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MPP.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253
Ino Witte become wit o wat no menmrrtced .dhe1 11m days 1•an Wt eb•nsu,nce DR. h .vs has ben "banded or awrooned lot a pram os sin ays
I ILI NSLD COk'1AACIDRS D(Cl AM1OSI 1 hwaby $"am that I am licensed under aeva•o•a of Chaplet o ILommennnp
-11PLetsv lila, at Dwa•on 7 01 the Busutess and Protns.w Code and my ka rtae D in lull iota aro theta
I•s tea Cliffs
Date Cordracta
lk Number
OWNS R BUILOL0 DI C1 ARAIIDN 1 hereby loam that 1 am ttttmpt hom the Carilrana's lwnst U. tot the 1011D.mo
tr•son (sat Tal S Bustnrss and ►rotessons Code Any city a county which reofnrrs a pomd to Conshvel. that,
tmp0.I dtmolah M rt Pace any situelura, p••a to its nW.Ict, at" rrounn trr
the applicant for such prld to lit If
s•prwd sbb• M Inst he M Latroad puts W n1 to tfit pto•ntom of the Conti actor's l west Law lChapltl o lcomintrlcrrp
.dG Sec l ion 70mt of d+non 7 0l d. r— liven. Veld Pr ofr_stont Co0t1 or that hen attempt therelrpm and the baso la
eh ar:,vc ea rmprpn Any-.001-pn o: SeNor, 7031.5 b) any apphcan, la a pumn sub)etls the applicant to a r va
"Is"I of not care Inas I"t hunb-td eoban (1500)1
El I as u.net of fix popely a my employers with rapes as Iheu sole Compensation, will do the wok. and Ills
iuv[Iwr n not rmr•drd a filleted lot sale Mee 7D4 Bustnrss and Prolessrom Coot Thr Conhaclot's manse to.
Burs no' a;pl1 Ic an o.•wr of p"or"n' who put161 a rmptovrs Ihneon, and who dof s; %ucI �ot1 h -spill m Ih�oup6
his rmployrn. pp+dap Ihal such rmpro•rmrnts sat not Winded a filleted fm Petr, It,s�.+t-ler, the bvh7np or
tmp•ove meat a sold w,Mn one file, of Completion. the ownn-builder will have the bV din a aortng IN' t`• nib -04-
th". 0• "p, gat
lot IM pu•ppse of sale)
1 n o -w of ata ptopeny.lm Nelusively conliamnp with licensed conttaclms to E06S•,acr the pho)cn (SCC 7DK
.nos aid Polnuom Loot Tne Contaflor*l license law don not apply to an --- dt ptopcny •roLud6s o
•mf•o•ts Irtr•mn and who conhacts la such pto)tcts with a LphvaCID111) IOLMSCd ptr•••snt to the ComMrVO P
1 a-.• r•rmJ•I canon Set _ . B A or (Attach Cenihcatel
Date — —_ _ — Dwner
WJ:e!P,S CDuri NSA110A DI Ci ABtIIDN I htteby affnm Inal I t.ave It lerbhUtr DI Consent to Sell insulta a
t rr:a.:ah o' wo••m' CDn.pr nsatnn Inw ance oh a unhLed copY Visitant (Sr: 3.&M lab C.)
Pohtcy No __
Company
LCrnd.r0 Copt n I•rtr'uy lu•ntsncd
E4�l•tme cope M I- CIInn-, County Rudomp Inst -t, r. Dq rel County beoann•ent
Ea4 _ 2 Z OY / Ay, hunt
Art t. •yT ata uE IL r, uq _
•_,Rt 5500,
CII Y.COu uUNll Y/Sl Al LIZ IP
joe S.1 I. aCDRI SS S' CE
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CGhl R•C7 WFAu. NAME
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CE R1111C.AT1 OF ( RLMPIIDA FROM WORKERS COMPS NSA710h 1NSLlkANCE ,Tan sadlon awed rpt be completed d the
peirm a for one Iuntheo If1DOh O less I cendy Ilial in the pRlormanp of me woe► ea .rich IM o.mn a rssued. t
,halt not employ any pr son many manner a0 as to (<wmr Wt.).0 to the Workers' Compensation L r.s o! CJhla ata
Dale Apphcard
N0110E 10 APPLICAM. ff ,tier making this CenrlNlle of be -phot. you should become sulg.a to Iht Waters'
Comprrurhon provlsrons of list Labs Code, you mutt fonftwrth campy Win such povesiona a this permit shag to
dermtd revoked
DIV1S10N Of INDUSIPJAl SAFETY KRMIT CERIIFICAISM.
O 1 hneby euhty that no reuvahon het (5) a mar lett in depth into Arch a person ls rpuard 10 6esc.'e. vul tal
made in WnnechOn with wDd aulhotured tly this permit, and that no building slruclurr. sutlold ng lahr.ork. o
Ormohbpn a 6r5ma11,np Ihrteol will be molt than INny-ya PS) lett high (Chap )Z GrpZ AM 2 Sec 341. 7,,*
C A C.)
Ali owns b.,ILW 1 wilt not employ anyone to dig .owl which .0u16 repu.e a permtthorn tht D"".0n of InoushtAl
.Iety ,s islet afire unless such petson hay a 1>s mit 10 00 weh .ort I'm that Ownpo
J Dtswof tnduslual Saltfly"Prhmd No
Darr Appltutf
CCNSiRUCI1DN LENDIN6 AGENCY. I heathy aflum that that is a tonslruelion lending agency, lot the pedoim nce of
ane .ort Ito which Iris noun a Muted (Sec 3047. CN. C.).
Ltndels Want; _A
enc. s Andress y_
,'Cr" Thal 1 ata rt read itis aDDh;ahon and slalt that the above mlormalhon M coned I apret to comply .nn a0
VIy an0 county or6mance5 ant slate laws rrfalmp 10 WJd'lV catsb uatpn, aro Weby aum.w, reMrsmlauves of
Inns Lou ly to emn upon the abu—nirm-oneo propcny la inspection proposes
Stpnaluhe of Apphcanl a Agent Date
CI RIII ILAIE 0 MRIANCE AND AUIHOR,ZA11ON Of [WRY I Lraity I havt r,a01Ms appl.caltnn ane start It.at Inc
rnlamal,on pjll'eCal
a1 aphr to comply//M�isr all 9atr s anf •p}�umy otOhnances rfla"D It I.-In'tp cm
Shucthon. )nit, ar7Dr es I rve o11hr L.�r.l,/ ei/Cr7,e �/r (licnl of 11.46hnp and .eal[t) to rntr upon
the D rr� lrt a riled Ice Ilus p . for the �p%(upDsr of maI,ng rho
-z�P3
hpna Applicant oh A e Date
P-1 Apphant;Agenl h'amt
APPL•PRMT rPS DAT - --
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City of La Quinta
TCITAL
FEE