806, New garage and sport court, Miscellaneous, Other•
jh C
DEVELOPMENT
461 W. 6th St., Suite 300, San Pedro, CA 90731
LETTER OF TRANSMITTAL
To: City of Rolling Hills
Address: 1 Portuguese Bend Road
City: Rolling Hills, CA 90274
Re: 17 Crest Road East
Attention: Ms. Yolanta Schwartz
We are sending:
Shop Dimas
Letter
Prints
Change Order
Plans
Specifications
Other(s) X
Item No Copies
1 1
• Project:
Code:
17 Crest
1514
(310) 519-9500 FAX:(310) 519-7221
Submitted for: Action Taken:
Your Use
As Requested
Review & Comment
Your Approval/Signature
For Files
For Review
Date: July 18, 2013
X Approved as Submitted I
X Approved as Noted
Returned
Submit
Via:
Mail
Email
FedEx
UPS Originals
X Hand Deliver
FAX Pages:
FAX #: 310.377.7288
Description
That certain original Performance Bond No. MS1530358 (the "Performance Bond") as prepared by
Great American Insurance Company ("Surety") on behalf of Ann L. Johnson ("Principal") for the City of
Rolling Hills, California ("Owner") for the purpose of ensuring that Principal shall faithfully perform
certain landscape and irrigation obligations at the property commonly known as 17 Crest Road E.,
Rolling Hills, California.
RECEIVED BY: V- 5 DATE:
U
Its:
Comments:
The Performance Bond hereby supersedes that certain performance bond No. MS1530358 (the "Prior Bond")
dated June 12, 2013 as prepared by the Surety for the Owner on behalf of the Principal and submitted to the City
of Rolling Hills on June 21, 2013. The Prior Bond is hereby terminated by the Surety and the Principal and is null
and void.
cc: File Jerico Development, Inc.
5teve bache
• w •4110
THIS BOND MUST BE RECORDED IN THE OFFICE OF
THE RECORDER OF THE COUNTY IN WHICH THE
CONTRACT IS TO BE PERFORMED IN ORDER TO FULLY
Acceptance of this bond supersedes prior bond with a signed and COMPLY WITH THE STATUTE AND FULLY PROTECT ALL
sealed date of June 20, 2013, which then becomes null and void. PARTIES AS PROVIDED IN SAID STATUTE.
GREAT AMERICAN INSURANCE COMPANY
PERFORMANCE BOND - PRIVATE WORK
(California)
Bond No. MS1530358
KNOW ALL MEN BY THESE PRESENTS: That we Ann L. Johnson
of Rolling Hills, CA (hereinafter called the Principal),
and GREAT AMERICAN INSURANCE COMPANY, (hereinafter called the Surety), are held and firmly bound unto
The City of Rolling Hills
Eighty-nine thousand, seven hundred fifty-seven
(hereinafter called the Owner), in the sum of
, Dollars, (S 89,757.00
for the payment whereof said Principal and Surety bind themselves firmly by these presents.
WHEREAS, the Principal has entered into a written contract dated
with the Owner for Landscape irrigation at 17 Crest Road East, Rolling Hills, CA 90274
),
a copy of which is or may be hereto annexed:
NOW, THEREFORE, the Condition of this obligation is such, that if the Principal shall faithfully perform the work
contracted to be performed under said contract, then this obligation shall be void; otherwise to remain in full force and effect.
SUBJECT, HOWEVER, TO THE FOLLOWING CONDITIONS:
First: That in the event of any default on the part of the Principal, written notice thereof shall be given to the Surety
as promptly as possible, and in any event within ten (10) days after such default shall have become known to the Owner or to
any representative of the Owner authorized to supervise the performance of said contract. If the Principal shall abandon said
contract or be compelled by the Owner to cease operations thereunder, the Surety shall have the right to proceed or procure
others to proceed with the performance of such contract, and all reserves, deferred payments and other moneys provided by
said contract to be paid to the Principal shall be paid to the Surety at the same times and under the same conditions as by the
terms of said contract such moneys would have been paid to the Principal had the contract been performed by the Principal,
and the Surety shall be entitled thereto in preference to any assignee of the Principal, or any adverse claimant; but if the
Owner shall complete or re -let the said contract, all reserves, deferred payments and other moneys remaining after payment for
such completion shall be paid to the Surety or applied as it may direct to the settlement of any obligation incurred hereunder.
