No Permit No (AR)�•_ ARROW PRINTING. INDIO 2e00r eJa 1595111 -CN
�IGI rI'I�IGt/
P.O. BOX 1504 APPLICATION ONLY
Building 78-105 CALLE ESTADO
Address G LA OUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE CONST._ OCC. GRP.
Address el, -
A.P. Number :z2y_/03 —0./Z
City Zip Tel.
Legal Descriptiortk
r
Contractor Project Description
1 -
Address 6u
-509 6 -
City Zip Tel..
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
A—k C- Size Stories Units %
Designer
Address Tel.
City IZip IState#
LICENSED CONTRACTOR'S DECLARAT1oN
I affirm that I am licensed under provisions of Chapter 9 (commencing with Section
bMsbn 3 of the Business and Professions Cade, and my license is in full force and
,FlGNAT1nE DATE
OWMER40MDER DECLARATION
I hereby afitrm that 1 am exempt tram the Contractors License Law for the following
reasak (Sec. 7031.S.Aeshess and PrDlasalorrs Code. Any city or co my which requires a
pan* to construct, ate►. hpwe. daaofsh, or repair any sombae, prior to is Issuance also
mquilres the FM= liar such Pemtf to tib • a Warns! !/rat he k licensed pursuant to
One Provisions d the Contradbrs Ltcanse ==
ar 9 (armnanchp I o Seeuar 7000) of
Q>ahlon 3 of the Busies and Pmfesmb ns Cafes or that. he is exempt therefrom. and the bask
lbr the a19-1 assnw t x Any vhlthn of section 7051.5 by- 'any appkw for a perM
subjects the aI I I to a chf penalty of not more than &D hundred dofars ($500).
❑ I. as owner of the property, or my employees with wages as their sole compensation, will
do the worn and the structure Is not Intended or offered for safe (Sec. 7044. BuIsness and
Professions Code: The Contrador'b !loans. Law dies not appy to an owner of property who
bits or lowroves Owreon and of does suds aortr hhsat or through his own employees,
pro~ that such AnIprovernents hpovertnerd tr � the oanerIrtandod or offered for �builder however,
O lave Odie �rden
Of proving that he did not bid or hprore far the purpose of sab.)
D 1, as owner as the property, am aocqusivey contracting with lira contractors to con•
stnuct the project (sec. 70�e. Business and Polessions Code: The Contractors License Law
Anes not appy to an owner of property who buds or hproves thereon, and who contracts for
such projects with a contractor(s) fconsedPursuant to the Contractor's License Law.)
❑ 1 am exempt under sec_ R d P.C. for this reason
Date owner
MIORILERS' COMPENSATION DECLARATION
I hereby affirm that I hate a cite of consent to self -Unsure, or a certificate of
worker" Co fion tnsurenoe, or a certified copy thereof. (Sec. 3600. Labor Code.)
Policy No d ompanp .
❑ COPY Is filed with the city. ❑ Certified copy Is hereby furnished.
CERTLFICATE of EXEMPTION FROM
11foRic� COMPENSATION DTSURANCE
(This sadiron need not be cDrraab1 9 the pamf b for ane farmed doNbrs it 100) vaAuetion
th
j
at tothewrfr sack provlNont or thl pemrf shat be
CONSTRUCTION LENDINLG AGENCY
1 affirm that there Is a construrfien leading agency for the performance of the
work for Mb permit is Issued. (See. 3097. Ctaf toAa.)
Lenders 'Name
Lendef a Addrgts
This Is a budding permit when properly filled cut signed and validated, and Is subject to
expiration N work Mererrnder is suspended for Jar days
I =that chs at 1 have read Oapplication and state that the above information Is correct.
1 spree fo corrgly with all =county county ordbwroes and state laws relating to building
construction and hereby auftrorize representathres of this city to enter the above.
meMlorled property for Inspection purposes.
New ❑ Add A Alter ❑ r Repair ❑ Demolition O
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 by:
•
•
itimated Valuation
/40120
T
PERMIT
- AMOUNT
Plan Chk. Dep.
If
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S'
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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 by: