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MISC (0111-084)51545 Avenida Martinez 0111-084 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of ,Chapter.9 (dommencing with Section 7000) of Division 3 of the Business sand Profegslonals Code, and my License is in full force and effect. License # Lic. Class Exp. Date r 10/3 110 1 a e 'Y- ' 411Y Signature of Contractor r . r y' j --• `'' t 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). ( ) I, 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. ( _ ) 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 worker;; compensation insurance carrier & policy no. are: Carrier OT °! `tfM FUND Policy No.. '015201 (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 z workers' compensation laws of California, and agree that if I should beconje subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. , Date: 4, ._ ^ -Y Applicant 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 on s'his application. `r 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 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 State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. s' j 'yr rro` LSignature (Owner/Agent) ! ' f Date, r,• 'BUILDING PERMIT —PERMIT; DATE VALUATION LOT TRACT 1119MI SAX) JOB SITE APN ADDRESS .h9-iir lK .it TSia •, OWNER CONTRACTOR / DESIGNER / ENGINEER 9M» "t MRO77C++ttICEIT MMCC ## , 144O' AR CORY! fir. REIAODEK I :M-273AVIR .i'swI . i a .DiS 770..27 CA.Dr:J.l`.6 DR.. LAc.N 1I A CA _922i3 RA,LUDES2 .,C T CA 92211 CnIlGlt 2213 USE OF PERMIT M l 5 C >kR3k'd , AR t ? hty:3..EiII;`!'2d Ottit"a•Id t ` . '! ?, « llsL'il t'. .:-. < r•,:1 V7'71 f iTts: _ ( /t `; ` f L. t ' ` FRIMATED C0910 03r i"OAFIERUCITON 0.00 D nFr. t2001 CITY OE LAOUKrA RM IX)TAL AMD RLAN CWZK. 0 8SA.AVPEIFMaY i tPS..4!'UE',{OYT/ bPP-so RECEIPT DATE ) BY T NA D INSPECTOR ,z > - e r ' 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 Exhaust Fans O.K. to Wrap F.A.U. Framing /= =V Compressor Insulation f of — fQ f / Fireplace P.L. Vents Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath (— / U _ Final r l _L ` BLOCKWALL AP ROVALS Final Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final 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 Test f l j Z Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final01 Utility Notice (Perm) Z COMMENTS: CROCKETT LIVING TRUST, DATED 04-10-01 TO SUSAN R. CROCKETT as SUCCCESSOR TRUSTEE under the CROCKETT, LIVING TRUST DATED APRIL 10, 2001 of which KRI'STY ANN BRAD Y is the TRUSTEE. Pursuant to the rights reserved to the undersigned as Trustee under the provisions of Section 5 paragraph 5.2 of the above, specified Trust, Trustee, Kristy Ann Brady hereby resigns as acting Trustee of the above specified Trust. The Trust provides that Susan R. Crockett shall act as Successor Trustee. Said Section is setout below. 5 Trustee. 5.1 Successor Trustees. If Richard G. Crockett becomes unwilling or unable to act, Kristy Ann Brady shall act as Trustee of the trusts established by this document. If both Richard G. Crockett and Kristy Ann Brady are or become unwilling or unable to act, Susan R. Crockett shall act as Trustee. No bond shall be required of any Trustee named in this trust, whether acting jointly or alone. Executed and accepted at Palm Desert, California, on September 5, 2001. TRUSTEE: SUCCESSOR TRUSTEE RISTY ANN BRAD .Y SUSAN R. CROCKETT hr -a"` 5 'ezo %o CoPi6D I L6-?Az11 1�13 � �0 W r • ACKNOWLEDGMENT STATE OF CALIFORNIA ) ss. COUNTY OF RIVERSIDE ) On September 5, 2001, before me, Ronald M. Stark, the undersigned Notary Public, personally appeared Kristy Ann Brady and Susan R. Crockett, and proved to me on the basis of satisfactory evidence) to be the persons whose names are subscribed to the within instrument, i.e., the "Resignation of Trustee to the Crockett Living Trust," dated April 10, 2001, and acknowledged to me that they executed the same in their respective authorized capacities, and that by -their signatures on the within instrument