Second: That the Owner shall faithfully perform all of the terms, covenants and conditions of such contract on the
part of the Owner to be performed; and shall also retain the last payment and all reserves and deferred payments until the
complete performance of said contract, and until the expiration of the time within which notice of claims or claims of liens by persons
performing work or furnishing materials under said contract may be filed, and until all such claims have been paid,
unless the Surety shall consent, in writing, to the payment of said last payment, reserves or deferred payments.
Third: That the Surety shall not be liable for any damages resulting from strikes or labor difficulties, or front mobs,
riots, Civil commotion, pu) lic enemy, fire, the elements, acts of God, or defect or fault in the plans or specifications referred to
ill said contract or for rep'cir, or reconstruction •of any work or materials damaged or destroyed by any of said causes, or for
damages from injury to, ok for the death of any person, or under or by virtue of any statutory provision for damages or
compensation for injury to, or the death of any employee. This bond does not cover any provisions of the contract, or
specifications respecting gu rantees of efficiency, or wearing qualities; or for maintenance or repairs, nor does it obligate the
Surety to furnish any bond, !'lolicy or obligation other than this instrument.
Fourth: That no suit, act on or proceeding by the Owner to recover on this bond shall be sustained unless the same
be commenced within six months from the completion of said structure or work of improvement, as "completion" is defined in
Section 3086 of the Civil Code of the State of California. Any notice to the Surety may be addressed to or served upon it at
its office in Foster City , California.
Signed, Sealed andDated this July 17, 2013
By:
S-9238 - 7/77
Principal •`
NSUR CE COMPANY
• •.
CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
County of
Los Angeles
On 1 1 1 '1 l 3 before me,
Caitlin Massey, Notary Public
personally appeared 1e4fP0,t I.lND m 11EN
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(.) is/are—subscribed to
the within instrument and acknowledged to me that he/she/they executed the same in his/herftheir authorized
capacity(ies), and that by his/her/their signature() on the instrument the person* or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNES
Signature of Notary Public
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or e ' ion of attached document)
(Title or description of attached doc hnept continued)
Number of Pages Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑ Individual (s)
❑ Corporate Officer
(Title)
❑ Partner(s)
❑ Attorney -in -Fact
❑ Trustee(s) •
❑ Other
(Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document. The only exception is if a
document is to be recorded outside of California. In such instances, any alternative
acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that Lr illegal for a notary in
California (i.e. certifying the authorized capacity of the signer). Please check the
document carefully for proper notarial wording and attach this form if required
CAITLIN MASSY
Comm. #1889962
Notary Public • California
Los Angeles County
Comm. Expires May 18,2014
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
mmission followed by a comma and then your title (notary public).
• Pn • e name(s) of document signer(s) who personally appear at the time of
no
• Indicate the • • t singular or plural forms by crossing off incorrect forms (i.e.
he/she/theft- is /en • circling the correct forms. Failure to correctly indicate this
information may lead to tion of document recording.
• The notary seal impression be clear and photographically reproducible.
Impression must not cover text or m es. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
A Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
4 Indicate title or type of attached document, number of pages and date.
+ Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document
GREAT AMERICAN INSURANCE COMPANY®
Administrative Office: 301 E 4TH STREET • CINCINNATI, OHIO 45202 • 513-369-5000 • FAX 513-723-2740
The number of persons authorized by
this power of attorney is not more than TWO
No. 0 14535
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the GREAT AMERICAN INSURANCE COMPANY, a corporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than
one is named, its true and lawful attorney -in -fact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds,
undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below.
Name
CRAIG DOUGHERTY
RICHARD B. LINDGREN
Address Limit of Power
BOTH BOTH
LONG BEACH, $75,000,000.00
CALIFORNIA
This Power of Attorney revokes all previous powers issued on behalf of the attomey(s)-in-fact named above.
