06-1856 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:06-00001856 - -^.
Property Address: . ____77420 VISTA ROSA
APN: 658-2207022- - -
Application description: ADDITION RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 800000
Applicant: Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Owner:
MULLIN JOHN F
C/O GREEN ACRES TRUST
2033 M
SOUTH,
Contract
GEMETT
74300'
PALM D
(760)3
Date: 7/09/07
. Date: Owner: 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 iss4buildin
r ' , or cessatio work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to cancellation. -
I hereby affirm. under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and ste' formatio is c rcect. ply with all
work for which this permit is issued (Sec. 3097, Civ. C.1. city and county ordinances and state laws relat'struction, n ere ize representatives
of this county to enter upon the above-mentioninspection pu oses.Lender's Name:'Date: % _v / Signature (Applicant or Ag
:- ,Lender's Address: -
LQPERMIT
Lic. No.: 280103
- LICE COTR OR'S DECLARATION
- WORKER'S COMPENSATION DECLARATION
�I hereby affirm under penalty of perjury that I m 71,ense�,Nl u der rovisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following. declarations:
Section 70001 of Division 3 of the Business dfesson Is ode, and my License is in full force and effect. ..
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided.
License Class: B. ense : 280103 -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date: '�7 -Contractor:
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: -
`I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 0008398-2007
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performan o the work fo w ch this permit is issued, I shall not employ any
construct, alter, improve, demolish,. or repair any structure, prior to its issuance, also requires the applicant for the
,. person in any manner so a to ecome subj ct the workers' compensation lawsofCalifornia,
.permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should me subject. o e work ensation provisions of Section
' License Law (Chapter 9 Icommencing with Section 7000) of Division 3 of the Business and ProfessionsCode)or
3700 of the Labor Code, I II forthwith ply w ose provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by -
_ -. �^—"•'�+ '
any applicant for apermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date:? -9-0) Applicant:
(_) 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
WARNING: FAILURE TO SECURE W ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL. -
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
,
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES,AS PROVIDED FOR IN. '
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OFTHE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. '
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.). - -
- APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building' and Safety for a permit subject to the
.7044,.Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
' property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
. 1 . Each person upon whose behalf this' application is made, each person at whose request and for
- pursuant to the Contractors' State License Law.). f
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
1 _ 1 ,I am exempt under Sec. , B.&P.C. for this reason
- 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.
. Date: Owner: 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 iss4buildin
r ' , or cessatio work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to cancellation. -
I hereby affirm. under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and ste' formatio is c rcect. ply with all
work for which this permit is issued (Sec. 3097, Civ. C.1. city and county ordinances and state laws relat'struction, n ere ize representatives
of this county to enter upon the above-mentioninspection pu oses.Lender's Name:'Date: % _v / Signature (Applicant or Ag
:- ,Lender's Address: -
LQPERMIT
Application Number
06-00001856
Permit . .
BUILDING PERMIT
Additional'desc .
Permit Fee . .
2939.50 Plan Check Fee
1910 .68
Issue Date
7/27/06 Valuation . . . .
800000
Expiration Date
9/30/07
Qty Unit.Charge
Per
Extension
BASE FEE
2039.50
300.00 3.0000
THOU BLDG 500,001-1,000;000
900.00
------ ---- T. Permit - T-.^.
ELECT - ADD/ALT/REM --� -^. --
--^---- --- -
Additional desc
Permit Fee . . . . .
46.71 Plan Check Fee
11.68'
Issue Date .". . .-.
7/27/06 Valuation
0
Expiration Date.
9/30/07
Qty Unit- Charge
Per
Extension
BASE FEE.
15-.00
906.00 .0-350
ELEC NEW RES - 1 OR 2 FAMILY
31.-71
_ Permit MECHANICAL
Additional desc..:.
Permit Fee
52.50 Plan Check Fee
13.13
Issue Date
7/27/06 Valuation
0
Expiration. Date
Qty Unit Charge
Per
Extension
'.
BASE FEE
15.00
1.00 9.0000
EA MECH FURNACE <=100K
9.00
1:00 9.0000
EA" MECH B/C <=3HP/100K BTU :.
'9.00
3.00 6.5000
EA MECH VENT FAN
19_.50 _
f Permit PLUMBING
_
Additional desc .
