Loading...
08-0402 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: r, 08-00000402 Property Address: 52735 CLARET COVE APN: 770-330-012- - - Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 40000 Applicant: Architect or Engineer: PIP ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT - I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C53 enseNo.: 672850 9atttr��/ Cy ractor: / 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 3 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).: (_ 1 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 awn 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 1, 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 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 ISec. 3097, Civ. C.). r Lender's Name: Lender's Address: eL iM Ar LQPERAIIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/06/.08 Owner: ABY INVESTMENT, LLC 454 S. ROBERTSON BLVD. STE. G LOS ANGELES, CA 90048 1 Contractor: �,� 2an GATTUSO POO C RP ION G 667 S. EUGE OAD 4A�Ui�Y� PALM SPRINGS DIE?7, (760)327-759 fINARC� Lic. No.: 67 ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 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 insurance carrier and policy number are: Carrier DELOS INS CO 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 become subject to the workers' compensation laws of California, and agree that, if 1 should become subject to the workers' compensation provisions of Section 700 of the Labor Code, I shall forthwith comply with those provisions. at ,pplicant> 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 1$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 Director of Building and Safety 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 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this counp to gnter upon the above-mentioned property for inspection pur oses. acure (Applicant or Agent): � 1 _ Application Number . . . . . 08-00000402 Permit . . . BLDG POOL PERMIT Additional desc . Permit Fee 349.50 Plan Check Fee 227.18 Issue Date Valuation 40000 Expiration_Date 9/02/08 Qty. Unit Charge Per Extension BASE FEE 252.00 15.00 6.5000 ---------------------------------------------------------------------------- THOU BLDG 25,001-50,000 97.50 Permit . . . MECH POOL Additional desc . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 9/02/08 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 11.0000 ---------------------------------------------------------------------------- EA MECH FURNACE >100K 11.00 ' Permit . . . . . ELEC POOL PERMIT -RES Additional desc . Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date Valuation . . . . "0 Expiration Date 9/02/08 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 ---------------------------------------------------------------------------- EA ELEC PRIVATE SWIMMING POOL 30.00 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation. 