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13-1369 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO 4,4 a LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENTS—� BUILDING PERMIT Application Number: 13-00001369 Property Address: 53323 VIA DONA APN: 777-420-029-46 -298944- Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 16000 Applicant: Architect or Engineer: 'V VOICE (760) 777-7612 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 "�. /2 8 / 13 Owner: — RYAN THOMAS 53323.VIA DONA LA QUINTA, CA 92253 (760)777-9920 Contractor: GJH DEVELOPMENT INC 29207 RIDGELINE CT TEMECULA, CA 92590 (760)777-9520 Lic. No.: 916227 -------------------------------------------------- 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 Prof ssionals Code, and my License is in full force and effect. License Clas : 13 License No.: 916227 - Date%"Cont actor: .. OWNER -BUILDER DECLARATION 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 r she is exempt therefrom and the basis for the alleged exemption. An violation of Section 7031.5 by - t he e e pt g e p y any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: " 1 _ I 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 am exempt under Sec. , BAP.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: LQPERMIT D ° OCT 2 8 2013 CITY OF.6A QUINTA FINANCE DEPT. ------------------ WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: - - I I . _ 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 EXEMPT Policy Number EXEMPT 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 tho provisions. Date j /•/ Applicant, WARNING: FAILURE TO SECURE WORKERS' COMPENSATION IeOVERAGE 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 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 build• .e trY6n, and hereby authorize representatives - of this county to nter upon the above-mentioned pro rt o �S�Bc ' n purposes. Date 3 Signature (Applicant or Agen C-- ' LQPERMIT _, Application Number.. . . . . 13-00001369 Permit . . . WALL/FENCE PERMIT 2013 Additional desc . Permit Fee 104.39 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 16000 Expiration Date 4/26/14 dty Unit Charge Per Extension • 1.00 47.1900 LS MISC WALL, FIRST 100 LF 47.19 4.00 14.3000 EA MISC WALL, ADDL 50 LF 57.20 ---- Special Notes and Comments BLOCK WALL - INSTALL 280 L.F. OF 6 FT. HIGH BLOCK WALL WITH (6)24 IN. X 24 IN. PILASTERS. PROPERTY LINE WALLS TO BE INSTALLED•WITHIN PROPERTY LINES OF THE SUBJECT PROPERTY (PER ATTACHED APPROVED PLAN AND,ORCO BLOCK WALL DETAIL). PRECISION CONCRETE BLOCK.SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2010 CALIFORNIA BUILDING CODES. Other Fees . . . . . ... . BLDG STDS ADMIN (SB1473) 1.00 ` PLAN CHECK, WALLS 60.06 Fee