IN WITNESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
officers and its corporate seal hereunto affixed this 16TH day of FEBRUARY 2012 .
Attest GREAT AMERICAN INSURANCE COMPANY
Assistant Secretary Divisional Senior Vice President
STATE OF OHIO, COUNTY OF HAMILTON - ss: DAVID C. KITCHIN (877-377-2405)
On this 16TH day of FEBRUARY , 2012 , before me personally appeared DAVID C. KITCHIN, to me
known, being duly sworn, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great
American Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal
affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his
name thereto by like authority.
KAREN L. GROSHEIM
NOTARY PUBLIC, STATE OF OHiO
MY COMMISSION EXPIRES 02-20-16
This Power ofAttomey is granted by authority of the following resolutions adopted by the Board of Directors of Great American Insurance Company
by unanimous written consent dated June 9, 2008.
RESOLVED: That the Divisional President, the several Divisional Senior Vice Presidents, Divisional Vice Presidents and Divisonal Assistant Vice
Presidents, or any one of their, be and hereby is authorized, from time to time, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company,
as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof to prescribe their respective duties and
the respective limits of their authority; and to revoke any such appointment at any time.
RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant Secretary of the
Company may be affixed by facsimile to any power of attorney or certificate of either given for the execution of any bond, undertaking, contract of suretyship,
or other written obligation in the nature thereof such signature and seal when so used being hereby adopted by the Company as the original signature of such
officer and the original seal of the Company; to be valid and binding upon the Company with the same force and effect as though manually affixed
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and
the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in full force and effect.
Signed and sealed this
I'YlH
day of
7gAl d'p13
Assistant Secretary
S1029AC (4/11)
• •
Great American Insurance Company
0 Great American Insurance Company of New York
Great American Affiance Insurance Company
GR,I3ATERICAN.
COMMERCIAL SURETY APPLICATION
BOND EXECUTED BY COMPANY INDICATED ABOVE HEREAFTER REFERRED TO AS THE SURETY
AGENCY NAME: AGENCY PHONE:
AGENCY ADDRESS:
(Street)
SECTION I: BOND APPLIED FOR:
(City) (State)
INSURANCE GROUP
Commercial Surety
(Zip)
TYPE OF BOND: Performance Bond EFF.DATE: 5/08/2013 EXP.DATE:. 5/08/2017 AMOUNT: $89,757.00
OBLIGEE: City of Rolling Hills OBLIGEE ADDRESS: 2 Portuguese Bend Road, Rolling Hills, CA 90274
SECTION II: GENERAL INFORMATION
APPLICANT'S NAME Ann L. Johnson SS#: 545-70-2208
RESIDENTIAL ADDRESS: 17 Crest Road East, Rolling Hills, CA 90274 HOME PHONE: (310) 544-1707
(Street) (City)
BUSINESS NAME:
BUSINESS ADDRESS: BUSINESS PHONE:
(zip)
BUSINESS TAX ID:
(Street) (Gay) (Stet.) (Zip)
(state) (Zip)
(Street) (City) (State)
DATE BUSINESS BEGAN UNDER CURRENT NAME:
HAS ANY COMPANY REFUSED TO ISSUE BONDS FOR ANY PURPOSE? YES 0 NOQ
IF YES, PLEASE EXPLAIN:
HAS APPLICANT EVER FAILED IN BUSINESS? YES 0 NO 0
IF YES, PLEASE EXPLAIN:
HAS APPLICANT EVER FILED BANKRUPTCY? YES 0 NO 0
IF YES, PLEASE EXPLAIN:
DO YOU HAVE ANY LIENS, CLAIMS, OR JUDGEMENTS AGAINST YOU? YES ❑ NO 0
IF YES, PLEASE EXPLAIN:
SECTION III: BUSINESS INFORMATION MAY 3, 2013 - SEE PERSONAL FINANCIAL
STATEMENT OF ASSETS & LIABILITIES AS OF STATEMENT ATTACHED HERETO
ASSETS
ICASH IN BANK
CASH ON HAND $
I STOCKS & BONDS $
I ACCOUNTS RECEIVABLE $
NOTES RECEIVABLE $
INVENTORY $
CASH VALUE OF LIFE INSURANCE g
EQUIPMENT I $
REAL ESTATE I $
OTHER ASSETS S
I I
I I
I TOTAL ASSETS I $
� I
NAME OF OWNERS
LIABILITIES
NOTES PAYABLE TO BANKS
NOTES PAYABLE TO OTHERS
ACCOUNTS PAYABLE
FEDERAL & STATE INCOME TAX DUE
ALL OTHER TAXES
ACCRUALS, PAYROLLS, ETC.
