0209-024 (SFD)LICENSED CONTRACTOR 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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
B C36 C42 a:11 1.1 r 0y2c
,Date '"' " Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 &. Professionals Code).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). /
() I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
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.
c( )ill have and will maintain workers' compensation insurance, as required by
S tlo,3700 of the Labor Code, for the performance of the work for which this
permit.is issued. My workers' compensation insurance carrier & policy no. are:.
Carrier 1:j?'31 Policy No. I�3�
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 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 provisions.
Date `' ' - lApplicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth oris his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuanf to
any permit issued as a result of this applicaton agrees to, & shall, indemn'f D
& hold harmless the City of La Quinta, its officers, agents and employe
2. Any permit issued as a result of this application becomes null and voi
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above information s
correct. I agree to comply with all City, and State laws relating to the buildi g
construction, and hereby authorize repCresentatives of this City to enter up
the above-mentioned property for inspection purposes. s
sf1 ' Date .. ,
Signature (Owner/Agent)
BUILDING PERMIT PERMIT#
+02X29.0
DATE VALUATIONd r� a tf 2 .3t7 LOT ry TRACT 73 rs
t�I 7.
JOB SITE
ADDRESS a'�3� •'� �^iR1. eF' .1L If
APN T :y
770,-164-M-3
OWNER
CONTRACTOR/DESIGNER/EN (NEER
..�p�j+/%i.J���ay� l:7'.�y��.�.;n�'��y^��'�u��y .�(p,.�y�y`{j�
��.`pgg\�.
�f 3—"3 1''YJ' �'A71:1�dG1'�.`�.•C1-",, ELf' XE
`F1Ai:.'t�+.`.'(:3WtRXt CA 922611
(160)7771 72 0—BLf< 2903
USE OF PERMIT
1004'.3'. F. SPID. PnvRJT DQy N0T rNCLUD., Pr Cr. bVt.1_.4'POcA I, OOR,
t91"tJ�'•� lto?�a,�.,�&'I'�C��i,K:i•t, 74S10 I��k� � tl�t".�. �i~o X''tl�Ljl'TCj�.T3 j�ijF$. FJif3'9 Ji�I��
ISSUANCE 017 aAAM PLAN TYPP,
TRACT COMS`I` :UC -TION W
�'�' OI1.'.t~� CQST Cly' i^C��o4Sr`.�,T,tVM� N
771:3WA D
�• �p gyh''m�,{./�Qa ¢ ••�� gyp-
.L f:�S.�..`�i�, r i`7 {�:IyV� i��3;;ffi S��ULAr.WR.Y
.
/ [�2{ ��J�j 1 / 9. yy{{//jj ��••��ii
S�E-E 01-00041.'iR-0 0 �ii[P'f1H�
InA14CHECK $136,92
PER DEPOSIT .4501010
.
MEC 14 .NIC L yrt4'IQ7• t-�'.2�- Q"J $13.00
i+t.iiMltINOFF11? 301-X700.419 30 W26100
!01'RO140 MQ'I ON ate": •• RESID 101-000441-000 19.74
AV1lDINO MOZZ 101••000-423-000 $3,$.00
.s
SM-TMA01 t
SEN I i iii►.!% I
CITY OF LAQUINTA
FINANCE DEPT. ^ _
RECEIPT
DATE - f { M
BY A �
DATE FINALED0
INSPE T R
__ N
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs -.
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck G: /
Exhaust Fans
O.K. to Wrap
F.A.U.
_
Framing
Compressor
Insulation ��2? , v2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection �
Encapsulation
Gas Piping
Gas
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
• -r�ra._ ^x. . -. r .� r .- .. T.9 . T.....y,-...y, T. �!'.^ � Y _ �i M'laC��������� r 'L,��'1^, "_- �G✓ ':,�Ti[?F`r �`T^�'ZC']�71n:'�.
P.O. BOX 1504 APPLICATION ONLY
BuildingQQQ // 78-495 CALLE TAMPICO
Address .� ` –Li ' h - i ri r urJi 1 rtti_ LA QUINTA, CALIFORNIA 92253
Owner r t_
1� 1
Mailing IA.' R' ! '"�' BUILDING: TYPE'CONST. rf / OCC. GRP.
� ��Address � r A.P. Number 101 �• �1 r'7
gCity Zip Tel.
