9555 (COMM)P.O. BOX 1504 N o . 95.55 ,
Building . 78.105 CALLE ESTADO
Address ' 49-955 Park LA QUINTA, CALIFORNIA 92253
ft Of L3 W=KXX Quinta BUILDING: TYPE CONST. OCC: GRP.-
Address
RP.Addres P. O. Box 1504. „ e
City
Zip
Tel.
La-Quinta
92253'
564-2246
Contractor
James Dunphy
Address
_ Hermosa t
City
Zip
Palm 3pgs
92262323-1948
State Lic.
City r
& Classif. 456650
LIC. #
Arch., Engr.,
Designer �- •r
Address Tel
City - Zip State
Lic. M
LICENSED CONTRACTOWS DECLARATION
I hereby affirm 018*181n licensed underprovisions of Chapter 9 (commencing with Section
7af1 X01 Division 3 f the BusinessIona and my license Is In lull force and
SIGN ATURE DATE
OWNER• 9UMDER DECIMATION
1 eMirin that I am -exempt from the Contractors License Law for the following .
reaa0re (See 7031. t .,/shoes and Pnabaslan Code: Any cry or panty - fth reprr/ee a
parmT ro oma rucf. ager. knixom, derrtcssP or repair my structure, prior to Its ksuance also
r"*" Me MVMont for Such Pam* to Ise • a¢W� st�atanmem that he b< acerrsed praaurent ro
ths prov4alars of the Conbaceorlr lkcansa Law, chapter 9 (oonsnwrcing with section 7000) d
QNlalbn 9 of Me Bueints and PIO/easbrrs Coda. or that. he Is axwrpt thershorn. and Me bwb
stoped exarrptlon. Arty vlafatfon of Saclbn 7091.ti by
arty art for a •pnvrrtf
applearu ro a Gd parrasy of not more than ftvw hundred empire (fti00/. ,
rmer of the property, o1r my employees with wages as their sob compensation, will
do- work and the atnrebtre is not intermded o► offered for sale (Sea. 7014, llulerreaa and .
Plofaasions Code- The Contractors Its=@ Law doss not apply, to an owner of property who•
&** or frpmves thereon and who doss such work Mastiff or through. his own ar ployeee,
or vertirarsuch rrsM Is � oneyaam are rrorr r ftxW or offered for der owwnnerr� wilowever. the l ham die burden
of provip that he did not build or Irprove for the purpose of sab.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to cor►
struct the project (Sec. 7044. Business and Professions Code: The Corntnctovs License Law
does not apply to an owner of property -who buMds or improves thereon, and who conbaob ror
such projects with a eontraclor(s) Mpnsed pursuant to the Contractorls License Law.)
❑ 1 am exempt under Sea ma ti P.C. for this reason
Number
jai Description
ject Description
Youth & Community Center .
Sq. Ft. 4970No: No. Dw
Size Stories Units
New ❑ Add ❑ Alter O Repair O
PERMIT
Plan Chk.'bep.: - e s .
Plan-Chk. Bal.
Const. �{ i • r.
Mach.'
Electrical -
Plumbing
S.M.I.
Driveway Enc.
Dateowner IrNrastructure
WORKERS' COMPENSATION DECLARATION
WorkerarConmapensatffirm l Insuranhat I ce,ave 0ertitt eormaent to eelRinaure ora certificate of
or a certified copy thereof. (See. 3800, Labor Cade.)
Policy Na Company
❑ Copy Is flied with the city. ❑ Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be corpisted d the pemtM is for one hundred dollars (t 100) valuation
or Mss.)
I certify that In the performance of the work for which this permit is Issued, 1 shell not
employ any person in any manner so as to become subject to the Workefs' Compansation
Laws of California
Date owner
NOTICE TO APPLICANT: If, after repro MIs Certificate of L:xerpoon you should become -
subject to the Workers' Corrpenaanon provisions of the Labor Codeyou must kMnMN
cwrpb with such provisions or rich Parmit sass be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit Is Issued. (Sec. 3097, Chi Code.)
Lenders Name
Lenders Address
of �a building permit when property filled out, signed and validated, and is subject to
m it work thereunder is suspended for 180 days.
ry that I have read this application and state that the above Infomretion Is correct
I a 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 purpose&
Signature of applicant Date-
Mailing
am
Mailing Address
City, State, Zip
REMARKS
Demolition ❑
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
atePermit'Validated by:
Validation: