0007-098 (SFD)LICENSED 'CONTRACTOR 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
Professionals Code, and my License is in full force and effect.
License # , Lic. Class Exp. Date
604-541 All
Date -- *"'Signature of
ER -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). y
() 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 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 & policy no. are:
Carrier Policy No.
STATE, FUND 13212V-0-101
(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-p,fovisions of Section 3700 of the Labor
Code, I.shall forthwith comply wl h''th s'e,p visions.
Date: '�. ^ /ADDlicant
Warning: Failure to secure W6W&r§'"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 peirgon 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, indemnify
map & hold harmless the City of La Quinta, its officers, agents and employees.
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 sushi
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�resentatives of this City to ,enter upon
the above-mentioned property1b. i p�ection purposes. *� :�p�..
f# Signature (Owner/Agenf)/�Dates y
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �Q-1098 TRACT
JOB SITE
ADDRESSry
APN
yV
OWNER
CONTRACTOR / DESIGNER/EN (NEER
MkR MOv3 P.CFdTERS0011T,
4&VO 1EN4J9 .R r
TEW,C' 1LA ("A 925.91
USE OF PERMIT
:{�AtDyQa] PZ r 'OE ROT l?J'(::LUDIi l LID, CI ,.V AL4 irt3EOL OR, ;e:)D.tidBd'EWAY
(loll
P01W' HlPAT10 'fi01JF
GAR,p` OWCA11PORT 1� 043160
5 Fr. Won,FMI CE 200.00 Uy
IYA ilbXED COST OF C;OAX:W117.i:'dGiX
12:3,6415.10
�E
�:S:cy.I�,.`1• dT .Yw.JRT.• FY 7.e�.1i7J1ALI:V.A
0, NS`CiBUC'! JOW Z&V VW50
k'.(1A`N C `if�'✓C:fi WE 103 -000-439- 318 $63;1.-'25
1.01.000.421 -OW W.0
101 -000 -420 -OW $130.2.6.
PLUMP.N. o RF 101.0004,19x000 1241:.00
R..E'[3�7�d4t�pMO,y`!'ION �''�' E . RESID 1 01 �• 000-24 `,t -00 .$1 X.96
/S'�'`'
'•hl.it{7DIi.`6\� !'.O.!1 EIt "kJ4�W�'"T �}'"4NG3� $710a09
V11VELOPE3?.lMPA'C'1' h"R'..Y $1,901.00
P1'Eu➢1.iH;1 LAN $101.00
VFWM11rPOS):`i' .$250.w
ARD KANcs%WX
V,747.07
LYMIS ir,R_l✓', D PN. S
LSA
4250.00
r
SEP 2 4 2001
.'CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE i
BY
DTE FIN D
-o'Z
INSPECTOR
7,
,�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
O Z ��
Underground Ducts
Forms & Footings
Slab Grade
/
/ •C
Ducts
Return Air
Steel.
Roof Deck
O.K, to Wrap
Framing
Insulation
` � py
f'—�y� ?�
S-� . o z.
}
(f�
Combustion Air
Exhaust Fans
F.A.U.
Compressor
vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
` �-
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
Heater Final
_
Waste Lines �— f- d/L
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
`
Encapsulation
Gas Test
zl_7 v Z_
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
Final
Utility Notice (Perm)
l':-lV tom-
4
P.O. BOX 1504
/ 78-495 CALLE TAMPICO
Address.513) (o N t Y �V n `t LA QUINTA, CALIFORNIA 92253
mailin
Address��
City Zip Tel
�� � .
�Cttor
�
Address '
,b<1 1 ITel.
Arch., Engr.,
Designer
Address Tel.
City Zip State
uc. #
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 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 penalty of not more than five hundred dollars (5500).
I7 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, Bukness 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.)
Il I, as owner of the property, am exclusively contracting with licensed contractcrs 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 ccntracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
f! I am exempt under Sec. B. 8 P.C. for this reason
Date !� V ! Owner
WORKERS' COMPENSATION DECLARATION
I 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
r7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
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.)
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.
Date Owner
NOTICE To APPLICANT: 11, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performarce 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.
