The URL can be used to link to this page

14-765 (SFD)78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 4 4Q" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: SFD-14-765 Property Address: 43-365 CROISETTE COURT APN: 609052002 Application Description: DARBY ESTATES PLAN 2 - MODEL COMPLEX Property Zoning: Application Valuation: $177,211.00 Applicant: G H A ENTERPRISES INC ��- 30-875 DATE PALM DRIVE STE C CATHEDRAL CITY, CA 92234-3747 W G 2 6 2014 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/26/2014 Owner: ADOM VENTURES 77-682 COUNTRY CLUB DR. STE A3 PALM DESERT, CA 92211 Contractor: G H A ENTERPRISES INC 30-875 DATE PALM DRIVE STE C CATHEDRAL CITY, CA 92234-3747 (760)969-1400 O"O0F LLA OUINTA LIC. No.::CONV:140528101254140347 COMM t4M DEVELOPMENT DEPARTMENT LICENSED CONTRACTOR'S DECLARATION 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 Professions Code, and my License is in full force and effect. //��LicenseClClass: _L License No.::CONV:140528101 54140347 ,( Date: �+ v J -/ 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 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the allege 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.). (_) 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 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 Name: Lender's Address: 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. _ I 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:— 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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those (r�ovisions. Date: ! Applicant �— 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 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 city to enter upon the above- mentioned pro erty for inspection purposes. Date: 6 0� Signature (Applicant or Ag .nt)'� _" �i FINANCIAL • . DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BLDG PC 25001-200K 10160003428200 $1,000.00 $1,000.00 6/4/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for BLDG PC 25001-200K: $1,000.00 $1,000.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $8.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA; $8.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - LIBRARIES 253-0000-43200 0 $344.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 $0.00 PAID BY METHOD' RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for DIF - SINGLE FAMILY DWELLINQ $6,894.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $36.48 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $15.03 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY 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: $241.70 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR 101-0000-42402 0 $71.50 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $47.66 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD 101-0000-42402 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD PC 101-0000-42600 0 $4.77 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FURNACE 101-0000-42402 0 $71.50 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FURNACE PC 101-0000-42600 0 $47.66 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE VENT FAN 101-0000-42402 0 $59.60 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE VENT FAN PC 101-0000-42600 0 $23.85 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for MECHANICAL: $338.46 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE MULTI -SPECIES RESIDENTIAL 0-8 UNITS 101-0000-20310 0 $1,292.