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BRES2015-021278-495 CA4LE TAMPICO LA QUVNTA, CALIFORNIA 92253 `&ht 4 # Qu!Krcu COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRES2015-0212 Property Address: 43510 CROISETTE CT APN: 609052002 Application Description: DARBY ESTATES TM 31087 PH 4 PLAN IM Property Zoning: Application Valuation: $155,694.10 Applicant: G H A ENTERPRISES INC 30-875 DATE PALM DRIVE STE C CATHEDRAL CITY, CA 92234-3747 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. License Pas . B License No.: 750957 ,—Date: Contractor: r `OWNER -BUILDER DECLARAT N 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).: (_) 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 Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/18/2015 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 Llc. No.: 750957 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 uld become subject to the workers' compensation provisions of Section 37 00 a Labor Cf3e, forthwith comply witFythose provisions. � Date: �ss16/I- Aoolicant• �/ /t WARNING: FAILURE TO SECURE WORKERS' COMPENSATION t OVERAGE 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 la s relating to building construction, and h eby authorize representatives of this ity, -ter upon the above• mentioned p 7J, for inspection purposes. Date: Signature (Applicant or Agent): DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $7.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $7.00 $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 DWELLING: $6,894.00 $0.00 DESCRIPTION ACCOUNT QTY. AMOUNT PAID PAID DATE TEMP POWER SERVICE 101-0000-42403 0 $24.17 $0.00 PAID BY, METHOD RECEIPT # CHECK # CLTD BY CRIPTION "ACCOUNTQTY AMOUNT PAID PAID DATE TEMP POWER SERVICE PC 101-0000-42403 0 $16.92 $0.00 - PAID BY METHOD RECEIPT # CHECK # 'CLTD BY Total Paid for ELECTRICAL: $41.09 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $145.03 $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 $47.86 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for ELECTRICAL - NEW CONSTRUCTION: $192.89 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL PRECISE GRADING -TRACT HOME 101-0000-42408 0 $133.43 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forGRADING: $133.43 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR 101-0000-42402 0 $72.52 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $48.34 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD 101-0000-42402 0 $12.09 $0.00 PAID BY . METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD PC 101-0000-42600 0 $4.83 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FURNACE 101-0000-42402 0 $72.52 $0.00 PAID BY < : METHOD RECEIPT# CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FURNACE PC 101-0000-42600 0 $48.34 $0.00 -PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE VENT FAN 101-0000-42402 0 $48.36 $0.00 PAID BY METHOD RECEIPT # CHECK # {LTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE VENT FAN PC 101-0000-42600 0 $19.32 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for MECHANICAL: $326.32 $0.00 DESCRIPTION ACCOUNT QTY 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 QTY AMOUNT PAID PAID DATE NEW CONSTRUCTION PERMIT 101-0000-42400 0 $545.41 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for NEW CONSTRUCTION PERMIT: $545.41 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,113.80 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forNEW CONSTRUCTION PLAN CHECK: $1,113.80 $0.00 .DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BUILDING SEWER 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BUILDING SEWER PC 101-0000-42600 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP 101-0000-42401 0 $181.35 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $181.35 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $36.26 $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 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $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 $12.09 $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 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PLUMBING FEES: $490.83 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $20.24 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forSTRONG MOTION INSTRUMENTATION SMI .