10-1214 (RPL)CITY Or LA QUINTA SUB —CONTRACTOR LIST
JOB ADDRESS 55rO_5 (� r� gr'OF_ 3if-,eT PERMIT NUMBER OWNER 7Ev\�s4 Jew BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
or Duiiaing permit. ror eacn appncaple traae, all inrormation requestea beiow must be completea by applicant. -L)n rue" is not an acceptable response
-: Trade / Classification
Contractor
State Contractor's license
rJtcrs Compensation
Insurance
City Business.
iicehs.o
Codipany Name
-
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
e
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
CONCRETE IC-8)
FRAMING IC-81
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