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 a0plicant Date
Mailing Address
City, State, Zip
-��'!'ri�►-s'"'f't �q'r•�' w ave
APPLICATION ONLY
ILDING: TYPE'CONST. OCC. GRP.
'. Number - t
egal Description
roject Description t 13S -TC) A A V\ 0AVE
I_ Qs L ) Kat A� .
Sq. Ft.
Size
New Add ❑
ft`0
11
No. I)Wt
Units
Alter ❑ Repair ❑ 1 Demolition ❑
/////,U scl= U1f Ai ,fit f///DG/l ll / / /
Mmated Valuation
�C-G C,6 G U
PERMIT
Plan Chk. Dep.
AMOUNT
n y
Plan Chk. Bal.
;
Const.
Mech.
Electrical
Plumbing
r'- : _ -- r`•�
l
S.M.I.
p9radin9
Driveway Enc.
rastructureJUL
e''' f
iI
,1 U"! fj
� � 1
TOTAL
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
t
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated' 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/13/01
No. 22251
Owner NameWilmar Family Partnership
No, 51-320 Street Avenida Juarez
City La Quinta
Tract # Lot #
Type of Development
Comments
Single Family Residence
APN # 773-043-007
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area
Square Footage 2084
No. of Units 1
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 2,084 or $ 4,272.20 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By CASH - Carolyn Waters of Wilmar Family Partner. Telephone' 918-999-;81731
Name on the check
By Dr. Doris Wilson -
4
Superintendent t
Fee collected /exempted by Annette Barlow
4�� to--ol
Signature
Payment Received $4,272.20
Check No.
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above 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
RECORDING REQUESTED BY
F5'& HADDEN
AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN
BELOW, MAIL TAB STATEMENT TO:
Name Mary Agnes Montgomery
c/o Carolyn Watters
Address
City
State
Zip
Tide Order No. Escrow No.
DOC a 2000-517067
12/28/2000 08:00A Fee:9.00
Page 1 of 2
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk & Recorder
M
S
U
PAGE
SIZE
DA PCOR NOCOR
SMF
MISC.
UZ
A
R
L
COPY LONG REFUND
NCHG
EXAM
T 360 LEGAL (1-94) Quitclaim Deed
Grantors & Grantees hold same interes
THE UNDERSIGNED GRANTOR(s) DECLARE(s) XX*')M&()XWX=t KWMM 1XXNXX
DOCUMENTARY TRANSFER TAX IS $ 0
unincorporated area City of
Parcel No. I�ZNeal W �-Ariera adden
computed on full value of property conveyed, or
computed on full value less value of liens or encumbrances remaining at time of sale, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Mary Agnes
Montgomery, a single woman, as to an undivided 97.42% interest, Carolyn Frances Watters, a married woman (spouse of James Watters), as
to an undivided .86% interest, James Watters, a married man (spouse of Carolyn Frances Watters), as to an undivided .86% interest and
Carolyn Frances Watters as Custodian for Daisey Mae Montgomery, a single min='=' oman, under the California Uniform Transfers to
Minors Act as to an undivided .86% interest
hereby REMISE, RELEASE AND FOREVER QUITCLAIM to
the WILMAR Family Limited Partnership, a California Limited Partnership
the following described real property in the County of Riverside, State of California:
Lot 21 of Block 49, Santa Carmelita at Vale LaQuinta, Unit 4, Map Book 18, Page 62.
APN 773043007-9
Dated L } ' b Q
STATE OF CALIFORNIA ) Ag '' Mo�
COUNTY OF LOS ANGELES 1 S.S.
On. D Cr—'£,n Pc -ft— 19 �.LOZ before me,
6- L &Q-,fA �(ALZQ-fv� C 1 nFrances
A Notary Public In and for said County and State, personally appeared
Mary Agnes Montgomery, Carolyn Frances Watters & James Watters S Watters
Cl
personally known to. me (
evkWaee) to be the person(s) whose names) jetare subscribed to the
within instrument acknowledged to me that heleHe/they executed the Caro T c
N�er/
same in h+Awdtheir authorized capacity(ies), and that by hictheir unde a or
signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
WITNESS my hand and official seal _
Signature
• .�• r� o, .Ott.