Legal Description I, 7 T
Contractor Project Description
Address
City jf Zip Tel..
State Lic. City
& Classif.Lic. #0.J Sq. Ft.� No. No. Dw.
Arch., Engr.,
Size /(.5; 7 Stories Units
Designer J `.
Address 1 / Tel.
vt
City / Zip V State
t• % 1 i. �7i r �� �'"i Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm 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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Ihereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires e
New 2 Add ❑ Alter ❑ Repair ❑ Demolition ❑
permit to construct, after, improve, demolish, or repair any structure, prior toItsissuance also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that -he is exempt therefrom, and the basis —r
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep.
subjects the applicant t0 a civil penalty of not more than five hundred dollars ($500).
I'll I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees, Mech.
provided that such 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 Electrical
of proving that he did not build or improve for the purpose of sale.)
1 11, as owner of the property, am exclusively contracting with licensed contractors to con. Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for S,M,I-
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
17 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
f-3 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATIOWINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions Of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the ( I 1;'
work for which this permit is issued. (Sec. 3097, Civil Code.) M! ide Setback fro... _t �perty Line
Lender's Name '
Lender's Address '
,This is a building permit when properly filled out signed and validated, and is subject to FINAl A1' I TOR
•
expiration if work thereunder is suspended for 180 de s. 1/�
I certify that 1 have read this application and state that the above information is correct. Issue '�` -� V �iD� ie Y .Permit
I agree to comply with all city and county ordinances and state laws relating to building ._...may 7—
construction, and hereby authorize representatives -of this city to enter the above A
mentioned property for inspection purposes. Zidatior
lda ed b CITY OFLAQUII�I'iA
FIN
Signature of applicant Date
Mailing Address_ - :
City, 'State, Zip 14 v
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
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 $2.14 X 1,604 S.F. or $3,432.56 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 OCMells Fargo - James Belknap Check No. 0737703489
Name on the check Telephone 777-9572
Funding Residential
By Dr. Doris Wilson
Superintendent
1
Fee collected /exempted by Juanita Green $3,432.56 1 $o-oo
Payment Recd Over/Under
Signature �,j,UJA.1JO ,
NOTICE: Pursuant to Gov ment Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified a e 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 tothe District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
JFIED�
Desert Sands Unified School District
47950 Dune Palms Road
z4�o
Q BERMUDA DUNES r
Date
9/10/02
La Quinta f CA 92253
RANCHO MIRAGE CJ
ti
{� INDIAN WELLSALM
No.
23589
(760) 771-8515
.
DESE
nP LA QUINTAL �y
INDIO
y^i"
v J
O
Owner
James Belknap
APN #
770-164-003
Address
51-288 Calle Hueneme
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0209-024
Tract #
BLK 4
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.'
Street S.F.
Unit 1 22
51288 Calle Hueneme 1604 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
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 $2.14 X 1,604 S.F. or $3,432.56 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 OCMells Fargo - James Belknap Check No. 0737703489
Name on the check Telephone 777-9572
Funding Residential
By Dr. Doris Wilson
Superintendent
1
Fee collected /exempted by Juanita Green $3,432.56 1 $o-oo
Payment Recd Over/Under
Signature �,j,UJA.1JO ,
NOTICE: Pursuant to Gov ment Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified a e 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 tothe District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
JUN 04 '02 09:22AM
rev � '•�' .. r :; •� �:1:i C� C1
Cia1,lii;► i ) ! E. C;JiV?A
RECORDING REQUESTED BY
American Title Company
AND WHEN RECORDED MAIL TO:
James C. Belknap, )r.
32 Camino Arroyo Plate
Palm Desert, CA 92260 �n
CAS
A.P,N.: 770-164-002-7 TRA #: 020.1
and 6_70_-1_6_4–_0_0_3–'8'—)
SERVICE
P. 212
,DOC its 2002-277096
05/23/2002 Ot1:00A Fee!?."