summary Charged PaidCredited Due -- - -- - - - - - - -- - - -- - •Permit Fee Total 104.39" .00 .00 104.39 -Plan Check Total .00 .00 00 00 Other Fee Total 61.06 .00 .00' 61.06 Grand Total 165.45 .00 00 165.45 LQPERMIT _, Bin # Qty of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Per it # / Project Address: Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: Zg- Contractor ne%Telephone: Address:mqpi X Project Description: City, ST, Zip: Telephone: <'.;.r.,: ;;::: �;:.:;:,::;;•;;�:>:;:��:>s':;;;. O State Lic. # : City Lie. #: Arch., Engr., Designer: 40 - Address: City, ST, Zip: Telephone: P State Lic. # :>:;>;;:::;>.•:v<> >>>:s:< :>:::<:.;:;».:;:: :>.a:s::::;•:•>::s:<;:%:t::s:;<zr::i:•»>::••::.. `:` :<: Construction Type: Occupancy: Project type circle one): New Add'n Alter Repair Demo Name of Contact Person: L . Sq. Ft.: # Stories: #Units: Telephone #,of Contact Person: 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 Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god 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 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 2 r /'� CITY. OF LA MANTA -SUB -CONTRACTOR LIST JOB ADDRESS- 7 V' Q��PERMIT NUMBER�/J7OWNER BUILDER. "-®roxor This form shall be costed on the job .with the Building Inspection *Card at all times in a con picuous place. Only persons appearing on this list or their employees are aut orized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. de Classification Trade-/ / : r Contractor :. :;; :: :::;:::<:::::>State::Contrac :.:: .....;: tot .s License . ::.. :. '. Workeri Co a sa on:�nsu�ance`:.;;.°..`:..<>:::. mpn t! Git . f3iis e s License;:;::..'.. Y n Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (pix/xx/xx) Carrier Name (e.g. State Fund,_CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number .(xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C712) CONCRETE (C-8) FRAMING STRUCT: STEEL• (G-511 MASONRY (C-29) s f Cf r - 1 ` .�,�$ 3 /A 0 PLUMBING (C-36) EATH; PLASTER (C=35) . DRYWALL (C-9) . <..: HVAC. (C7201':..::'?.;.. ELECTRICAL. (C=10) :.. , SHEET METAL (C43)' FLOORING (C-:1'5);. GLAZING (C-17).` INSULATION 1972) SEWAGE DISP• (G-42) PAINTING (C=33) CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) 1 LANDSCAPING (C=27.) .�� POOL (C-53) D cr ORC'O STANDARD 61 TO 8 ` CMU SITE BALLS OPTIONAL FIAT GAP DESIGN OZITERIA: PER THE 2010 COC 1. ALLOWABLE SOIL BEARING PRESSURE = 1500 PSF Z ALLOWABLE LATERAL PASSM PRESSURE= ISO PCF 3. GROUT STRENGTH = 2000 PSI @ 28 DAYS. 4. REINFORCING STEEL : GRADE 60. 5. 1500 PSI MASONRY COMPRESSION STRSVGW - NO SPCL INSPEG770N 6816, 6616, OR 6618 CMU GROUTED ONLY@VERT AND,FOOTING DIMENSIONS. 