DUE ON EQUIPMENT
DUE ON REAL ESTATE
OTHER LIABILITIES
CAPITAL STOCK (IF A CORPORATION)
SURPLUS & UNDIVIDED PROFITS
TOTAL LIABILITIES
NET WORTH
NAME & TITLE OF OFFICERS FINANCIAL WORTH OUTSIDE CORP.
• •
SECTION IV: REFERENCES
NAME
BUSINESS ADDRESS
FRAUD WARNING: My peace who knowingy and w@h intent to defraud guy Insurance company or other person files an application for In uaance or statement of dalm containing any
malede4y false Information or conceals for the purpose of misteadng Wamalion eonaming any fad material thereto, aromas a fraud/al Insurance ect, Mfddt is a a4ao'and that also be
goblet( to civil penalty not to exceed Ave thousand dollars and the stated value of the claim for each suds ridden 'State of NY only.
THE APPLICANT HEREBY AGREES:
The apptcent(s) and the Indemnitor(s), If any, hereby authorize the Surety to obtain credit reports and hlstortes and to confhm the brink balances claimed, and ell
other Items on any balance sheet or Income statement furnished until all liability of the Surety for any suretyship or claim obligatone expire.
INDEMNITY AGREEMENT
The undersigned hereby declare that the statements made herein ere true and correct, and ere made Io Induce the Surety to execute, renew or co(dinue a bond or bonds (hereinafter referred toes the
'Bonds'). In consideratcn «the exertion, renewal or continuation by the Surety of the Bards, the Undersigned, Jointly end sevhraly, agree an felowr. To pay the premtom foe the last year and crassly
advance thereafter as long as fabdty shalt continue under the Bonds, or eery continuation orreu ewal tiered, or substitute therefore; To indemnify the Surety against et loss, tabllty, costs, damages, attorneys
fees end expanses whatever, which the Surety may sustain er bier by reason of executing the Bonds, In malting any Investigation on account tired, In prosecuting or dofendng any action which maybe
brought in cotnectlat therewith, in obtslnbig a release therefrom, and in enforcing any dthe agreements herein coreahted; That the Steely shaft have the tight and is hereby authorized, to Wesigete, wiliest,
settle or compromise any daim, demand, suit or Judgment upon the Bondi To deposit halts the Surely, upon demand, an amount sufident to dtsdrerge any darn on the Bothdr, To waive, and here does
waive, a4 right to claim any property, Wining homestead, exempt from levy, exeahton, sale or otter legal process under the Inv of arty state or slater, That the Surety Mal be under no obdgedon to execute,
renew or continue any bond, end slag have the absolute eight to cancel the Bonds, or any of them, In accordance with any canedatton provision contained therein, or to procure its release from any bond
under any !env fa the release of sureties, and llrely is hereby released from any damage trot may be sustained by tiro undersigned by reason et such emulation crrelease; The Unde signeds' ebrgadoes
sunder this Agreement may only be terminated by sending widen notice to the Surety. Such notice shall be effective Nrenty (20) days after receipt of the notice of temdnation, but In no swot that suds notice
operate to molly, bar, a dscharge the Undersigneds as to the Bonds that may have been exeauled before the effective data of tenninedorr That ids Agreement shall be bincng upon the Undersigned and
each of them whether sigrdng as applicant for the bond or as Indemdtor, end upon their respective heirs, exeatton, adrdntsUaton, nuccessas and assign,, and shell be sbera'y construed as against the
Undersigned.
