BRES2014-109378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&ht 4, stP Qubtro
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BRES2014-1093
Property Address:
79102 LIGA
APN:
776130001
Application Description:
ADDITION TO EXISTING CASITA 309 SF
Property Zoning:
Application Valuation:
$45,000.00
Applicant:
ROPER MORRIS CONST
50855 WASHINGTON ST C216
LA QUINTA, CA 0
•---------------- - - - - --
LICENSED CONTRACTOR'S DECLARATION
2 2014
L— CIT_77tn .,Its-' A�r{RTMENT
OOMMUNn 1': -
—
I hereby affirm under penalty of perjury that I am licensed un er rovisions of Chapter
9 (commencing with Section 7000) of Division 3 of t usin ss nd Prof ions Code,
and my License is in full force and effect.
License Class: _ License No.::CONV:1405 1 25 6
Date,�l ' I Y Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division ?
of the Business and Professions Code) or 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).:
(_) 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 Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within 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.).
1
( I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
I ) I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/22/2014
Owner:
STEPHEN SEHER
Contractor:
ROPER MORRIS CONST
50855 WASHINGTON ST C216
LA QUINTA, CA 0
Llc. No.::CONV:140528101253005736
----- ----------------------------------------
•! WORKER'S COMPENSATION DECLARATION
I hereby ffirm under penalty of perjury one of the following declarations:
have and will maintain a certificate of consent to self -insure for workers'
comp t ria s provided for by Section 3700 of the Labor Code, for the performance
ofti. for which this permit is issued.
I ave 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 insurance carrier and polity number are:
Carrier: _ Policy Number:
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to b come subject a orkers'
compensation laws of California, and agree that, if I uld b, a subje to the
workers' compensation provisions of Section 3700 9f lie L o Code, I s II forthwith
comply with those provis ons.
01 Da'��V. �� Applicants
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , 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.
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 permit to cancellation.
I certify that I have read this application and state that the above informati n is correct.
I agree to comply with all city and county ordinances and state law rel ti g to b ' ing
construction, nd hereby authorize representatives of this city to ter n e ove-
mentiioo�ned pr pert for inspection purposes.
Dater V. " Signature (Applicant or Agent)
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT QTY _ AMOUNT
-' : PAID
PAID DATE
ADDITION; EA ADDITIONAL 500 SF
101-0000-42400
0 $61.49
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
ADDITION, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$17.16
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
ADDITION, FIRST 100 SF
101-0000-42400
0
$120.12
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
<"PAID
PAID DATE
ADDITION, FIRST 100 SF PC
101-0000-42600
0
$168.74
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forADDITION: $367.51 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$2.00
$0.00
PAID BY
METHOD
RECEIPT#
CHECK #
CLTD BY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $2.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HOURLY PLAN CHECK - YES
101-0000-42600
1
$70.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forCITY STAFF - PER HOUR $70.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$143.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$47.19
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for ELECTRICAL- NEW CONSTRUCTION: $190.19 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
APPLIANCE REPAIR/ALTERATION
101-0000-42402
0
$11.92
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
APPLIANCE REPAIR/ALTERATION PC
101-0000-42600
0
$4.77
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION "
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
VENT FAN
101-0000-42402
0
$11.92
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
VENT FAN PC
101-0000-42600
0
$4.77
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forMECHANICAL: $33.38 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
FIXTURE/TRAP
101-0000-42401
0
$23.84
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
FIXTURE/TRAP PC
101-0000-42600
0
$23.84
$0.00
PAID BY
METHOD
RECEIPT#
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$11.92
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$11.92
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $71.52 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SMI - RESIDENTIAL
101-0000-20308
0
$S.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for STRONG MOTION INSTRUMENTATION SMI $5.85 $0.00
TOTALS:0.40.00
Description: ADDITION TO EXISTING CASITA 309 SF
CONDITIONS
Type: BUILDING, RESIDENTIAL
Subtype: ADDITION
Status: APPROVED
Applied: 8/27/2014 MFA
Approved: 8/27/2014 JJO
Parcel No: 776130001 Site Address: 79102 LIGA LA QUINTA,CA 92253
Subdivision: TR 24890-6
Block:
Lot: 2
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $45,000.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
LA QUINTA
Details: ADDITION TO EXISTING CASITA. 2013 CALIFORNIA BUILDING CODES.
