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05-3053 (BLCK)P.O. BOX 1504 4 • �� 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: 05-00003053 Owner: Property Address: 49045 CALLE FLORA NAGELBERG JEFFREY APN: 658-210-007- - - 126 N RIDGE ST Application description: WALL/FENCE RYE BROOK, NY 10573 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3300 Contractor: Applicant: Architect or Engineer: D Q SOUTHERN HILLS DEVELOPMENT INC 78150 CALLE TAMPICO STE 101 LA QUINTA, CA 92253 AUGp� Zi��S (760)771-3497 - LiC. No.: 838041 V4 CF AIVCP QUINTA ------------------------------------ 7---------- UCENS CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am ,censed under rove sof Chapter 9 (commencing with Section 7000) of Division 3 of the Business an fessionals ode, a y License is in full force and effect. License Class: B i se No.: 838041 : • O tractor: 74 1 'v OWNER-BUILDEd�� TION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).: (_) 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 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 through his or her own employees, provided that the improvements are not intended -or offerdd 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.). 1 _ 1 1, 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.). 1 _ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a 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: LQPERNIrr Date: 7/20/05 z_zJ------------ -- WORKER --'S- --- COMPE—NSATION ---DECLARA-----TION ———————— — — — — —— 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 and policy number ar Carrier EXEMPT Polic Number EXEMPT I c=at' in the performance of the ork for which ermit is issued, I shall not employ any person in any manner so as to bec a subject to a works ' compensation laws of California, and agree that, if I should become bject to the nsation provisions of Section 3700 of the Labor Code, I sh rth it o 'those provisions. r e: • !r 0 ,cant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CVJGE 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. APPLICANT ACKNOWLEDGEMENT. IMPORTANT Application is hereby made to the Director 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 Quinta, 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 II and void if work is not commenced within 180 days from date of issuance of such permit, cessation of for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above i ormation is c rect. I agree o comply with all city and county ordinances and state laws relating to building cc do and h r representatives of this county to enter upon the above-mentioned property for n ect p p Qate: •�nature (Applicant or Agent): Application Number . . . . . 05-00003053 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 63.00 Plan Check Fee .00 Issue Date . . . . Valuation 3300 Expiration Date 1/16/06 Qty Unit Charge Per Extension BASE FEE 45.00 2.00 9.0000 THOU BLDG 2,001-25,000 18.00 ------------------------------------------ Special Notes and Comments - --------------------------------- 132 L.F. 6' GARDEN WALL, ORCO SYSTEM Fee summary Charged --------------------------- Paid Credited ---------- Due ---------- Permit Fee Total 63.00 .00 ---------- .00 63.00 Plan Check Total .00 .00 .00 .00 Grand Total 63.00 .00 .00 63.00 LQPERMIT OA� SONTLHKRN REAL ESTATE & DEVELOPMENT July 20, 2005 City of La Quinta Building and Safety Department 78-495 Calle Tampico La Quinta, Calif.92253 Attn: Kay SENT VIA FAX Re: Request for permit for 6 foot Garden wall 49-045 Calle Flora La Quinta, Ca 92253 Dear Kay, We are presently under construction in building a new single family residence in the Enclave at the above mentioned address. We are preparing to install a six foot garden wall at the above address. We will be installing 132 lineal feet of wall with the Orco block system. Southern Hills Development, Inc. is the General Contractor and Sabor Masonry is the subcontractor installing the wall. My cell phone is 760.413.4800. Please call me when I may pickup the permit. Thank you in advance for your help. Since Fly, /effifrey M. Read SOUTHERN HILLS DEVELOPMENT, INC.