Mae Montgomery
Act
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE; IF NO PARTY SHOWN, MAIL AS DIRECTED ABOVE
SAME AS ABOVE
Name Street Address
City &State
9.2153. 1
ILLEGIBLE NOTARY SEAL DECLARATION
(GOVERNMENT CODE 27361.7)
I certify under penalty of perjury that the notary seal on the document to which this statement is
attached reads as follows:
Name of Notary 6. 0 k,-,-
Commission
ZCommission No.
Date Commission Expires
Date and Place of Notary Execution
Date and Place of This Declaration
REC-91-000008 (7/94)*
Signature
Firm Name (if any)
' FARAH ENGINEE&MG STRUCTURAL DESIGN
1411 S. Rimpau Ave. Ste. # 209 Corona, Ca. 92879 Tel.: 909 738 1215 Fax.: 909 738 1153
STRUCTURAL SITE OBSERVATION REPORT
PROJECT NAME : WILLMAR FAMILY TRUST
PROJECT ADDRESS: 51320 AVENIDA JUAREZ
LA QUINTA, CA
THIS LETTER ADVISES THAT WE HAVE OBSERVED THE STRUCTURAL REQUIREMENT THAT
ARE VISIBLE DURING CONSTRUCTION AT THE TIME OF OUR SITE VISIT.
FARAH ENGINEERING BELIEVES THAT THE AS -BUILT CONSTRUCTION AT THE TIME OF 0UR-, � '
VISIT IS IN GENERAL CONFORMANCE WITH OUR STRUCTURAL PLANS AND RELEVANT
CORRESPONDENCE ISSUEED BY OUR OFFICE RELATING TO THE REFERENCED DWELLING.
WE OBSERVED THE BUILDING IN ITS FRAMED CONDITION PERIOR TO INSTALLATION OF
DRYWALL AND STUCCO. WE OBSERVED THE VISUAL AND ACCESSIBLE STRUCTUREAL
REQUIREMENT. (EXCLUSIONS ARE ITEMS SUCH AS: SIZE OF FOOTINGS, REINFORCED STEEL =
IN THE FOUNDATION, ROOF AND TOP PLATE SPLICE CONNECTIONS AND ROOF SHEATHING.)
THIS REPORT IS UNDERSTOOD TO BE AN EXPRESSION OF OPINION BY ENGINEER, WHICHIS
: BASED ON HIS BEST KNOWLEDGE, INFORMATION AND BELIEFS. AS SUCH IT CONSISTS OF A
REPORT FOR ONLY STRUCTURAL ELEMENT (AS ABOVE OUTLINED) AND IS NEITHER A
GUARANTEE NOR A WARRANTY, EXPRESSED OR IMPLIED FOR TRADES OR REQUIREMENTS
OF SUBJECT DWILLING.
IF YOU HAVE ANY QUESTIONS PLEAS CONTACT OUR OFFICE.
t
a
VERY TRULY YOURS'
FINEERING
M1IARAH
PRINCIPAL
4
dNc. 514
it
Exp.��� �
J'P9 CIVIL �@
OF CAL%E
Certificate of Occupancy�0
Citof La Quinta
Y
Building and Safety Department �°<MoFTM
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 ADDRESS:
Use Classification: SFD
Occupancy Group: R3
51-320 AVENIDA JUAREZ
Type of Construction: VN
Owner of Building: WILMAR FAMILY PARTNERSHIP
Building Official
Y
Bldg. Permit No.: 0007-098
Land Use Zone: RC
Address:
City:
By: KIRK KIRKLAND
Date: 09-05-02
POST IN A CONSPICUOUS PLACE
Sladden Engineering
6782 Stanton Ave., Suite E, Buena Park, CA 90621 (562) 864.4121 (714) s23-0952 Fax (714) 523-1369
39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772.3893 Fax (760)'72-3895
Date
Job No. -Z
FIELD MEMO
Project Name _— Client:
Site Address 5! 3Z0 c�—
Job Phone
Work Done
4 1
Comments 1 % ) a �
s 1 „A<S.'.4A ►Q t /� _
..�� Super. or Agent
field Tech.
24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service.
Td e6s:ol ao LO ueC