0
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
ROPER MORRIS CONST
50855 WASHINGTON ST
LA QUINTA
CA
0
C216
CONTRACTOR
ROPER MORRIS CONST
50855 WASHINGTON ST
LA QUINTA
CA
0
C216
OWNER
STEPHEN SEHER
3818 HORSEHEAD BAY
GIG HARBOR
WA
92253
DR NW
Printed: Monday, September 22, 2014 2:43:42 PM 1 of 3
Printed: Monday, September 22, 2014 2:43:42 PM 2 of 3
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
ADDITION, EA
101-0000-42400
0
$61.49
$0.00
ADDITIONAL 500 SF
ADDITION, EA
101-0000-42600
0
$17.16
$0.00
ADDITIONAL 500 SF PC
ADDITION, FIRST 100 SF
101-0000-42400
0
$120.12
$0.00
ADDITION, FIRST 100 SF
101-0000-42600
0
$168.74
$0.00
PC
Total Paid forADDITION: $367.51 $0.00
BSAS SB1473 FEE
101-0000-20306
T 0
$2.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $2,00 $0.00
BSA:
HOURLY PLAN CHECK -
101-0000-42600
1
$70.00
$0.00
YES
Total Paid forCITY STAFF - PER HOUR: $70.00 $0.00
RESIDENTIAL, FIRST
101-0000-42403
0
$143.00
$0.00
1,000SF
RESIDENTIAL, FIRST
101-0000-42600
0
$47.19
$0.00
1,000SF, PC
Total Paid for ELECTRICAL- NEW CONSTRUCTION: $190.19 $0.00
APPLIANCE
101-0000-42402
0
$11.92
$0.00
REPAIR/ALTERATION
APPLIANCE
101-0000-42600
0
$4.77
$0.00
REPAIR/ALTERATION PC
VENT FAN
101-0000-42402
0
$11.92
$0.00
VENT FAN PC
101-0000-42600
0
$4.77
$0.00
Total Paid forMECHANICAL: $33.38 $0.00
FIXTURE/TRAP
101-0000-42401
0
$23.84
$0.00
FIXTURE/TRAP PC
101-0000-42600
0
$23.84
$0.00
Printed: Monday, September 22, 2014 2:43:42 PM 2 of 3
PARENT PROJECTS
REVIEWS
RETURNED STATUS
REMARKS
REVIEW TYPE
REVIEWER
SENT DATE DUE DATE
CLTD
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
8/27/2014
APPROVED
NON-STRUCTURAL
BY
WATER SYSTEM
101-0000-42401
0
$11.92
$0.00
TOM
INST/ALT/REP
APPROVED 2ND PLAN CHECK .1ST P/C DONE BY
STRUCTURAL
8/27/2014
9/11/2014
APPROVED
WATER SYSTEM101-0000-42600
0
$11.92
$0.00
1
1
1
1
1
1
INST/ALT/REP PC
Total Paid for PLUMBING FEES: $71.52 $0.00
SMI - RESIDENTIAL
101-0000-20308
0
$S.8S
$0.00.
Total Paid forSTRONG MOTION INSTRUMENTATION SMt $5.85 $0.00
$740.45 $0.00,
PARENT PROJECTS
REVIEWS
RETURNED STATUS
REMARKS
REVIEW TYPE
REVIEWER
SENT DATE DUE DATE
NOTES
DATE
TOM
8/27/2014
APPROVED
NON-STRUCTURAL
APPROVED 2ND PLAN CHECK
HARTUNG
TOM
APPROVED 2ND PLAN CHECK .1ST P/C DONE BY
STRUCTURAL
8/27/2014
9/11/2014
APPROVED
HARTUNG
YOUNG ENGINEERING
Printed: Monday, September 22, 2014 2:43:42 PM 3 of 3 I _„___.._
-
ILS • .a-o
- r
Bin #
y � Q Cit Of Quinta
Wading a Safety Division
P.O. Box 1504, 78495 Calfe Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 79-102 Li a St.