0 Expiration Date 9/02/08 i Qty Unit Charge Per Extension V BASE FEE 15.00 2.00 6.0000 EA PLB FIXTURE 12.00 1.00 3_,0000 EA' PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 -------------------------------------------------- Special Notes and Comments 7 -------------------------- POOL/SPA, WATERFALL. ALARMS/BARRIERS 4 I LQPERMIT �L Application Number 08-00000402 ---------------------------------------------------------------------------- Special. Notes and Comments SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCOSURE NOT INCLUDED Fee summary ----------------- Charged Paid ---------- ---------- Credited ---------- ---------- Due Permit Fee Total 453.50 .00 .00 453.50 Plan Check Total 253.18 .00 .00 253.18 Grand Total 706.68 .00 .00 706.68 LQPERMIT,,,�ps tA. q Bin # City of La Quinta Building at Safety Division - P.O. Box 1504. - 78-495 Calle Tampico La Quints, CA 92253 - Building Permit Application and Tracking Sheet Permit # V'( Pmj&-t Address: 52--735 G LARET COVI_ ` • '.Owner's Name: A ;rNVE.Sr AAEN r r G A. P. Number }>x.�+f::zy.;��+;.fNt+r Address: 5 +.5. 0 GdLTSoN L vp SXJ 47 Lrsal Description: n vrW;.:u-='�:'-•.- f 'r �i Wil..' aLd yr,_..=.G.%Hnr.. K :3:;a:n...: .: City.ST. Zip: 0,5 G .S C /4 D D fJ -3`70 1 Contractor. Gr&Tru t) Qbot_ CA QP Telephone: Address: (o C.VvFN>r R Project Description'' O�' s to wAT AL Citv.ST. Zip: ' 5 0.L— C.Aa ZZ Iv - '(. :,: rh�:f!., . t Telephone: Z 5: Z � ;:�>.,.,..: State Lir. = : (,p Z, 5:0 City Lit Arch.. Ener.. Designer. EL410 S srss talcs. - :t ;:.-:.r• '�'a�IIe�`foao►c�•P�anws:;;. : {?; �: Address: 7 3 (D (O cit.'. ST. Zip:PAILS o t.er cA ' ' UPO yy�� ��jj•��- • r�.-,•i�•. �.�;; V...h''-��`z �{.:• Telephone: 7 _ © &.5 .:i x Construction Type: GVL Stz I0=q nCy: State lac- ': ,3?j Project type (circle out): New Add'n Aper -Repair Dema Name of Contact Person: C� Sq. Ft.: # Stories T# Units: Telephone = of Corsa Person:'' 3Z7-7,5 Z �M.. Estimated Value ofProjc= 4' �O O �'— •Y! 4i,3--J}}}ntf:�:1.y.,»"1'=:rT: ':;:: %[M'Pi:{GAl1i� zOQ%'AiQ��ti(l�#�z$Qii3Hf<r-.d•'},.tir:ri. ;;':>;:< :x:.:..:.,.•:: -:r::.{'- .... :_5. .... ....... E , 't •';:FSr.i- •-�Yr°om;". ;Nr•.v,, Y ml :;R4d kSobmit }>x.�+f::zy.;��+;.fNt+r ' PhD Stu n vrW;.:u-='�:'-•.- f 'r �i Wil..' aLd yr,_..=.G.%Hnr.. K :3:;a:n...: .: : , rr• A- 'r :F 24:-:'-.,:. - •.: .:: .; .: Ted►r�L.1:5 �""~'r.'/S'S'• t.: Srir�rDf ii Yi�VY.r .' .^ v .i-:.-lYi�•v^ - '(. :,: rh�:f!., f7rilr"" y�M: � ;:�>.,.,..: srss talcs. - :t ;:.-:.r• '�'a�IIe�`foao►c�•P�anws:;;. : {?; �: TnkZ3Calcs. ..... yy�� ��jj•��- • r�.-,•i�•. �.�;; V...h''-��`z �{.:• Grant-Deed•='<=,�'- x - ., ,'.�•.{ ...::Yf `f Fes.!/.� y>��:}Jv:;.. } v:. . School, FCC:•::. .:.:•:-.:..-.:nvv ....:: •..... �M.. ' 3*1 JYteeD a ...,,.... ta[t0�•t%�E%x `. .}:.:....r: ..w. ::r-...dy:-ii: -.• , y X,:,':}•?::: .'}"f.•: •:: 4:,..J. i � /^���r� fa�vriFj' is if v'.::if%{: -..Y {'ry--: • :..: ,.. .: ......�- }:;•,{.,.+.�.,.,.....: � `:'3i'-.:rw •}y_N :/�!'>1i: : !Y>i•--...,,..: r..r..:...,, �:.: .r :�l11e'rr old:: .;,r "k;' �a?asj✓; t,{fy} .f: y ;��;rfi,{ CiY DsrDcasJ.IK. ............. --Y. r•' Y : .:::: :: rri:Y ':c - � �•� rte:'--%i:i�-:?Y r :::....::::..: •:.}:-�,..:-.v :..+ .. ...... s' .. .... v::.,.'- .......}}i-.:,: t-.,.}r.,...;..r.........}>':r : f :<>i: , vj�'l�,fa. : �� ica is{_::+. l ::: ..z�::. { ....::......1. ....\ ..t.::•. ry-vy .