41 ! f L/V ! d d Q�1! �i 2 S/6' MIN. /TEAR CEU` 0196V REQU� TO LOSE 6616 SLUMPED OLU. ORCO WIDE CELL SLUMP V ` 0 S c Fy � � m w m C31925 ���EXP . 12-31-2014 CIV0, CA�`FO Si N07E5- 1. CONCRETEBLOCX SHALL CONFORM 70AS7M C 90. V40GE1.0a BLAO4 SLUMP SLOCKANDSPLRFACEBLOCJCAREACOFPTABLE r DROP-IN BAR 2. CONCRETEROR fOOTINGSHgtt BE 1 PART QrMEi,?TO 2-x/1 t Q PARTS S4ND TO 3-W PARTS GRAVEL WITHA MAXIMUM OF I -k2 GALLONS OF WATER PER 54CX PORTLAND CS LENT SH8AU, CONFORM TO ASTM C 150 TYPE DTV. Fc = 2500 PSI 2 �657DJDINT 6 RQNFtORCEMENT @ 24'01C 3. REINFORCING STEEL SHALL HE DBURMED AND CONFORM 70 (3 PLACES - 4 PLACES FOR T ASTMA 615 GRADE 60. PROVIDE 48 B4R DIAMETER LAP. & 8' WALLS). GCSE #5 STD. 4� FOR SLUMP BLOCK • 4. RLE4R SHALL BE CENT ERM IN THE CONCRETE BLOOC CELL IN WNICH ITIS LOCATE Nf N07E' PROVIDE 04 DOWEL & x K 04 DROP-IN 84R AT EACH SIDE OF CONTROL JOINTS, 5. CONCRE7FBLOCK -91ALL BE LAVED INA RUNNING BOND PATTERN WnNVERTICALCOn77NUIT7.OF SVDSOF WAt1SAND (.WALL THE CEZI UNO. Q HEIGHT 01AN.GES 6. ALL BL04 X CEZL.S CONTAINING VER77C4L RE34R SHALL BE SOLID °p O , GROUTED. e7. 7Y DOWEL @ CUMOF USE TYPES MORTAR PROPOR77ONED USING ASTM C 270 PART CL:MDVT TO 1/2 PART LIME TO 4-1/2 PAR75 DAMP LOQSE54ND. ip CMU. , 8. GROUT FOR CONoL-m iLOCK PER ASTM C 476 TO BE 1 PART CEMENT 70 3 PARTS SAND (GROUT MAYCONTAIN 2 PARTS 3/8' C PEA GRAVEL IF WEATHER CONDI770A5AREFAVOR48LEAND BLOOC UNOBSTRUCTED CELL SIZE ISSUFF7abVr70ALLOW GOOD GROUT i FLOW). WATER SHALL BEADDED 70 PRODUCE GOOD GROUT FLOW WITHOUT SEGREGATICNN OF THE CONS77UENT R, Z 2 SEIB4 SEE CIiART 9. BLOCK STEM MAYBE WET -SET I-1/2'INTO THE F0077MG WHILE +n L 7HECONCRE7E5PLASTIC BLOCK STEM AMYHEPLACED TO I go L71HER EDC£, Of THE 7RL3Y0y TYPE FOOTING. D _III— 10. F00TING MUST BE FARM ON OR INTO UNDISTURBED -nt 2 i 1—III 1 MAX. NATURAL SOIL OR ON COMPACTED FILL WITHA MMMUM COMPAC770N OF 90%. cz Sl. FIRST DWEC77ON TO BE AFTER FOOTING TRENCHES ARE Q READYFOR CONORE7EAADALL REQUIRED STEEL IS TIED IN PLACE. SEC13ND INSPECUOIN 700E WHEN THE REQUIRED VERTIC4ISIN m i PLACEAND 7HE BLOCK WALL IS READYTO GROUT. �I #4 HORZ. 'CONT. 12. M4A7MUM CONTROL JOINT SPAC2NG: 40' O/C 20'01C FOR $ WALLS TO BE MORTAR WASHED OR STUCCO COATED. 7h 5' TO [DAYLIGHT NEIN. F0077NG DEP7;4 FOR 5'T0 DA LIGHT "" to a I, SLOPE wal @ wAll ® WALL DONT TOP 1 FT. SEMCK 2 FT. SFnMa 2701 26' 1-0' SEE CHART FOR REQUIRED REBAR 3 To 1 z -r AND,FOOTING DIMENSIONS. 41 ! f L/V ! d d Q�1! �i 2 S/6' MIN. /TEAR CEU` 0196V REQU� TO LOSE 6616 SLUMPED OLU. ORCO WIDE CELL SLUMP V ` 0 S c Fy � � m w m C31925 ���EXP . 12-31-2014 CIV0, CA�`FO t F l8 -LV4 N DuonulSNOO a0=l' F s 'ld3 Jll3JVSOgf ,zIRMF R 6' %0 8`.�M WALL W1 TRENCHFoo7yNG ..w. w� 1 ilrld{Cl7rjvl lw=gl( J)'ACJ/11Ci /HAT 5 CLOSER TOGE7HER THAN THE 16" LONG BLOCK SPAQNG. FOR BAWL E.