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forMULTI-SPECIES RESIDENTIAL• $1,292.00 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE NEW CONSTRUCTION PERMIT 101-0000-42400 0 $555.79 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forNEW CONSTRUCTION PERMIT: $555.79 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $157.73 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forNEW CONSTRUCTION PLAN CHECK: $157.73 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE BUILDING SEWER 101-0000-42401 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE BUILDING SEWER PC 101-0000-42600 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE FIXTURE/TRAP 101-0000-42401 0 $202.64 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $202.64 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $35.75 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $23.83 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $7.15 $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: $531.61 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $23.04 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forSTRONG MOTION INSTRUMENTATION SMI; $23.04 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SINGLE FAMILY DETACHED 224-0000-20320 0 $1,837.44 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forTUMF - RESIDENTIAL: $1,837.44 $0.00 TOTALS:$1,000.00 Description: DARBY ESTATES PLAN 2 - MODEL COMPLEX Type: BUILDING, RESIDENTIAL Subtype: DWELLING - SINGLE Status: ISSUED Applied: 6/4/2014 FAMILY DETACHED Approved: 8/26/2014 PJU Parcel No: 609052002 Site Address: 43-365 CROISETTE COURT LA QUINTA CA 92253 Subdivision: DARBY ESTATES Block: Lot: 17 Issued: Lot Sq Ft: Building Sq Ft: Zoning: Finaled: Valuation: $177,211.00 Occupancy Type: Construction Type: Expired: No. Buildings: No. Stories: No. Unites: Details: SFD - PLAN TYPE 2, 2709 SF LIVING (622 sf 3 CAR GARAGE) ELEV. A. 2013 CODES. 2010 ENERGY. PERMIT ISSUED AS PART OF MODEL COMPLEX. Y 4 � :X.ni� � �'. t X Process Summary 83 Applied to Approved FINANCIAL INFORMATION s' Printed: Tuesday, August 26, 2014 8:33:36 AM 1 of 5 OPOW"". J _' y< r Ax 15 ..M1 � .. x : _ a.. f k•L .1 -"As?' .._ q¢ s. iti T f _A.'wF ) '° Y!j 3^ '" ✓. .f Y -.T Y 4 � :X.ni� � �'. t X M � `{ t�-,a •A .+ 7..x �, �kF'' ' .l .�',`41 n y.� ita �..'.s.d."f: ! �Gii' `tid "w � _. _ NAME TYPE NAME ADDRESS1 CITY STATE ZIP PHONE FAX EMAIL APPLICANT G H A ENTERPRISES INC 30-875 DATE PALM CATHEDRAL CA 92234- (760)200-5989 DRIVE STE C CITY 3747 CONTRACTOR G H A ENTERPRISES INC 30-875 DATE PALM CATHEDRAL CA 92234- (760)200-5989 DRIVE STE C CITY 3747 OWNER ADOM VENTURES 77-682 COUNTRY CLUB PALM DESERT CA 92211 (760)200-5989 DR. STE A3 FINANCIAL INFORMATION s' Printed: Tuesday, August 26, 2014 8:33:36 AM 1 of 5 OPOW"". J Printed: Tuesday, August 26, 2014 8:33:36 AM 2 of 5 CRE" TFM� 'METHOD CLTD DES CRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # PAID BY� BY BLDG PC 25001-200K 1 10160003428200 $1,000.00 $1,000.00 6/4/14 Total Paid for BLDG PC 25001-200K: $1,000.00 $1,000.00 BSAS SB1473 FEE 101-0000-20306 0 $8.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $8.00 $0.00 BSA: DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $0.00 DIF - COMMUNITY 254-0000-43200 0 $129.00 $0.00 CENTERS DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $0.00 DIF - LIBRARIES 253-0000-43200 0 $344.00 $0.00 DIF - PARK 256-0000-43200 0 $40.00 $0.00 MAINTENANCE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $0.00 DIF - STREET 255-0000-43200 0 $116.00 $0.00 MAINTENANCE DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $0.00 Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $0.00 RESIDENTIAL, EA 101-0000-42403 0 $36.48 $0.00 ADDITION 1,000SF RESIDENTIAL, EA 101-0000-42600 0 $15.03 $0.00 ADDITION 1,000SF, PC 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: $241.70 $0.00 Printed: Tuesday, August 26, 2014 8:33:36 AM 2 of 5 CRE" TFM� Permit Details PERMIT NUMBER f 1 -` City of La Quinta