- iv:iii::%'1�3n:" •'nUi'r}{{+If,: ..,. .:C,�... ir:jwnr: •: ?.:;{':>Yr}:-.ham.:•v v.,; -i}..: ••:: ::: .,.-.,. �-r5 ..:'-�� �-'!{:}: -: Y.J}::.. .Y..:� :y;va1}`•jv}r. �v.}r :i:4'fY' :%-. r . s :rra: yr} .-X.r /�Cr•. .rY.f:w'G: :fik::n+-1 ow .R}•::::- . - :.,-f.;.::-{r;>;::.::::..: . -- -.r.•. ..., ,.:ff{.:.,:;�<.; N:;::;rs.�:.�-i�� :�'�a > iii 8' ..,-..;:..•.:- .... .:»J?:. ::..- ' . d:...,::...•::r..:�}r�•...r : d�. r�'?.��.�:.:... . i/ ':J,dr:NJr,'., . ... ...• .........!?,i..l. planning rre��ff f�q ffi - .:}•'i-'..: .!}4% 4i:+ii:G}fJ{fRY ". f!'>ti•-'-�... �v,{:i. ...,.y.Y.� % !i%:n>�i•' : ' i?sir r$.di'• i?fi:-:{.�}.vv''• ./. -. r '}-r r '%fel' ?:.; >:: a .. r •...v .....:......:'. .... .:,•:•:. :- -. :. .r :.}-:.` ..fir}...,rY.: .,. f/.O: .. -. r• .. -: . !.. =... :F :Jr.4..:C r 1r? :.{!.-:!:.1. . Pub. Rks_'Acppt .. ir. }.^i.f-ivi..r}Nir,v:-.-:tw•:.Lt$v:i.r-f.rh•f .-...:.'.�r,.Y!:•.'�:;5; N..F,'.. fiv:::.r-:.,: :: ';%-. Ct•^...•..i.�.}::• :r: .. , {:.i:ia{ F•:�Y.t.{:}�r.ry.J.<:}.}: -r -. :•-:1?rirV... .. :. •;: f::h�Sj .. •:v..'•.. {.:i:frJ{-�..' ri-' ..:.:,••.:,:-::-•..-...::...:•.{....- ....:.:•.ziri.ft{ir.:.}r.. '.R/r-. :,�i .G::i.,i."y,/v. ,:-....,: ..,.•}.-,.. . ..:..::...i:.: .v...:...:... ISO A.AY..:.;::.::{:....>.... ..t.: .. .'.:' ..:....... ... .:r:,-rin. ...f.;�;i::: :'4r .-.::.-;,},: ..: •:: �:...:. .i ...... :?r`:!�'+ ..yl;: rte• -i ........ .. '-.: . ; ._ :.... •-•::?.:...:::... .x... r. .: .. r....h r..:r vii: i}: i:.r .a..:. ....:.• - 1'SJ: !i:f 'iii _.,. -.: ... ....:... • :.. .:: .. .....: • .r -:.ter..-: .,,. :iS:> `%z' x:�i5:+i .... r.. ..... .. xo....:.-i.!..•::Y'iiii:^Y..r-'r'::'?5^�s"`'".qC•} . ?fi:;,. :... ...: :: .:. :r .r. .... r. ............. Fut Msr.AW..:..: v. v....:.. :. .. r..•rrrs;.,r.y.> .•-:.r::.;•.ri::._{::.::.}:ai:x..�..;...?.;:..;r .;:....:..:.:::::.: ::.-+ t'!` -Y.• is }:a:{=-.r:tx: .rill:'.% t... r. tr.. .. ...:.: :.. {. :r: vrf .,.v -:?^Y:': ": •� x.. +: tk}'_{.}¢.:ti/.{,., :.4-!nv •`->... �:!-%;t.:. %;/}rr��+ "'`i �Y:.. -i;'"" .. _ yv4., - :.:........ rr;..., Yd.: r,.^•>'�'4{::w.x,' yyr:•r •:t" .... r..�i';�.>.. . ••f-: :?'fr`fj �i • :...:.:. .r. :•::... .;i,}; :•::..-::• ::: :......,:.:-:;.?{-.::::.: ......:::... ::: .... . ttn-.,.? :::::...:: : +•: ::. .,,.,. ..-.,. v, v; t.,{r.,- IL�.�.�F... ....... ..... Dept.:ii.: {.•.;: ;?�:.ik?'t:':.:: ::f...: i-r!tii:•-'•d ii:i?`d'":vy...d'�" .. X:v .. {t}.: y..,. nvi v.� . .. .. r •. nv.f.; i.,v...:•: { • v:-•: f i•} .., . r }. � �i ri-}f1�r }A:{•:I•r: 1:. ...v ;x.... n,v..n• v :.. :?LC;r:G _ :il.{y:�:•li?i!^r..i:??r.: N..:Y-.:.C.:....... ..f .. .•n.nv.t:. .- ..:. : ,?^-,iiti:•.:4:'F.v' {�:•i.:iii : ..:.:: ..: :':. .. .-.. ...... :.:..... ...:.v:::. n:.t. 0: :.::.. ��f..::: .:.:. .. . ': i -y.:{ ':4:td"{i}S!:}i'.•} "i: ry..-,: ..:ii-i}y!,J _�,•. - .... ..:. ?.:v -- '.-.. ...'-}J.: .::.: ... ....f.. }w.: •. ..: .. J:!.0".i!fi: .?:i.: fi Y.$: - i Approval;.::;;.z .:...:-.::::>:. ,.._.. bi�aaaaf3raipeceioa.,.<.:::-' ::..;`•:=oFP"evraieR..i.n�?A; Fc....i�f{•:- }r z.. �.. y• : "Il';is"�wJ '•r'M'r� F-5(y YY- aw a£ s��i v Tt '���' • d .. �5"j x �" Y _ d rAe•�•e�{.�-� Y 7.y�S��—�®ral& 'y $+.: " . ' f S rr. -• .Sr.' f r., �.