DATED THIS 3rd DAY OF May
,20 13
WITNESS: APPLICANT:
110/
SECTION(: COMPLETE FOR CASES REQUIRING ADDITIONAL INDEMNITY & ATTACH FIN khCIALS OF INDEMNITORS
In consideration of the Steely exeat log. ofproaring the execution of, orretrdndr g from presently vomiting Its right to cancel, the bend herein rippled for, we Jdrxy and severally agree lobe • - .. by the
foregoing agreement and V the trsderalgned►s a corporation, h warrants that 4la tinersdarty be welled In the performance of the obtiigadoi vfdds sold bond smiled for is given to secure, ... . tat it Is
tiny empowered to obligate Caetf hereby.
DATED THIS DAY OF
WITNESS:
WITNESS:
WITNESS:
INDEMNITOR:
INDEMNITOR:
INDEMMTOR:
,20
SSA
SSA
SSA
INDEMNITORS' SIGNATURES MUST BE ACKNOWLEDGED BY A NOTARY PUBLIC (A H ADDITIONAL ACKNOWLEDGMENTS AS NEEDED)
STATE OF
COUNTY OF
On this
resides In the City of
(CORPORATE ACKN e.a ED
day of , In the year 20 , before me personally comes
, to me known, who, being duly sworn, depose(s) and say(s) that he/she
/ , that he/she Is
of the corporation
described herein an htch executed the foregoing instrument; that he/she knows the seal of the said corporation; that the seal affixed
to the said ins nt Is such corporate seal; that It was so affixed by the order of the Board of Directors of said corporation, and that
he/she sign s/her name(s) thereto by like order.
Notary Public
F.9685 (11/07)
page 2 of 4
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT COOL CODE § 11139
A
}
No71
Here Insert Name and Tilyoot�thee Officer
370k1f0Y7
Name(s) o1 Sfgner(s)
who proved to me on the basis of satisfactory
evidence to be the persona)'whose namep)' is/re
subscribed to the within instrument and acknowledged
to me that s,/she/tty executed the same in
1}i6/her/tl3eff authorized capacityktj, and that by
Kherf%tJr signature(sj' on the instrument the
person or the entity upon behalf of which the
person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature:
OPTIONAL
Though the Information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document p
[�Lf •
Title
or Type of Document: St f.4 Z77
?)/1eee/ 3: ;19/3 Ntlberof Pages:
Signer(s) Other Than Named Above
Capacity(ies) Claimed by Signer(s)
Signer's Name: 4f41'1 G. .il-1n2E'o-»
❑ Corporate Officer — Title(s):
O Individual
❑ Partner — 0 Limited ❑ General
O Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
f "Other: o�Gw
Document Date:
.G'C.cZ^�'.•Cv('t"- ".tYS[.'4'.L•�" `T+.FYZ�'t^d'�%.7�'.:LR'.L�" . .C5 .ZYCL` 00•0.2a'+GZ'Sc.\.G`,t.;‘,c,.l N.t.:„tk. ^.(:C.25.'
State of California
County of XVIL v,
On 11 31 �/ 3 before me,
Date
personally appeared
L. M. BALLANTYNE
Commission # 1966042
Notary Public - California
Loa Angeles County -.
My Comm. Expires Jan 6, 2016 t
Place Notary Seal Above
Signature of Notary P
Signer Is Representing:
((OF.SIGNER ''
Top of thumb here
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Individual
❑ Partner — 0 Limited 0 General
❑ Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
0 Other:
Signer Is Representing:
Top of thumb here
_ _ = "cc S•C.^i-C9.Lt"tdcbr(75>44...ctect?'9,
0 2010 National Notary Association • NationatNotary.org • 1.800•US NOTARY (1.800.876.6827) Item #5907
H
•
DEVELOPMENT
461 W. 6th St., Suite 300, San Pedro, CA 90731
LETTER OF TRANSMITTAL
To: City of Rolling Hills
Address: 1 Portuguese Bend Road
City: Rolling Hills, CA 90274
Re: 17 Crest Road East
Attention: Ms. Kathryn Bishop
We are sending:
Shoo Dwas
Letter
Prints
Change Order
Plans
Specifications
Other(s)
Item No Copies
1 1 ea.