Owner's Name: Steve & Suzanne Seher
A.P.Number. •776-130-001
Address:79-102 Li a St.
Legal Description:
Contractor: Roper Morris Construction
City, ST, zip: La Quinta, CA 92253
Tacphone:
Address:
Project Description, proposed addition to
City,ST,Zip: La Quinta, CA 92253
existing cas'
Telephone: 760-272-9292
;}
State Lic. # :
CityLia lit
Arch., Engr., Designer: Gabriel Rios
U 2
Address: 49901 Cinnabar Ln.
CIN OI_ Lr, QUINTA
City,ST,zip: COachella, CA 9226
COMMUNITY DEVELOP MENJ
Telephone: 760-485-7431 £r as ^ ,
P'
State Lic. #:
Name of Contact Person: Gabriel Rios--;Z:Sq.
Construction Type: V— B Occupancy: R— 3 .
Project type (circle one): New Add'n Alter Repair Demo
Ft.: 3 0 g #s1 # Units:
Telephone # of Contact Person: 7 6 0 — 4 8 5 — 7 4 31
Estimated Value of Project: $45,000•.00
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item - Amount
Structural Cale&
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance.
Title 24 Cales.
Plans picked up
Construction 14
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
Z'' Review, ready for correctto a/issue
S12Electrical
40
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.T.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
°'0 Reyiew, ready for correctio ssue
2
Developer Impa e
Planning Approval
Called Contact Person
Z
A.I.P.P. CROC
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
7/11 ? 1'7
X53
I
Tihf 4 4 a"
COMMUNITY DEVELOPMENT DEPARTMENT
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
(760) 777-7012 FAX (760) 777-7011
CERTIFICATION OF BUILDING AREA
STREET ADDRESS OF JOB:_ 79-102 LIGA ST.
APN: 776-130-001
DESCRIPTION OF WORK: ADDITION TO EXISTING DETACHED CASITA
SQUARE FOOTAGE: 309 SQ. FT. RECEIVED
OWNER'S NAME: STEVE & SUZANNE SEHER
11,
For questions regarding this letter, please call:
City of La Quinta Permit Center
(760) 777-7012
Coachella Valley Unified School District
83-733 Avenue 55
P O Box 847
Thermal, CA 92274
(760) 398-5909
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
SEP� -1 it, 2014
:�
FACILITIES SERVICE'
f-
. • t
-IT
ti
.
t a ... ... 1. -A
s
i O C,. —
Please note: This letter verifies conditioned square footage. Please
your School District to verify school fees, requirement for.cashier's
or money order and hours of operation.
(J
LA I Y '-Ut-4,.A LIVIN I H ,6U15-UUN 1 HA—U'V'1JH LIJ 1
DRESS_'/'7lDeP- Z,161* . PERMIT NUMBER OWNER �� BUILDER
m shall be posted'on the iob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are. authorized to wor
job., Any•�hanges to this list must be approved by the 1302 n�, D vision prior to commencement of wo,-X. 45ailure to comply will result in a stoppage of work and/or the voidanc
Jing Dermit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Ye / Classification
Contractor
::.:.:::: •......... :. :.:.:.; ::.;:<
:>: State;:Contractot . License•.. •
.:....::..: ..:• . • ..: Workerr•Conipersatton �nsurani:e`:':<': :' :'•.• :a`>.::.:
City Business License:'>. '::
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
Ixx/xx/xx)
Carrier Name
(e.g. Stato Fund, CalCo//mttp_�)
Policy Number
(Format Varies)
Exp. Date
Ixx/xx/xx)
License Number.