-.'-.r.� i�h ^4.Y•' •*.9,„r 1' _ "+�,3F t•� `gC g ] 4�# •�gr��=� '�Jw��_g +� fit., r- � •�',�'�li �r -�. � � �:Y� .s��• L .` •� yam, �. � � •r• ' • a� ���'���� � �'. ��`'`' . � � �. ` — +•:. '•� �������� a ��; xs fir, �$ MINA vom RAN 9 T�': IRA-, -Ell Errs .of�ur ��" - ,s -•.AND" OLAi+ ".' 4� . ;w1W 7M�cF ASS.�:+'z-'�S? �'•='r(Yi'[ .� AM Now r k9F>:' •■ ► • - i -. a;ri ='._ „�Lmmrnt�fiE E Bin i�. o «q 1 YTO' fa'*" �, `� nity; of La Quin to Building 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permwk Mp Project Address:52 — 73 S -6A veS TG 6 ve-- Owner's Name: Ta I �r p� Clti GlG A. P. Number: Address: Legal Description: City, ST, Zip: rj Contractor: 0 no �nd d 1 Telephone: Address: &16211 t%h Project Description: City, ST, Zip: '^ : U T e leP hone• 7G d 7S �O 0 Vt e, State Lic. # : (1r673 City Lic. #... un Arch., n r., Designer: AA -110-1r /`•V K GS3 Address: 71 irGZ C �✓ e rp%2 City., ST, Zip: —jrli`U CA 922U� S Telephone: G r/ 27 <;;;::::::.<;.;.;>:,„::;<:>;>::>:Construction >: . :: Type: Occupancy: State Lic. #: Project type (circle one): New Add n Alter Repair Demo Name of Contact Person: JQj K S Jc� s S G- Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: fa. pZ 067 Estimated Value of Project: 000 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2pd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- '”' Review, ready for correctionissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue 10 School Fees Total Permit Fees Bin # Qty of La Quinta Building &' Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 52 ' 735 C V.Q_ Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: Contractor:d I Nacre ►� E ems, telephone: >' Address: 79g0Z �qpa �. Project Description: � G1�i�.. / City, ST, Zip: d CA 1-1-7,&-3 j2 e Telephone:7�o 7s .36,T :....,:...........:: 4e, State Lic. # qVr/ g Arch., Engr., Designer: City Lic. #t L J. c)y Address: City., ST, Zip: Telephone: `'?s ;F#:::.><.::;; ; ;;: ;::;::::: Construction Type: Occupancy: State Lic. #: Project type circle one): New Add'n Alter Repair Demo Name of Contact Person: �du �% Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: p P Z O/G Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Coles. Called Contact Person Plan Check Ilalance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Decd Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees s. ".ContractorsState Li . Contractor's License Detail - License # 946508 s;z'Zus V1/CVw'I/VY/UW 1///V///@04440// tO/tC// //V1/1 U/C VVVLI //NG//JG Ua K//IG.IG. relying on this information, you should be aware of the following limitations. CSLB complaint disclosure is restricted by law (B&P 7124.6) If this entity is subject to public complaint disclosure, a unK Tor complaint aisclosure will appear Delow. LUCK on me unK or Dutton to obtain complaint ana/or legal action information. Par RRP 7n71 17 nnly rnnctnorfinn ralatorl rwil istdnmPnts renorted to the SLR are ftelosed. Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration:. F Uue to worKloaci, there may be relevant Intormatlon that has not yet been enterea onto the 1:30ard•s license database. License Number 946508 Extract Date 2/27/2014 ......