Permit. Fee
140.25 Plan Check.Fee
35.06
= Issue Date.
7/27/06 Valuation
0
Expiration.Date.
9/30/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00 .
15'.00 6.0000
EA PLB FIXTURE
90.00
2:00 6.0000
EA PLB ROOF DRAIN
12.00
.2.00 7.5000
EA PLB WATER HEATER/VENT
15.00
1.00 3.0000
EA PLB. WATER INST/ALT/REP
3.00
Application Number
06-00001856
Permit . . . . . . PLUMBING
Qty Unit Charge Per
Extension
7.00 .7500 EA PLB GAS PIPE >=5
5.25 .
- ---------------------------
Special Notes and Comments
--------------
-------------
--------------
906 sq. ft. addition.July 27,
2006
,.
11:46:35 AM jjohnson
- - --------------------------------------------------------------------
Other Fees . . . . . . .
CHANGE OF CONTRACTOR
4.50
ENERGY REVIEW
FEE
191.07
STRONG MOTION
(SMI) - RES
80.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 3178.96
------- ----------
3178.96
----------
.00
,
.00'
_. Plari Check Total 1970.55
1970.55
.00
.00
Other Fee..Total 275.57
271.07
.00
4.50
Grand Total 5425.08
5420..58
.00
4.50
LQPTRMIT
.
P.O. BOX 15 . 04 TAtyl 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 06-00001856
Property Address: 77420 VISTA ROSA
APN: 658 -220 -022 -
Application description: ADDITION - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
_ Application valuation:_. --..__8.0.0.0.0.0,
Applicant:
Architect or Engineer:
Owner:
MULLIN JOHN F
C/O GREEN ACRES TRUST
2033 MONTEREY RD
SOUTH,PASADENA;'CA 91030
Contractor:
STARK CONSTRUCTION COMPA
39725 GARAND LANE, SUITE
PALM DESERT CA 92211
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777.-7153
Date: 7/27/06.
(760)345-97117
y Lic _ No.: 577776. �UL 2 ( 2006•
CITY OF LA QUINTA
FCE DEPT
.PT.
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with.. 1 hereby affirm under penalty of perjury one of the following declarations: "
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for'workers'compensation, as provided
License Cla B /��.�] ./J %License jNo.: 577776 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
_ _�d/d� C/f/���h issued.
Date: ircontractor: ,? L 4 _ 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
'I he eby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 0019497-2005
_ following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to_ I certify.that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws.of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should b e subie he workers' compensation provisions of Section
License Law (Chapter.9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Cod a ort ply with those provisions.
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).: Da2NG
- Applicant:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 1
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The ✓WA: FAILURE TO SECUR ORK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO C MI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and .who does the work himself or herself through his or her own employees, provided that the 'DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or,improvement is sold within- SECTION 3706 OF THE LABOR -CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT -
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. • IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions setforth•on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose.behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , BAP.C. for this reason 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.
Date: Owner: - — 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
CONSTRUCTION LENDING AGENCY - permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the • I certify that 1 have read this application and state that the above in m •tion is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and count ordinances and state laws relating to building ton, an by authorize representatives
of this count o enter upon the above-mentioned propert spa io
Lender's Name: - - -
Y /Date: i Signature (Applicant or Agen[I:
Lender's Address::-�✓
LQPERA11T
Application Number .
. . . . 06-00001856
Permit
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
2939.50 Plan Check Fee..
1910.68
Issue Date . . . .
Valuation
800000
Expiration Date
. 1/23/07
Qty Unit Charge
Per
Extension
BASE ,FEE
2039.50
300.00 3.0000
THOU BLDG 500;001-1,000,000
900.00
Permit
ELECT - ADD/ALT/REM .
Additional desc'.
" Permit Fee
46_.71 Plan.Check Fee
11.68
Issue Date
Valuation . .
0 -
Expiration Date
1/23/07
Qty Unit Charge
Per
Extension
-
BASE FEE
15.00
906.00 .0350.
----------------------------------------------------------------------------
ELEC NEW RES - 1 OR 2 FAMILY-
'31.71
Permit . . .-.
MECHANICAL
Additional desc .
Permit Fee
52.50 Plan Check .Fee
13.13
Issue Date
Valuation
0
Expiration Date..