Paps t Of 1 Does T Tax Paid
Recorded in Offioial Records
County of Riverside
Cary L. Ors*
Assessor, County Clark 4 Recorder
1111111111111111111111111111111111 II111111111111111
t!■Oe
��Omm
MEN
GRANT DEED
THE UNDERSIGNED GRANTOR(s) DECLA s) THAT DOCUMENTARY TRANSFER TAXIS: COUNTY 10.8040 1 J
X J computed on full value of properu conveyed, or
] computed on full value less vrilue f li�t6 or encumbrances retraining at time of sale,
to j unincorporated area: [ X ] City La Quinja , and
✓1
FOR A VALUABLE: CONSIDERATIO , Receipt of which is hereby acknowledged,
0 William R. Riley, Trustee or The WI1 liam R. Riley 1994 Trust
.fes
t� herrby GRANT(S) to James C. Belkna , Jr., Trustee of The -James Belknap Separate Trust dated May S, 1992. '
the following described property in the ity of La Quints, County of Riverside State of California;
Lot 22 d 23, Block 4, Desert Club Tra it Unit No. 2, in the City of La Quinta., County of Riverside. State of California,
as per map recorded In 8,wk 20, Page ) 6, of Maps, it the Office of the County Recorder or said County,
William R. Riley, Trustee of The W
BY�
William R. Riley, Trust
Document Date: March 18, 2002
STATE OF CALIFORNIA
COUNTY OP RIVERSIDE
On M 42.k4 :2 -
perwtn,lly app d
per.%unally kmiwn ut me (of prove] 10 me an the
anU acknuwledgcd w me (hot hetshekhey exccuo
IN! perspn(s) or the entity upon behalf of which I
WITNESS my hard and uf►icW .teat.
S
:c:KATHRYN
A.
0 i COMM. t'
t- NoTAay PUBLIC
RIVERSIDE
COMM._ EXP. N
R. Riley 1994
1% _ .
)SS
A of satiAtoory cvidcnco) t0 be the person(s) whose name(t) isiatwsubscribt:4 ,, the wuhln instrument
he same in hislherAhek audtoriud capaClry(les) and that by hisihartgseir signaturr(s) un the ins"ment
person(s) acted, execute] the instrument.
This ares for otTiciat notarial seal,
Mail Tax Sig iemcnis to: SAME AS ABOVE or Address Noted Below
Deacription: Rivereido,CA Document -Ya r.DOCID 2002,277096 Page: 1 of 1 -
Order: i Comment:
1
..• iT15
t
78-495 CALLE TAMPICO
LA QUINTA, CA 92253
(760) 777-7075
Sl' EN? 8f3 JI APPLICATION
003
FLOOD PLAIN DEVELOPMENT PERMIT
BUILDING SITE LOCATION
FLOOD ZONE "AD"- DEPTH 1
COMMUNITY- PANEL NUMBER
rk L r_'kt� * 0, - f6�- a
060709 0005 B
Map Revised: 8/19/1991
APPLICANT INFO ATION SECTION
APPLICANT NAME
APPLICANT
ADDRESS
(MAILING ADDRESS, NOT THE BUILDING SITE)
P,,,2 c
DAYTIME TELEPHONE NO.
gr 7)r
INSTRUCTIONS
1. A Flood Plain Development Permit is required by LQMC Section 8.11.040(A). The Applicant should complete the
Applicant Information portion of this application and submit it to the Engineering Department along with the
required documentation noted hereon at the same time the Precise Grading Plan is submitted to the Building and
Safety Department for plan checking.
2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for Building Permit issuance
• Copy of the proposed Precise Grading Plan for review and approval containing all information required by
the checklist shown on the back of this application.
3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval.
Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety
Department authorizes foundation construction.
• Submit a completed FEMA "Elevation Certificate" form to the Engineering Department.
• Submit 95% relative density soils compaction certification to the Engineering Department.
STEP 1 OF 2 APPROVAL
The Precise Grading Plan submitted for this application has been
STEP 2 OF 2 APPROVAL
All requirements have been satisfied. This Flood Plain
reviewed and found to contain all data required to satisfy the
Development Permit is approved.
requirements of LQMC 8.11 The proposed dwelling is eligible to
receive a building permit upon satisfying all other Building &
Safety Department requirements.
AUTHORIZED SIGNATURE DATE
La Quinta Engineering Department
AUTHORIZED SIGNATURE DATE
Lain�ll�L n4De nit
Victor Monz. Assistant Engineer I
FILE: LJnnn Stan 7 a na.�l ..�� •r�__�
onnR Ilio, vv vutitv A cant
PLAN
it
PCN �; Rn
FOSO Please use this Plan Check Number (PCN)
REV -2 on all correspondence While Plant 7/00
are In plan check
o�
CHECKLIST
FOR
PRECISE GRADING PLANS
IN "A0" FLOOD ZONE
1. Prepare Precise .Grading Plan in accordance with Checklist for Precise Plans
and the following additional items.
