0312-172 (BLDG)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
(
pate r' -- " 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 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.
(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.
Date: Applicant
Warning: Failure to secure Workers' 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, indemnify
& 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 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
the abo e=mentioned property for inspection purposes.
i nature (Owner/Ag t)"—� --"' Date
BUILDING PERMIT PERMIT"'
DATE VALUATION LOT TRACT
12/1 7 0C $2,966. r '
JOB SITE G
APN
ADDRESS 78•••0 i. AGED ia'S
OWNER
CONTRACTOR / DESIGNER / EN (NEER
,T01.W MEX CHE
SAT ?+ISA ERJ.? f3RD:"T2 S
121 g N. MAY PLACE
819 '14 �?AMVV W► Yrffi E7
AI..:ESAMPRA CA 91701
IWALNUT QA 91789
USE OF PERMIT
i3MNERAL'AtT.TLDING
1101..F 6` BLOCK 'WAt. U 10 If VB i_-0Cr'WALL PER CITY
STANDA 'D AU)NO SYDR IPX,
0 FIT. WALL ' 1101601.F
5 T7'S. 7iJALL 10.00 E,r""'
PFIRWRTFEE SUMMARY
CONST'f1.1rC:'dTeiH PEE 101-000.418-000
i. TOTAL ONSI MUCT:CtyRAIMP1:.:AR
$54,00
IMS PIM-111AIDx. N
K ti.
p Lp p
$0.4
DEC 1.7 2003
CITY OF LA QUINTA
FINANCE DEPT. .
RECEIPT
DATE
) 'y
BY "' (
DATE FINALE
INSPECTOR'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings — / —
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
G—nderground Plbg. Test
Final _
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
RVga h Wiring
lcry Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
LAW OFFICES OF
ALEXANDER F. SUN AND ASSOCIATES
735 W. DUARTE ROAD, SUITE 206
ARCADIA, CA 91007
Tel: (626) 821-8600 Fax: (626) 821-8630
November 6, 2003
City of La Quints
78495 Calle Tampico
La Quinta, CA 92253
RE: lot 13 and 14 of the Desert Club Manner
Tract #1; in the City of La Quinta, CA.
(As known as 78-635 Sagebrush Ave., La Quinta, CA)
Cc: Tsai Masterbuilders (General Contractor)
Kathryn Mitts (Owner)
To Whom It May Concern:
We hereby represented Mrs. Kathryn Mitts, the property owner of lot 13, of the Desert Club Manner (a. k. a.
78-635 Sagebrush Ave., La Quinta, CA.) to disclose the fact that the westerly adjacent blockwall was
encroaching V-6" into said property per surveying and staking by Sanborn'A/E, Inc. on March 7`h. "2002.
The block wall was built without any City permit and inspection approved by the City or County
Authorities.. We obviously declared here that the wall had to be removed and rebuild along property line
per Title shown as recorded. Therefore we reserved the right to take any legal actions in the future.
Si rel yo r ,
Alexan er . Sun
Attorney at Law