$20.24 $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 :•� m Description: DARBY ESTATES TM 31087 PH 4 PLAN IMB Type: BUILDING, RESIDENTIAL Subtype: DWELLING - SINGLE Status: APPROVED Applied: 6/4/2015 MFA FAMILY DETACHED Approved: 6/18/2015 MFA Parcel No: 609052002 Site Address: 43510 CROISETTE CT LA QUINTA,CA 92253 Subdivision: Block: Lot:7 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $155,694.10 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 ADDRESSI Details: 2,415 SF DWELLING PLAN TYPE 1MB, LOT 7 [VB/RES-3/CLASS A-FR/13D] THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 2013 CALIFORNIA BUILDING CODES. __j Applied to Approved CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT G H A ENTERPRISES INC 30-875 DATE PALM CATHEDRAL CA 92234- (760)200-5989 MARIOGONZALEZ@GH DRIVE STE C CITY 3747 ACOMPANIES.COM CONTRACTOR G H A ENTERPRISES INC 30-875 DATE PALM CATHEDRAL CA 92234- (760)200-5989 MARIOGONZALEZ@GH DRIVE STE C CITY 3747 ACOMPANIES.COM OWNER ADOM VENTURES 77-682 COUNTRY CLUB PALM DESERT CA 92211 (760)200-5989 DR. STE A3 Printed: Thursday, June 18, 2015 10:43:07 AM 1 of 5 - 0E3 .,,, SYS7EM5 Printed: Thursday, June 18, 2015 10:43:07 AM 2 of 5 0? SY57FM5 CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $7.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $7.00 $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 j 0 j $2,842.00 $0.00 Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $0.00 TEMP POWER SERVICE 101-0000-42403 0 $24.17 $0.00 TEMP POWER SERVICE 101-0000-42403 0 $16.92 $0.00 PC Total Paid for ELECTRICAL: $41.09 $0.00. RESIDENTIAL, FIRST 101-0000-42403 0 $145.03 $0.00 1,000SF RESIDENTIAL, FIRST 101-0000-42600 0 $47.86 $0.00 1,000SF, PC Total Paid for ELECTRICAL - NEW CONSTRUCTION: $192.89 $0.00 Printed: Thursday, June 18, 2015 10:43:07 AM 2 of 5 0? SY57FM5 Printed: Thursday, June 18, 2015 10:43:07 AM 3 of 5 _ CmSYS7EMS CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY RESIDENTIAL PRECISE GRADING - TRACT 101-0000-42408 0 $133.43 $0.00 HOME Total Paid forGRADING: $133.43 $0.00 CONDENSER/COMPRES 101-0000-42402 0 $72.52 $0.00 SOR CONDENSER/COMPRES 101-0000-42600 0 $48.34 $0.00 SOR PC EXHAUST HOOD 101-0000-42402 0 $12.09 $0.00 EXHAUST HOOD PC 101-0000-42600 0 $4.83 $0.00 FURNACE 101-0000-42402 0 $72.52 $0.00 FURNACE PC 101-0000-42600 0 $48.34 $0.00 VENT FAN 101-0000-42402 0 $48.36 $0.00 VENT FAN PC 101-0000-42600 0 $19.32 $0.00 Total Paid for MECHANICAL: $326.32 $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 $545.41 $0.00 PERMIT Total Paid for NEW CONSTRUCTION PERMIT: $545.41 $0.00 NEW CONSTRUCTION 101-0000-42600 0 $1,113.80 $0.00 PLAN CHECK Total Paid forNEW CONSTRUCTION PLAN CHECK: $1,113.80 $0.00 BUILDING SEWER 101-0000-42401 0 $12.09 $0.00 BUILDING SEWER PC 101-0000-42600 0 1 $12.09 $0.00 Printed: Thursday, June 18, 2015 10:43:07 AM 3 of 5 _ CmSYS7EMS Printed: Thursday, lune 18, 2015 10:43:07 AM 4 of 5 (rM SYSTEMS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY FIXTURE/TRAP 101-0000-42401 0 $181.35 $0.00 FIXTURE/TRAP PC 101-0000-42600 0 $181.35 $0.00 GAS SYSTEM, 5+ 101-0000-42401 0 $36.26 $0.00 OUTLETS GAS SYSTEM, 5+ 101-0000-42600 0 $24.17 $0.00 OUTLETS PC WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 WATER HEATER/VENT 101-0000-42600 0 $7.25 $0.00 PC WATER SYSTEM 101-0000-42401 0 $12.09 $0.00 INST/ALT/REP WATER SYSTEM 101-0000-42600 0 $12.09 $0.00 INST/ALT/REP PC Total Paid for PLUMBING FEES: $490.83 $0.00 SMI -RESIDENTIAL 101-0000-20308 0 $20.24 $0.00 Total Paid forSTRONG MOTION INSTRUMENTATION SM! $20.24 $0.00 SINGLE FAMILY 224-0000-20320 07 $1,837.44 $0.00 DETACHED Total Paid forTUMF - RESIDENTIAL: $1,837.44 $0.00 $12,894.45 $0.00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES DATE DATE FINAL" BLD Printed: Thursday, lune 18, 2015 10:43:07 AM 4 of 5 (rM SYSTEMS - - __ .--- - _. _ -_- - -- -- - - -- - --- - – -- - – — -- -- - REVIEW TYPE I REVIEWER I SENT DATE IATE DUE DI DATE I STATUS I REMARKS NOTES Printed: Thursday, June 18, 2015 10:43:07 AM 5 of 5 SYSTEMS ATTACHMENTS Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED 43-510 CROISETTE 43-510 CROISETTE DOC 6/15/2015 BURT HANADA COURT - ROOF O.H. COURT - ROOF O.H. 1 PROJECTION AT PROJECTION AT SIDEYARD.pdf SIDEYARD.pdf DOC 6/16/2015 MARY FASANO BRES2015-0211-0213 BRES2015-0211-0213 0 SCHOOL FEES.pdf SCHOOL FEES.pdf Printed: Thursday, June 18, 2015 10:43:07 AM 5 of 5 SYSTEMS CERTIFICATE OF COMPLIANCE �o Desert Sands Unified School District 47950 Dune Palms Road 4' BERMUDA DUNES r 00 RANCHO MIRAGE b Date 6/18/15 La Quinta, CA 92253 INDIAN WELLS PALM DESERT No. 31837 (760) 771-8515 �va�, LAINQUINTA DIO S 3 �Q 0 y7 Owner Adorn Ventures LLC APN # Address 77-682 Country Club Dr Ste A3 Jurisdiction La Quinta City Palm Desert Zip Permit # Tract # 31087 No. of Units 3 Type Single Family Residence Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 6 43480 Croisette Ct Unit 2 7 43510 Croisette Ct Unit 3 12 43515 Croisette Ct Unit 4 Unit 5 Comments Darby Estates, Phase 4 2698 Unit 6 2415 Unit 7 2415 Unit 8 Unit 9 Unit 10 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 7,528 S.F. or $25,294.08 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 - Laken Jones Check No. 010007627 Bank Name/Recipient of Certificate Telephone Funding Residential By Dr. Gary Rutherford Superintendent P Fee collected /exempna/ Payment Recd 80.00 ^ -� - $25 294.08 Z *bver/ui�e'r Signature "orf NOTICE: Pursuant to Government Code Section 66020( 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 013