�.._.,a......a.�.,.......�.�.�.�...._..�m�..,�. NAVARRO POOL CONSTRUCTION INC .. o..�......®...�,.....�a.a•..n�.�..a.,..,Y.,....W.._.�.w_.......�...ma..�........,_.._, dba NAVARRO ENGINEERING Business Information Business Phone Number: (760) 272-0778 79-802 CAMDEN DRIVE .....e....n.,..K.._�....,.�..,,....�.,.n.m tNDIO, CA 92203a.��.���,.�.��,..e.�.A..s�m...��,....�.....s,.�n..�..........�..,-,..._..�,...n.�.�..�,..,�.�......�,.,m ,..Enti�!.....,�..�....,.....e.....,.®..........�.,.�....,.,Co�r�urationm..._,�...�.._.�.,��.�.�.,.�..�.,..�.,s...�...,.,....,e,..�,...�..ry.a..n�..,.�.....g,,..._.�,...,._.....,.�._.� Issue_Date ..Expire Date W w.._ �.. 04/302014 License Status ACTIVE This license is current and active. All information below should be reviewed. CLASS DESCRIPTION Classifications A GENERAL ENGINEERING CONTRACTOR UO3 6VVIMMINU FUUL CONTRACTOR'S BOND This license filed a Contractors Bond with SURETEC INSURANCE COMPANY. Bond Number. 5135265 Bond Amount: $12,500 Effective Date: 04/21/2012 Bonding Contractors Bond History BOND OF QUALIFYING INDIVIDUAL 1. The Responsible Managing Officer (RMO) NAVARRO JESUS ARISTEO SIQU certified that he/she owns 10 percent or more of the voting stock/equity of the corporation. A bond of qualifying individual is not required. ,ective [late: 04/30/2010 SECURITY NATIONAL INSURA iCE Wo►ke►s' Comoensafion Poiicv Number SWC10309 - Effective ®ate: 10/01/2013 Expire Date: 1 0101 /201 4 VVorkers' Compensation Hisiou Personnel listed on this license (current or disassociated) are listed on other ncensw. Personnel List ! L Other L censer Conditions of Use I Pnvacy Policy Copyright © 2010 State of California 'r , liWl — 0 olvolo I'* avzi owl imm a, ru mGOMM SMOOMPMOM a 36 GA GAS BBQ BBQ GAS FI" FEATU�- ISt-AND. CA• FAICIRETE SUY.,F,4.CE 1w �w O O Tait 4 `IDEMAN�DE`/, �,�:�CHEC�K�EREQUEST� C`c`yOF �•�� � •rr''�, fiY;�' �..d":.�. ,,:i3'. e.�4. •i7�' z • ':6>i:> >.,.�'1.:7'�';y-s�,t { . n . , x:� sro, Sr. Return check to requestor 0 Mail check Name / Title of person requesting check KRYSTENA BLONDELL- SENIOR ACCOUNT CLERK Department individual is associated with: FINANCE DEPARTMENT Check payable to: TRADITION CLARET LLC Amount: $ 97.24 (Name) (Vendor No.) P.O. BOX 1573 Account Number: 101-0000-42400 (Address) RANCHO MIRAGE, CA 92270 Project Number: Check description and invoice number: PAID FOR A BUILDING PERMIT WITH A CHECK WRITTEN FOR $275.99, BUT BP 14-194 FEE IS ONLY $178.75. NEED TO REFUND THE $97,24 OVERPAYMENT 0 Signature: (Department ea ( Date) aAP,PROVED F3OR'PAYMENT (Finance qpartment Use Mo 'Xr-,�Fi+ V it •fi t 4.�%F'h BY:, 21 v„ sY;rt .�. �� 4 3 „ � r„ •. SY„ � � t�r�s2dr�e� BY:,"t ? l5�i 2ti xa it *tig>6�r 2�i . KLt� a 9 Yra qtr r tiv t7 ACCOUNT,NO k k `g: ,e`Y'`Jt`! /`S'S Cj ,11,d'.l, t1P+V..rfY�. •. •C`{'.. „ tY} �s,+ �i�PvL' s.3i��'` x^�y,t r� F•y zj�'F:� yy.fry.g� r`' ; �z ,� s's4 ;bESCRIP,TION!�*—t c,.:,'"{;4} k y+�ti�`e,y« 4 'iir'•r ar,'S� tit tr 5 O, F ac r4 ke ds t'' ,{_4. r� a s• t ... _ ;'.:i. A � ..ai `4 � "l� 4M iF i� �7 � �fl.'1.�:-X' +;t" '.'r.. : s^4 t _Tip+: « r.K'. •-.+il...y:-"�t:4�.'+ .itt s