• 48" O/C SPAQNG FOR 16" LONG BLOCX REVER75 TO 45" O/C FOR 18" LONG BLOG4 40" FOP. 16" BLOCK GOES TO 36" O/C FOR 18" BLOCK - ETC #4 DownfAOaswEOF BWa-OL?W/04 DROalN BAR .. - wwmrairmrw�Kw•cswr 8'X8'BL=-Otff v .moo 0 o I L'I- ..CONI ii1DTIhG .v ••v v • v' MRMDEYAWMnONWAILSWNHtE _ 1mt w,vnr�mmsnraaw"esr j. MAYIB•7�CWI®SWALEGRAD!A PROVLOIE 04 DOWN AMD 04 DROP -0.1 BAR ON F40/. . SME CF THE 112 BLOCX DRAIN -AS SHOWN. F00774'G STEP DETAIL CITY OF LAQ111NTArr SS tDN BUILDI &SAFETY DEPT.-- �.7. APPROVED. � � � m P,evT��y�y TdFOR CONSTRUCTION w m C/! %197 LA QUI I /-I C331-2 N A � EXP. 1231-2014 � DAT `v • BY s v yr C�v��, - - E OF CAL\FO WIND MAX. D $ DESIGN WALL TRENCH r 'X' SPEED FOOTING DOWEL 'Y' BAR HEIGHT DEPTH =a#4@ 6'-0", 48" 0/C D+2'-0" 2'-0" #4 @ 48" 0/C U V 48' 0/C FOR '6' 48' 0/C FOR 6' Lu SLUMP• BLOCK SLUMP BLOCK K) x 111. 6'-8" 2'-2" #4@ 48" 0/C D+2' -O" #4 @ 48" 0/C z Z .W . 40' 0/C FOR 6- 40' O/C FOR 6' ' .. SLUMP BLOCK - SLUMP BLOCK w 1 N IL 7'-4" #4@ 40" 0/C D+2'-0" 2'-4" ) #4 @ 40" 0/C z I— 32' 0/C FOR 6' e 32' 0/C FOR 6' w :3 1' SLUMP BLOCK SLUMP BLOCK Lo co (D 8'-0" #4@.32" 0,/C D+2'-0" 2'-6" #4• @ 32" 0/C 9 24' 0/C FOR b' I 24' O/C FOR 6' j SLUMP BLOCK SLUMP BLOCK ..w. w� 1 ilrld{Cl7rjvl lw=gl( J)'ACJ/11Ci /HAT 5 CLOSER TOGE7HER THAN THE 16" LONG BLOCK SPAQNG. FOR BAWL E.• 48" O/C SPAQNG FOR 16" LONG BLOCX REVER75 TO 45" O/C FOR 18" LONG BLOG4 40" FOP. 16" BLOCK GOES TO 36" O/C FOR 18" BLOCK - ETC #4 DownfAOaswEOF BWa-OL?W/04 DROalN BAR .. - wwmrairmrw�Kw•cswr 8'X8'BL=-Otff v .moo 0 o I L'I- ..CONI ii1DTIhG .v ••v v • v' MRMDEYAWMnONWAILSWNHtE _ 1mt w,vnr�mmsnraaw"esr j. MAYIB•7�CWI®SWALEGRAD!A PROVLOIE 04 DOWN AMD 04 DROP -0.1 BAR ON F40/. . SME CF THE 112 BLOCX DRAIN -AS SHOWN. F00774'G STEP DETAIL CITY OF LAQ111NTArr SS tDN BUILDI &SAFETY DEPT.-- �.7. APPROVED. � � � m P,evT��y�y TdFOR CONSTRUCTION w m C/! %197 LA QUI I /-I C331-2 N A � EXP. 1231-2014 � DAT `v • BY s v yr C�v��, - - E OF CAL\FO v D QL4 c— OR 85' & 95 MPH FPO ' D o WIND CONDI TIONS. ►�Z0 _ ® cg), I 1'I CMN.FOOTING DEPTH FOR TO DA Y�ICHT mWALL ® WALL WALL 0 TOP I PT SE7840( 2FT. SETR40, � 1 2 6' 21' Ic6' TO1 1.�, V-4' PRECAST CAP------,, 24' SO. PILASTER - SEE DETAIL £LOW (4) #4 ERr DROP-IN BARS 0 EA. C RNER CELL ,#3 77ES 024' 0/ Z �o (4) 14 DOWELS W/ 24' A4/N. EXTENSIOj I INTO CMU. 0 EA. CO NER CELL 133` 9. 2 £QUAL v ail► a #4 HORZ 0 8' 0/C E. . 24' S0. 2'-9' SOUAR£ ",' r 0 "4Q'P DI211C.V OU1FRIA: PER THE 2010 CBC 1. ALLOWABLE SOIL SEARDYG pREygM . 1500 pSF Z. ALLOW.ABLELA75W PASSIVE PRE35UREa 150 p0y 3. GROUT STRENGTH - 2000 PSI 028 DAYS 4. RE7N)VRQNGS7EQ : GRADE 60. 5. SEE"C-7096 ONE SFC ACCaM77CML 6. 