2. All elevations shall employ the NGVD-29 convention.
3. Show and label elevation of "Highest Adjacent Grade" next to the building
footprint. This refers to the highest existing natural grade next to the
proposed building prior to constructing the elevated the building pad.
4. Show and label the "Highest Existing Elevation on Lot"
5. Show and label the "Lowest Habitable Finished Floor Elevation". Note, this
elevation shall be at least ONE FOOT higher than the "Highest Adjacent
Grade" elevation.
6. The following grading note shall appear on the plan:
All fill material placed under the structure shall be compacted to
ninety-five percent (95%) relative density.
F080A 10/88
r!'
1-1 i `•. V `
,70 1i `
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: PROJECT: P'
DATE: ?i OUR REPORT NO.:
TEST DATA:
" F-
TEST
NO.
DATE
ELEV.
DEPTH
SOIL ID
NUMBER
MAXIMUM
LAB DRY
WATER
CONTENT
IN PLACE
DRY
PERCENT
COMPACTION
COMMENTS'
3. BASE COURSE
s'
density obtained on sample indicated by
DENSITY
C.
DENSITY
soil ID number.
5. SOIL CEMENT
D.
MOISTURE IN EXCESS OF SPECIFICATIONS
ti
6. OTHER
E.
MOISTURE BELOW SPECIFICATIONS
1134
flijloZ
►�
I
�!� o
���
�'S 6
�,�
P/I1)01
b' `'
1,6.
1S3
�P•3
��
�►7_1/0t
��6.�
S
113,E
firs
,
1
"
TEST LOCATION:
low I&
NOTES: DENSITIES SHOWN: Lbs. per cubic foot
,,
A.
TEST RESULTS COMPLY WITH SPECIFICATIONS
WATER CONTENT: Percent of dry weight
2. BACKFILL
B.
PERCENT COMPACTION DOES NOT COMPLY
PERCENT COMPACTION: Based on maximum dry
3. BASE COURSE
s'
NOTES: DENSITIES SHOWN: Lbs. per cubic foot
"COMMENTS: 1. FILL MATERIAL
A.
TEST RESULTS COMPLY WITH SPECIFICATIONS
WATER CONTENT: Percent of dry weight
2. BACKFILL
B.
PERCENT COMPACTION DOES NOT COMPLY
PERCENT COMPACTION: Based on maximum dry
3. BASE COURSE
WITH SPECIFICATIONS
density obtained on sample indicated by
4. SUBBASE
C.
RETEST OF PREVIOUS TEST
soil ID number.
5. SOIL CEMENT
D.
MOISTURE IN EXCESS OF SPECIFICATIONS
ti
6. OTHER
E.
MOISTURE BELOW SPECIFICATIONS
REMARKS:' '
R ctfull ubmitted,
PSI A-100-2 (3)
JOHN -H A C K E R& A S S O C IAT ES
CIVIL ENGINEERING DESIGN • LAND PLANNING • SURVEYING
ENVIRON IM ENTAL SERVICES
,r
October 2, 2002
City of La Quinta
Public Works Department
78-495 Calle Tampico
La Quinta, Ca. 92253
ATTN: Public Works
RE: Lot 22, Block 4 — Desert Club Tract No. 2
Site Description: 51-288 Calle Hueneme
Builder: Belknap Construction
Gentlemen,
This shall serve as a pad certification letter stating that the grading for said lot has
been done for the above mentioned property. A field inspection has been done and shows that
the pad elevation has been graded as noted,
Pad Elevation
As -Built Elevation Approved Elevation
101.7 101.7
These elevations fall within the standards for grading practice and tolerances.
Sincerely,
�oin eH7Ha c k e R.C.E. 14614
Exp. 3/31/05
X0
(A 3 3��
� A S ��
LIF
68487 E PALM CANYON DRIVE • SUITE 44 • CATHEDRAL CITY, CA. 92234
(760) 324-0216 FAX (760) 321-5701
�a
{r
2
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