/ 2 1
�3
Comments:
cc: File
1
Submitted for:
Your Use
As Requested
Review & Comment
Your Approval/Signature
X For Files
For Review
• Project:
Code:
17 Crest
1514
(310) 519-9500 FAX:(310) 519-7221
Date:
Action Taken:
Approved as Submitted
Approved as Noted
Returned
X Submit
May 2, 2013
Via:
X
FAX #:
Mail
Email
Fed Ex
UPS Originals
Hand Deliver
FAX Pages:
310.377.7288
Description
'Complete set of wet stamped Architectural plans, sheets A0a, AI(Rev4.16.13), A1a(Rev4.16.13),
IAIb(Rev4.16.13), A2(Rev4.16.13), A2b(Rev4.16.13), A3(Rev4.16.13) A4(Rev4.16.13), A5,
IA6(Rev4.16.13), A7a(Rev4.16.13), A7b(Rev4.16.13), A8a, A8b, A8c, A9, A10a, AlOb dated December
1, 2012 except as noted otherwise as prepared by Michael Burch Architects
AO,
Certified copy of Fuel Modification Covenant and Agreement signed by the property Owner, notarized,
and recorded at the County of Los Angeles Official Records Recorder's Office
County of Los Angeles Fire Department Approval letter approved January 11, 2013
Jerico Development, Inc.
Steve backe
• Cr'I,n' p y
Los Angeles County REGISTRAR-RECORDER/COUNTY CLERK
DEAN C. LOGAN
Registrar-Recorder,Counry Clerk
If this document contains any restriction based on race, color, religion, sex, gender, gender
identity, gender expression, sexual orientation, familial status, marital status, disability, genetic
information, national origin, source of income as defined in subdivision (p) of Section 12955, or
ancestry, that restriction violates state and federal fair housing laws and is void, and may be
removed pursuant to Section 12956.2 of the Government Code. Lawful restrictions under state
and federal law on the age of occupants in senior housing or housing for older persons shall not
be construed as restrictions based on familial status.
RER 2011
P.O. Box 1250, Norwalk, California 90651-0489 - www.lavote.net
• •
This page is part of your document - DO NOT DISCARD
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20130458794
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Recorded/F ed in Offic a Records
Recorder's Off ce, Los Angeles County,
California
0000745965
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SEQ:
01
03/27/13 AT 01:49PM
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THIS FORM IS NOT TO BE DUPLICATED
P0004:
FEES: 24.00
TAXES: 0.00
OTHER: 0.00
PAID: 24.00
£OA210
When recorded return to:
Ann L. Johnson
Applicant's Name
461 W. 6th St., Suite #300
Applicant's Address
San Pedro, CA 90731
City, State, Zip Code
it
*20130458794*
(Space above this line is reserved for Recorder's use)
FUEL MODIFICATION COVENANT AND AGREEMENT
THE UNDERSIGNED, Ann L. Johnson Trustee (print)
do hereby certify to be the owners of the hereinafter legally described property located in the County of
Los Angeles, State of California as Recorded in the Office of the County Recorder:
Assessor's Parcel Number (APN) 7567 011 018
Book Page Parcel(s)
Assessor's Parcel Number (APN)
Book Page Parcel(s)
We do Covenant and Agree with the County of Los Angeles Fire Department as a condition for occupation
of the above property that the requirements of Fuel Modification Plan #4957 FFFM 201100403 approved
on January 12.2012 shall be met. The responsibility to implement those conditions shall be complied with
until such time that said conditions have been eliminated by the County of Los Angeles Fire Department.