SFD=1'4-765 Printed: Tuesday, August 26, 2014 8:33:36 AM 3 of 5 ��CYc iFRAC CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK`# METHOD PAID BY BY CONDENSER/COMPRES 101-0000-42402 0 $71.50 $0.00 SOR CONDENSER/COMPRES 101-0000-42600 0 $47.66 $0.00 SOR PC EXHAUST HOOD 101-0000-42402 0 $11.92 $0.00 EXHAUST HOOD PC 101-0000-42600 0 $4.77 $0.00 FURNACE 101-0000-42402 0 $71.50 $0.00 FURNACE PC 101-0000-42600 0 $47.66 $0.00 VENT FAN 101-0000-42402 0 $59.60 1 $0.00 VENT FAN PC 101-0000-42600 0 $23.85 $0.00 Total Paid forMECHANICAL: $338.46 $0.00 MULTI -SPECIES 101-0000-20310 0 $1,292.00 $0.00 RESIDENTIAL 0-8 UNITS Total Paid forMULTI-SPECIES RESIDENTIAL- $1,292.00 $0.00 NEW CONSTRUCTION 101-0000-424000 $555.79 $0.00 PERMIT Total Paid for NEW CONSTRUCTION PERMIT: $555.79 $0.00 NEW CONSTRUCTION 101-0000-426000 TI $157.73 $0.00 PLAN CHECK Total Paid for NEW CONSTRUCTION PLAN CHECK: $157.73 $0.00 BUILDING SEWER 101-0000-42401 0 $11.92 $0.00 BUILDING SEWER PC 101-0000-42600 0 $11.92 $0.00 �+ FIXTURE/TRAP 101-0000-42401 0 $202.64 $0.00 FIXTURE/TRAP PC 101-0000-42600 0 $202.64 1 $0.00 GAS SYSTEM, 5+ 101-0000-42401 0 $35.75 $0.00 OUTLETS Printed: Tuesday, August 26, 2014 8:33:36 AM 3 of 5 ��CYc iFRAC Printed: Tuesday, August 26, 2014 8:33:36 AM 4 of 5 ��CVCTFMC REVIEWS CLT D DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY GAS SYSTEM, 5+ 101-0000-42600 0 $23.83 $0.00 DATE PLANNING OUTLETS PC 6/30/2014 7/8/2014 7/3/2014 APPROVED MSHCP FEE CALCULATION: 0-8 DU/ACRE BURT 8/14/2014 8/21/2014 WATER HEATER/VENT 101-0000-42401 0 $11.92 $0.00 HANADA WATER HEATER/VENT 101-0000-42600 0 $7.15 $0.00 8/14/2014 APPROVED ESGIL REVIEWED & HANADA PC APPROVED WATER SYSTEM 101-0000-42401 0 $11.92 $0.00 INST/ALT/REP WATER SYSTEM 101-0000-42600 0 $11.92 $0.00 INST/ALT/REP PC Total Paid for PLUMBING FEES: $531.61 $0.00 SMI - RESIDENTIAL 101-0000-20308 1 0 $23.04 $0.00 Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $23.04 $0.00 SINGLE FAMILY 224-0000-203200 $1,837.44 $0.00 DETACHED Total Paid forTUMF - RESIDENTIAL: $1,837.44 $0.00 TOTALS:$1,000.00 Printed: Tuesday, August 26, 2014 8:33:36 AM 4 of 5 ��CVCTFMC REVIEWS RETURNED STATUS REMARKS REVIEW TYPE REVIEWER SENT DATE DUE DATE NOTES DATE PLANNING JAY WUU 6/30/2014 7/8/2014 7/3/2014 APPROVED MSHCP FEE CALCULATION: 0-8 DU/ACRE BURT 8/14/2014 8/21/2014 8/14/2014 APPROVED NON-STRUCTURAL HANADA STRUCTURAL BURT 8/14/2014 I 8/28/2014 8/14/2014 APPROVED ESGIL REVIEWED & HANADA APPROVED Printed: Tuesday, August 26, 2014 8:33:36 AM 4 of 5 ��CVCTFMC Date 8/21/14 No. 31519 Owner Adorn Ventures Address 77-682 Country Club Dr City Palm Desert Zip 92211 Tract # 31087 Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 Lot # No. Street Unit 1 17 43365 Croisette Court Unit 2 Unit 3 Unit 4 Unit 5 APN # Jurisdiction Permit # No. of Units S.F. Lot # No. 2709 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 BERMUDA DUNES VS RANCHO MIRAGE INDIAN WELLS .� PALM DESERT � , NLA QUINTA INDIO � 609-052-002 La Quinta SFD-14-765 1 Street S.F. Comments Certs #31519 & 20 used for CC totaling $18,167.52. COC created on 9/18/14 as software crashed on 8/14. Original to be mailed to Bldg & Sa fety and copy to be mailed to Karen Hansen, GHA Companies, 30-875 Date Palm Dr, Cathedral City 96623 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $3.36 X 2,709 S.F. or $9,102.24 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 CC/Rabobank - Karen Hansen By Dr. Gary Rutherford Superintendent Fee collected Signature Bank Name/Recipient of Certificate Ivrey Check No. 010007020 Telephone Funding Residential Payment Recd $9,102.24 0.00 Over/Under NOTICE: Pursuant to Government Code Section 66020(d)[f), this 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