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00. 9.0000
EA MECH FURNACE <=100K
9.00
1.00 9.0000
EA MECH B/C,<=3HP/100K BTU
9.00,
3.00 6.5000
EA MECH VENT FAN
19.50
Permit
PLUMBING
'Additional desc .
Permit Fee
140.25 Plan Check Fee
35.06'
Issue Date . . .
Valuation . .
0
Expiration Date
1/23/07
Qty Unit'Charge
Per
Extension
BASE FEE
15.00
15.00 6.0000
EA PLB FIXTURE
90.00:
2.00 6.0000
EA PLB ROOF DRAIN
12.00
..2.00 7.5000
EA PLB WATER HEATER/VENT
15.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
LQPERDIIT
Application Number -.
06-00001856
Permit . . . . . ..k PLUMBING
Qty Unit Charge � Per
Extension
7.00 .7500 EA PLB GAS PIPE >=5
5.25
----------------------------------------------------------------------------
Special Notes'and Comments
906 sq. ft. addition.July 27;
2006
11:46:35 AM jjohnson
----------------------------------------------------------------------------
Other Fees . . . . . . . ..
ENERGY REVIEW
FEE
191.07
STRONG MOTION
(SMI) - RES
80.00
Fee summary. Charged
Paid 'Credited
Due
Permit Fee Total 3178.96.
.00
.00"
3178.96
Plan Check Total 1970.55,
.00
.00
1970.55
Other Fee Total 271.01
.00
.00
271.07
Grand 'Total 5420.58
.00
.00
5420.58
r
LQPERMIT
CERTIFICATE OF COMPLIANCE Jif IED ,
Desert Sands Unified School District �: z4��o
47950 Dune Palms RoadVQ] BERMLIDAOUNES
RANCHO MIRAGE d
Date 7/27/06 y La Quetta, CA 92253 ! INDIAN WELLS
P
DESERT
No. 28770 (760) 771-8515 'oaLANDIO
0
Owner John Mullin APN # 658-220-022
Address 77-420 Vista Rosa Jurisdiction La Quinta
City La Quinta Zip 92253 ' Permit #
Tract # Study Area ,
Type Residential Addition No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 77420 Vista Rosa 906 Unit 6
Unit 2 Unit 7 ,
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments „
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for Irving, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.63 X 906 S.F. or $2,382.78 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed pT
ect may now be issued.
Fees Paid By OC/California Bk & Trust - Gary Stark Check No. 639980848
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson {`
Superintendent • •� �' } 42,
Fee collected /exempted Sh ron C yr Payment Recd 80.00 t
$2,382.78 er/U aer
Signature'F�
NOTICE: Pu ant to Government Code Section 66020(d)(1), this rve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building'Department/Applicant Copy - Applicant/Receipt Copy - Accounting
GEMETTE CONSTRU -TION, INC:`
74300 HighWdY .1'1:1
Palm Desed -CA 92260
(760) 34673248.
FAX (7,60)'3467W69
July 6, 2007
City of La Quinta -
Building Department
P.O. Box 1504
La Quinta, CA 92247-1504
RE: MullinResidence Remodel, 77-420 Vista Rosa, La Quinta, CA 92253
We have taken over the above project. Please change the contractor information listed on your
records for permit #06-1856, to Gemette Construction, Inc. We will be proceeding with this
project for Mr. and Mrs. John Mullin. Copies of our California Contractors License, City
License, and proof of insurance are attached. The following is our contact information:
Gemette Construction, Inc.
74-300 Highway 111
Palm Desert, CA 92260
Office: (760) 346-3248
Fax: (760) 346-3769
Cell: (760) 774-1058 George Gemette
Reg d ,
Ge ge Gemette
President
.'-` ate•` =-�" .il.i,.� �.. ��t�l��'�:. -..`i I" IM `�"� - zy, -. .'""
sO� ���:�6�fg.liztiNi''�.' •i I �� k �+, �''�it � It :.� _F __ - �4XI'l
- ,� � .I�� �t�I-I ,I'il'nnNIIte�lr � X3N1phI�teiNIIIWI�rI,J h��.!}1��, i�'i.'1I���Ir�IiPPy 4�N�d
4 � rD •" K .tc.t-.�aft
w ``s�:.a ,-lf llAN, jhq =
�.'