This Covenant and Agreement shall run with the land and shall be binding upon the undersigned, all future
owners, encumbrances, and their successors, heirs or assignees. It shall continue In effect until such time
as the County Engineer records in the Office of the County Recorder a statement that finds such
conditions are no longer applicable, or have been mitigated satisfactorily.
By:
Trustee 3/27/13
ner's gnature Date Owner's Signature Date
County Of Los Angeles Fire Department,
Forestry Division,
Fuel Modification Unit
605 N. Angeleno Avenue
Azusa, Ca 91702-2904
(626) 969-5205 Phone
(626) 969-4848 Fax
• •
Certificate of Acknowledgement
for Fuel Modification Plan # 4957
State of California
County of
On before me,
(Insert Name of Notary Public and Title)
Personally appeared
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within Instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(les), and that by his/her/their signatures(s) on the instrument that
person(s), or the entity upon behalf on which the person(s) acted, executed the Instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the forgoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature (Seal)
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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State of California
County of AA'
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On (Vl. .cl/i )1 . - O f 3 before me, L• m • f i%71e .
Date Here Insert Namg'and Title of the Officer
personally appeared
L. M. SALLAN1YNE
Coaanhtbn • 1g66042
Notary Public - California
Los Angela County
Comm. Mires Jan 8, 2016
Ann 14
Place Notary Seal Above
Name(e) of Signers)
CIVIL CODE § 1189
No ley
who proved to me on the basis of satisfactory
evidence to be the person(,.$)' whose names,$ is/pd
subscribed to the within instrument and acknowledged
to 1ne that Fi/she/y executed the same in
Fjrs/her/t r authorized capacity(j), and that by
Itia`/her/tX1r signatures) on the instrument the
person or the entity upon behalf of which the
person acted, executed the instrument.
1 certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature:
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document Title or Type of Document: Gt,t QQ t hcerch v L4 o-Q C(/1,.t
Document Date: Sad.i/ /a ,1D/}
Signer(s) Other Than Named Above: /
Capacity(ies) Claimed by Signer(s)
Signer's Name: AIM L • J64ti 5vv1
❑ Corporate Officer — Title(s):
❑ Individual - -
❑ Partner — 0 Limited 0 General
❑ Attomey in Fact
i< Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
OF SIGNER
Top of thumb here
Signature of Notary Pulfc
Number of Pages:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Individual
❑ Partner — 0 Limited 0 General
❑ Attorney in Fact
❑ Trustee
O Guardian or Conservator
❑ Other:
Signer Is Representing:
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0 2010 National Notary Association • NationalNotary.org • 1.800-US NOTARY (1-800-876-6827) Clem 15967
�31,11 lirwiwi�l�CPz.-:1;
MAR 27 2013
LOS i;:-C, ES COLLT1i, CALIFOMIA
• VS
•
COUNTY OF LOS ANGELES FIRE DEPARTMENT
FIRE PREVENTION DIVISION
Fire Prevention Engineering
4475 W. El Segundo Blvd.
Hawthorne, CA 90250-4411
Telephone 310-973-3044 Fax 310-263-2735
FIRE SPRINKLERS REQUIRED etz
TO: Kit Bagnell BUILDING OFFICIAL
LOMITA BUILDING AND SAFETY OFFICE
RE: 17 CREST E RD CITY: ROWNG HILLS
The occupancy listed above has satisfied all the requirements currently being required
by this Department. The applicant shall install a Department approved interior fire
sprinkler system.
To insure the fire sprinkler system is installed in accordance with Department
requirements, we are requesting the file of this occupancy to be flagged for Department
inspection at the following times: I
1. When rough plumbing is ready for inspecting.
2. When the occupancy is ready for final approval.
Following each inspection, the Department inspector will forward an inspection form to
the Building and Safety Office verifying whether or not the system has been approved or
disapproved.
Building address numbers and their location shall comply with Section 901.4.4
County of Los Angeles Fire Code prior to occupancy.
Fire Department approved street designation signs shall be listed on private and
public roadways, prior to occupancy.
NOTE: Allow ree to days perform an inspection
•
INSPEC"OR