penally of not more than rive hundred dollars ($500). I l: 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, Buisness 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 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 did not build or improve for the purpose of sale.) 1'I I, 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 contractor(s) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec. B. & P.C. for this reason 1 Date Owner x .a f WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company L 'J. -, n Copy is filed with the city. ❑ Certified copy is hereby furnished. Y CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ,if the permit is for one hundred dollars ($100) valuation or less.) fG b I certify that in the pdiformance 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: If, after making this Certificate of Exemption you should become subject,' to the Workers' Compensation provisions of the Labor Code, you must forthwith compli with such provisions or this permifshaft be deemed revoked. CONSTRUCTION LENDING AGENCY - 1 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 Lender's Address This is a building permit when properly 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. 1 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— Wailing ateWailing Address City, State, Zip Description l OL 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 Permit= Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sq. Ft. ) La,� Size d No. / No. Dw. Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ W i L_L. *.,'b Cot T (2*c- c) . I - I f Estimated Valuation 4 PERMIT AMOUNT t Plan Chk. Dep. ' ` .250-00. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. x Grading Driveway Enc. Infrastructure TOTAL ��c' REMARKS 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 Permit= Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 3/5/01 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN # 774-174-025 No. 21727 Jurisdiction La Quinta Owner NameThomas E. Thornton Permit # 0010-126 No. 53-780 Street Avenida Villa City La Quinta Zip 92253 Tract # BLK250U23 Lot # 23,'24 Log # Study Area Square Footage 2240 Type of Development Single Family Residence No. of Units 1 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 2,240 or $ 4,592.00 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may n` be issued ez. Fees Paid By CC / Valley Independent Bank - Thomas ThorntonTel phone x;760 `-564-5090 check Name on the ch .ti w By Dr. Doris Wilson Superintendent �X. . Fee collected /exempted by Annette Barlow Payment Received $4,592.00 Check No. 235322 Signature JOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified rbove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to :ollect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant ' Copy - Applicant/Receipt Copy - Accounting RLAE " 3 `� 's�-�By :1 Y T11 LE c`:O -RECORDING REQUESTED BY: FIDELITY NATIONAL TITLE.COMPANY 9923KC 540033 WHEN OR D pp AND, I UNL JLOfA lllfX MENTS 76LOW, THOMAS ED THORNTON and SANDRA.M. THORNTON P.O. BOX 1178 LA QUINTA, CALIFORNIA 92253 M GRANT DEED $ . U PAGE SIZE DA PCOR NOCOR SMF MISC. A R L /' COPY LONG REFUND NCHG -EXAM APN: 77 - - 25 - 7 OA0[S The undersigned grantor(s) declare(s): Y� Documentary transfer tax is $35.20 (XXX) Computed on full value of property conveyed, or ( ) Computed on full value less liens and encumbrances remaining at time of sale. i ) Unincorporated area:.( ) City of and FOR A VALUABLE CONSIDERATION, receipt of,which is hereby acknowledged, HOLY TRINITY ROMANIAN ORTHODOX CHURCH hereby,.GRANT(S) to r� THOMAS ED THORNTON and SANDRA M. THORNTON, husband and wife as joint tenants . vn the*real property in the City of LA QUINTA, County of Riverside, State'of'California, V described as: Lot (s) 23 & 24,, Block 250, Unit'No.`23,,,-Tract `� Santa Carmelita at Vale La Quinta, as per map recorded -in Book 20, Page(s`)-Z5 inclusive of map!;,—in-t°he"officeof the County Recorder of said County. Dated May 4; 2000 State of California County of i.a`� Ak-i a i_ftZ-$ On Lko W c before me, N-o-rA'eZ �i.cr3C-ri, _ Iw Ri21 til SA��i3a . , . persona y appeared 'R�cSid..Ct-M •0P CCU KCL L X17 _-R C L), L A Z A Z- S c.C2 L.T4Ry 1-12 C 4 _Sci iZ..t- Z personally known to me (or pro -Jed to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the'same in his/her/their authorized capacity(ies); and that by his/her/their signature(s) on the instrument the person(s),.or the entity upon behalf of which the person(s)' acted, executed the instrumen . ,.WITNESS my ha n o ial Signature HOLY T�INITYI ROMANIAN ORTHODOX CHURCH BY IDS a r AIC;, MARIN SARBU, PRESIDENT OF COUNCIL BY 0S C_ ­ L. P- i Ail/ozeA•S u e i;( VIRORC LAZAR, SECRETARY/TREASURER 20o006000000600000000e0000000000000e! IDORU AFLOAREI i RLOS ANGELES COUNTY COMM. #1251713 0 S .S; NOTARY PUBLIC - CAUFORMA e OMy Comm. ExOms January 28, 2004 e eoeoeee®Geeeeoeeeee000noeeeeooeoeeeee (This area for official notarial seal) MAIL TAX STATEMENTS TO: �=�neo=,s.w RC DISTRICT - PLANNING REVIEW FORM' This form is tothe used by CDD staff for review.of single family dwellings in the RC (Cove Residential) District, in order to determine the applicability of compatibility issues or need to -require the filing of Master Design Guidelines by, the applicant. It shall be transmitted to the Building and Safety Department as your, correction list. Please attach'additional explanations as necessary..' APPLICANT THOMAS ED.-'.,THOPlgTON SITE ADDRESS .. '53-780 -Avenida Villa APN 7.74 _ 174. , _ 025 , BIN NO.: CASE NO.: 20.00=320. LEGAL: LOT 23 & 24L -BLOCK 2.5 -UNIT .'r . 2 S.C.@V.L.Q. CHECKED BY:DATE: 9�z 8 ( 6U Wal1�nT��Yai� Inform the assigned Building. plan,checker upon your, assignment to this case. - The CDD 'Executive Secretary maintains a logbook to track applications and assign,case numbers: REQUIRED ITEM X N. COMMENT/CORRECTION CompatibilityReview AAP�(CA 13 (-e-, Case logged and number assigned X -61< Verify legal and-APN information' x 0-4-i/2 • /i3 /&fir APc/ c . Consistent with MDG on file (as.applicable )C iuolvE v.--/ 'e-1 a •. MDG filing required (5 filings since 9/3/98) Consistency with, sireet/surrounding area 0,;-r sr Colors C + Materials Architecture OK w r na .rwZ-0L­A. —& �! N�/Ctl NJJ�Z/fu�0 M Cri /Tim£ . x ` �p_ 0IwW /",7:.. v-1) Ti 47 4 L4'2 Other Requirements: , c 6 wl 01. V'LA%Ify�is,, oro _ iw �� £,-r c 14AC6C - uc _ 4 jox /�- q27% ox Certificate of Occupanc YT a City of La- in Q V� Buildingand Safety Dep'artm. e'nt This Certificate issued pursuant to the requirements of Section 109 of the,. Uniform Building Code, certifying that, at the time'of issuance, this structure was in compliance with the various ordinances!,' of -the City regulating building construction or use. ` For the following: BUILDING A©DRESS: 5,3-780 AVN EIDX VILLA,. ' Use -Cia fi .: f .. . , ssi cation: SFD BId'g. Permit No. _'0010-126,. �t, n Occupancy Group: R 3 Type of Construction:'i VN Land Use.Zone. RC' ` Ownerof Building: THOMAS THORNTON� t �� Address:, °P.O: BOX 1-78 Cit LA QUINTA CA 92253 t By: ' STEVE TRAXEL ; Date:, Y09-14-01 Building Official POST IN A CONSPICUOUS PLACE