1500 PSI MASONRY COMPREMON STREi UM, 1. CONOWIF &OQYSHAL L CONFORM TO ASTM C.90. ORCO STD. PRSOWO , SRJTFACF SLUMPED, OR WEDGaOCK&00(M4YBE USED 2. GtiWCRE7F FOR R7OAMG SKALL BE 1 PART O'sfavT TO 1-1/1 PARTS S4ND To 3-112 PARTS GRAVEL WITH A M4)QNUM OF 1-112 GALLONS OF WATER PER SACC PORTLAND CWSSHALL CONFORM TO A5774 C 150 TYPE Y Fc a 2500 P& 3. RETNi0ROW STEL SHALL BE DGURMED AND CONFORM TO ASTM A 615 GRADE 60. PROVIDE 48 BAR DIAMEnR LAP. 4. REB4R SHALL BE 090FRED IN THE CDNCRETF &Do( CaL IN WHICH IT IS LOCATED. S. CONORUFBLOLX &*LL BELAYED INA RUNALTNG BOND PA77FRN WITH VERTICAL CQVnNUITYOF THE CELLS UNO. 6. ALL &= CELL GONNA iVG M71CAL REH4R SHALL BE SOLID GROUTED. 7. USE OBP TYPES MORTAR PROPOR770NED USDYGASTM 0170. I PART CEM6VT TOW PART LIME To 4.112 PARTS "4P, LOOSE S4ND, B. GROUT MR C0 oZE7E &OC(PER ASTM C476 7D BE 1 PART LF74BVT TD 3 PAR7S SWD (GROUT MAY CONTAIN 2 PARTS 418' PEA GRA PR IF WFA7N& ComD17TONSARE FAVORABLE AND &OLX UNOBSTRULER aU=FLSS(1MCMTTOALLOWGtOODGROUT ROW). WATER SWU BEADDED TO PRODUCE GOOD GROIT FLOW WI7){O1T SEGRErATION OF THE covsr m 9. BLOC(STFM MAYBEWET-SET 1-1/1' L71R0 7HE FOOTM N9LILE THE CONCRETE ISPLASnC &=57EMMAYBEPLACED T0 UMER =E OF THE 7R&," TYPE FOO71FAV 10. FOOTIirG MUST BE POURED ON OR INTO UADISTURBED itATURAL SOIL OR ON CoMpAC7FD FILL WITH A MD&fUM COMPACTION OF 90% 11. FIRST INSPEC77ON TO BEAFTER M07M TRBVOY SARE READY FOR ETFAND ALL Rwmw STL$ IS 77ED IN PLACE ....NDFOR 70 BE WHEN THE REQUIRED K)MCAL IS IN PLACEAND THE BLOC( WALL L4 READY TO GROUT. 11. At4X AMN CONTROL JODVT SPAam 40'01C 0R 20'01C IF THE WALL 1S TD BEsnxw ca47ED. VOID AREA - DO NOT '- — #3 77£S 0 24' O/C 04 VERT 0 EACH CORNER 8816 SPLIT FAC£ CMU - BLOCK CELLS TO BE SOLID GROUTED ONLY. 61 '- — #3 77£S 0 24' O/C 04 VERT 0 EACH CORNER 8816 SPLIT FAC£ CMU - BLOCK CELLS TO BE SOLID GROUTED ONLY. CITY OF LA OUINTA *+�* CUSTOMER RECEIPT **+� Date: 18/28/13 81 Receipt no: 4138 Year Number Amount 2813 1251 49487 GUIJARRO PL LA OUINTA, CA 92253 BP BUILDING PERMITS :148.23 Trans number: 283598 HOT PURPLE ENERGY Tender detail CK CHECK 5473 $148.23 Total tendered $148.23 Total payment $148.23 Trans date: 18/28/13 Time: 14:16:57 *** THANK YOU FOR YOUR PAYMENT *** ,y x�yr�yydpp vrrvn n'.�r.+rN yxir+xnr_. .: �nNww rraxxlVw cn� nnrcrtnuc ni rnaC Col I 7tti41-777-7159 s� 3z3 a 4� DEMAND 1 CHECK REQUEST OF Return check to requestor Mail check Name / Title of person requesting check lopff,vkaA;&,� &MM & �rr. ■ .. -. J�W� Check payable to:(IJ-0 A / n 1 )� �fi�ipmo Mo-,' Amount: $ (Name) (Vendor No.) �/ - - -- - i4J . h j I I s��` Account Number: (Address) �T - - - �/� v1225 _ Project Number: Check description and invoice number: Signature: (Departmentead) (Date) APPROVED FOR PAYMENT (Finance Department Use Only) BY. BY: ACCOUNT NO. DESCRIPTION �[. 10/28/2013 228.80 228.80 1182 10/28/2013 228.80 GJH DEVELOPMENT 53323 VIA DONA 228.80