(xxxx)
Exp. Date
(xx/xx/xx)
HWORK(C-121`:•'`J
C� �j1�Stfl`(�%�C. tau,
E�E�y �IttifO C�..C"
C1-�� G"a�
&Do�S3
ltlZo
13
�%�ogrv/0S%O((%
y
%C/
—L'� t�;�3u-�T-�oY
t-- 4b
103 s7'V
161 y
Gr ��'�G� ��,•�'�Il� (N
1i2`
aS y�lO
`.CRE E. (c=s) ' ' tj
.... .: .;
MING :(G-5)� •;::' .
`�V�- �. �•-f7i`•-v t _ Q •
l -� _ ,-. - �
•�?
L.
I _
_ , _ .
-
� 31
i �/t — �
733 •�
S i
W�3t�
c
L...
- - -
-
.
to
:R u" T. .-STEEL jC-51)
_
�J
PL1.UMBING (C-361 �✓
i0AIVh-W luw+bt '.
C- 3
/S$y°I
I�'3� 13
��'r1q'i•G h%b
%� 9 �?
3 A/
/ 3 % /
-1
ATH; PLASTER 4G 3$)
V T Fit G P lAr1 }v�''
�'�i `,� C' �
i31 eb5O �
�►�� � tS�
� G rj %YJ/�!1(
% ST �00 3 S 8 g
%O�iC7�y
5-/
WALL'( : V
U(Arl! �( � Wl +d'� 1
r`
� 3� �"t
R
� �J ��
C� , � S
�/�%i�- iV��:iG�
(, ��TSnC%
/-ly
/Obl77y
91/
,.?'.
NVAC.It=-2o)':..'..::.'' ::
1VIMGWS q1 ✓L.
C Zv
ti
04v
05 7�,�
5—%�
�2�7
•!
ELECTRICAL. (C=1O)' :.
'�gO�JFING'�C.=39�:::;`':':.
pIVC�SI i'IEi ��ipOh lit
�.'3 r
/ 7�-J/ (
J /
W pgvt01�
/
�•SHEET•METAL (C'-43) �
�
I
FkOOiRING
GLAZING (C: .7):'.'. t. • `^ •
W fill y'
INSULATION (C-2) . •'
SEWAGE DIM. (6-42) '
PAINTING (C=33) :
Terra OW 'F/% -O h#r
C33
-3-7330 10
- !S
, veI(eS-r Alprj orur/
77GO v 76S ; J )A
tb
� 3
� t S
$ •sl ('
RAMIC TILE (C-54)
f
CABINETS (C-6) •'/
Ki '��NL
���
�f b?dr�
�- i 57
�!
pulite% (,11 1 6 Vi r5
`
4)KAI /31!'?.7&
�.J
U
FENCING (C-13)
LANDSCAPING (C=27).'•;;
POOL (C-53)
1�
IN
Date
9/18/14
No.
31547
Owner
Steve & Suzanne Seher
Address
79-102 Liga St
City
La Quinta Zip
Tract #
Type
Residential Addition
Lot # No. Street
Unit 1 79102 Liga St
Unit 2
Unit 3
Unit 4
Unit 5
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
No. of Units
S.F. Lot # No.
309 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
4' r
BERMUDA DUNES
V7 RANCHO MIRAGE d
r� INDIAN WELLS
PALM DESERT
LAQUINTA
INDIO
ri �
776-130-001
La Quinta
1
Street
S.F.
Comments COC created on 9/22/14 as software crashed on 8/14. Original to be mailed to Bldg Dept & copy to Roper Morris
50855 Washington, Ste C-216, La Quinta 92253
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 309 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Exempt - Roper Morris Check No.
Bank Name/Recipient of Certificate Telephone 760-272-9292
Funding Exempt
BY Dr. Gary Rutherford
Superintendent
Fee collected lexampt d b 5 aro 'McGilvrey Payment Recd $0.00 -I
Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1)� 61s will serve to notify you that the 90 -day approval period in which you may protest the fees
or 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 without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting