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Return check to requestor
":CHECK REQUEST'
Mail check
Name../ Title of person requesting check
Depart ent individual is associated with: /' . SLy� % 7 2013
y~ CFNAOFE QUIIyTA
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(Name (Vendor No.)
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Check description and invoice number:
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Amount: $ • -1 1 0 y
Account Number: 10 J,j
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Project Number: BP 1 v - d
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�DE`SCRIPTION
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CITY OF LA QUINTA
*+�* CUSTOMER RECEIPT *+�
Date: 8/22/13 81 Receipt no: 1559
Year Number Amount
2813 94
53725 AVENIDA VALLEJO
LA QUINTA, CA 92253
BP BUILDING PERMITS
$11140.63
Trans nuaber: 200729
STOCKDALE, CHARLES
OP BLDG PERMIT OVERPYNTS
1.00 $849.00
Trans number: 200730
BP/CK REQ-STOCY,DALE, CHARLES
Tender detail
CK CHECK 664 $11989.03
Total tendered' $11989.03
Total payment - $11989.03
Trans date: 8/22/13 Time: 11:28:55
i
* +� THANK YOU FOR YOUR PAYMENT **
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FOR QUESTIONS PLEASE CALL 760-777-7150
�,�a� G�CITY OF LA QUINTA SUB-CONTR - TO LSV
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JOB ADDRESS. PERMIT NUMBER f �j- l �'�Co OWNER BUILDER ..
This form shall be posted on the job with the wilding 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
of building permit. For each applicable trade, all information requested below must be cornpleted by applicant. "On File" is not.an acceptable response..,-
Trad _ ( Classifi ation Contractor _._ .....::...::...::. State:.Contractoy s. l cense... ; ` W.orkecs Co a sabon: nsurance:" "' `>:.....<::::. : Cit .Bus ne s License% .:.`.
:
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
((xxx//xx/xx)
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 -12i
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600OO913l
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CONCRETE (C-81
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2&?76LK
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STRUCT::S7EEL (C-51)
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MASONRY (C�29)
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PLUMBING (,C-36).
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LATHt PLASTER (C=3b)
DRYWALL (C-9) ..:'..:
ELECTRICAL. (CA0Y:. ,.
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1,:WEETWEYAL,
(C-43)'
FLOORING (C`:151.;'<`:`::,
GLAZING (C-17) .:` .:::>
INSULATIOR:(G-2)
SEWAGE DISP - (G-421 '.
PAINTING (C-33)'-: :
CERAMIC TILE (C-54)
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CABINETS. (C-6)
FENCING (C-13)
LANDSCAPING3.
.POOL (C-53)
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