S fi Y 78' 495Calle Tampico, La Qwnta, CA'92253 K`
e.
777 7000 '
g ,, w (i , ��
'�; _ = t: ;, fi it Ip. "'4�( III nl i. ��- _��.:�y"� jrl ..`,..I.. e•�
�� Ir r 5 ,.ie.,.
,.�C Pi -;. '�*Jku11'.'"'""u •w�'�i"?� .�,h,»t "l
� '1.10 I + r e � B �� �_�yi
�dr . ,' �tu - �' - _ ,� s,' „Js,'.` r .N' U ILLv•. 'I� I . lei �r„ ,.;
+_-� . `f- ;-';� i� M1 I I II I E, --- �x19�Iw
U`�II��I 11l PJ�ull��I �)1', 4 �v �u,. �� gI�W �JN n
s r� g I �i1,
Dear BusinessOtvner
s YBUSIlVES5 L,7 AT7, N �� :? � r w r k
., OUT rDE CITY# bl MI TS �` P;leese be aware that Issuance oi'a,busiaess.hcense by`thc Ciiy does,not u honz
you to'conduct business fu•a''bullding or tenan',tspece that lies not be
3Ien approved
•A: �+ ,. r �- e -� ; ;<r a t r occupancyzby:the Buil'dlug and Sgfety Department. If you have any questions 4,
regarding this issue or if you ere not'sure"If a';Certiticute hof Occupancy has been
n
f ",. �'-`�.-'�a�:, '�� �> :: •...'4 ��, �y o`.i` k. I -' ,_--•.-:�� ��=�Lssued�,foryour,placeo pu�11,11
ness�, IeesecoPtact�Bu�ldinE'grid-�afety_u_h��
l it N apt
r's`� �IA{{jj������i��' 4 760)73.7 7012 1�'�
�:. I % "�" �I�I S�
Bt%ST1biS 1�IE GEMS 4� �i� iNiF�RUCTI`ON IC The Licensee timed h rw o a Jng puuLto the City of LaQ3mta slt fe
required, hcense,�e hereby grentedsaidhcensee to traosegt fhebusiuess herein
a r r .•: r" ¢_ `set forth for theperiodsloted, m coaformlty witfi the $ro`visions ofbidmancet:;'
} BU5INES5 AADRESS
-7. 0 0 -HIGHWAY, 111 .
- No"'2 of this City. This Licensee is issued without venrkatiaton ththe licensee ;.{
PALM DESERT CA 922 6 0s is subject to or exempt from icensing by the Stato of Celifor'nia
r t �•' nr r "d' ', a �BIISINE55 LTC 0 01 Iu a
U , M !I!'
- _
r,� r� .-,aCLAS�IF�iTTU1 =��rTE c�tai,�^`k i..
--.f
.,--..K '�,. ,: ,. -,. .- ,.• •-..� -::.a s ,.,�s- _�u_;, .... _L"t_,- ger r s
POLICYHOLDER COPY •4, SK
STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 '
COMPENSATION
INSURANCE r
FUND CERTIFICATE OF. WORKERS' COMPENSATION INSURANCE
ISSUE DATE: -01-01-2007, GROUP: 000046
POLICY NUMBER: 0008398-2007
CERTIFICATE ID: 4
• CERTIFICATE EXPIRES: 01-01-2008.
01-01-2007/01-01-2008
CONTRACTORS STATE LICENSE BOARD 'SK 'LICENSE NUMBER:LICENSE #280103
P.O. BOX 26000 INCEPTION DATE:01-01=2007
SACRAMENTO CA. 95826 y DO:SK
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner -to the employer named below for the policy 'period indicated.. -
This' policy, is .not subject to cancellation by the Fund except upon 10 days advance written notice to the employer.
We will also give you 10 days advance notice; shouldthis policy be, cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and' does not amend, -extend or alter the coverage afforded
by the policy listed herein. Notwithstanding' any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance' may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions,'and conditions, of such policy.
h . -C_-/
THORIZED REPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
Y,
EMPLOYER `
GEMETTE CONSTRUCTION, INC. SK '
74300 HIGHWAY 111:;
PALM DESERT CA 92260 #F `
} M0409
IREv.2-051 PRINTED 12-15-2006