the person or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. [Seal] RONALD M. STARK ltp Commission # 1188398 Notary Public — California Riverside County My Comm. Expires Jul 3,2002 i Notary Public DOC a 2001-324861 RECORDING REQUESTED Y 07/13/2001 08:00A Fee:29.00 �� ��� Paye 1 ocia Recorded in Official Records County of Riverside WHEN RECORDE AIL TO Gary L. Orso AND MAIL TAX STATEMENTS TO Assessor, County Clerk 8 Recorder ADDRESS P.O. Crockett O. BOX 1440 I - I I M S U PAGE SIZE DA PCOR NOCOR SMF i MI ;C. i CITY La Quinta, CA 92253 STATE 8 ZIP c o D �� `✓� R L COPY LONG REFUND NCHC EXAM TITLE ORDER NO. 0 0a/ ` _( , ESCROW NO. NT APN NO. THE UNDERSIGNED GRANTOR(s) DECLARE(s)//�� Ci DOCUMENTARY TRANSFER TAX is $ 0 CITY TAX $ �(J computed on full value of property conveyed, or computed on full value less value of liens or encumbrances remaining at time of sale, Unincorporated area: City of se e (�,.�f O.L'�Irlp , and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Richard G. Crockett, an unmarried man hereby GRANT(s) to RICHARD G. CROCKETT, TRUSTEE FOR THE CROCKETT LIVING TRUST DATED APRIL 10, 2001 the following described real property in the County of Riverside State of California: See attached Schedule "A" Dated 9 - iD — of STATE OFC F.ORNIA) COUNTY OF M IV rs i d e, j S.S. On appeared THIS [�lif lfirlei�tf�Fl6rifSft tom;. "t BY ORANGE COAST TITLE COMPANY AS AN ACCOMODATION ONLY. IT HAS NOT BEEN EXAMINED AS TO ITS EXECUTION OR AS TO ITS EFFECT UPON THE TITLE. ichard . Crockett before me, IC title of the officer), personally personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) islare subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. JUDITH ROGERS Commission # 1226367 z Notary Public - California S I• • \;;y:�,;., Riverside Count F' c� My Comm. Wu -es Jul 24, 2003 JL:S67!i ORNMEED.DOC Parcel 1 51200 Avenida Vallejo 773-063-009 Lot 14, Block 71 of Santa Carmelita at Vale La Quinta Unit 9, County of Riverside State of California, As per map recorded in book 18, Page 69 of Miscellaneous maps in the office of the county recorder of said county Parcel 2 51795 Villa 773-182-014 Lot 3, Block 119 of Santa armelita at Vale La Quinta Unit 12, County of Riverside State of California, As per map recorded in book 18, Page 79 & 80 of Miscellaneous maps in the office of the county recorder of said county Parcel 3 1805 Villa773-182-015 Lot 2, Block 119 of Santa Car elita at Vale La Quinta Unit 12, County of Riverside State of California, As per map recorded in book 18, Page 79 & 80 of Miscellaneous maps in the office of the county recorder of said county Parcel 4 51785 Herrera 773-172-014 Lot 2, Block 60 of Santa Carmelita at Vale La Quinta Unit 5, County of Riverside State of California, As per map recorded in book 18, Page 63 of Miscellaneous maps in the office of the county recorder of said county Parcel 5 51545 Avenida Martinez 773-141-003 Lot 3, Block 114 of Santa Carmelita at Vale La Quinta Unit 12, County of Riverside State of California, As per map recorded in book 18, Page 79 of Miscellaneous maps in the office of the county recorder of said county �°�'a :m�N•111111111111111111111111111111111111111111111111111111 v _ I �, nJ ! i. .COUNTY OF RIVERSIDE ,r RIVERSIDE, CALIFORNIA CERTIFICATE OF DEATH ♦TE OF CA LIFORNIw STATE FILE NUMBER USE CLACK INK ONLrINO En OF CA VS -11 I.EV. , w ITEOUTe OR ALTERATIONS LOCAL REGISTRATION NUMBER I CERTIFIED COPY OF VITAL RECORDS STATE OF CALIFORNIA I Ss COUNTY OF RIVERSIDE jp� This is a true and exact reproduction of the document officially registered and placed on file in the office of County of Riverside, Department of Health. Gary Feldman M.D. Local Registrar RIVERSIDE COUNTY, CALIFORNIA DATEISSUED 99/86 12001 This copy not valid unless prepared on engraved border displaying seal and signature of Registrar. .uii.L..i.,.i.Lwa.,.l.'.LLW.L.L.LLQ.,.LLL..L,.��L,.,...,..,,.....,..,,., ............................ ........._.___.. ... .. _ _. _. N 9EoSFRj►R -VI`fliL '- S�T4T,ISTICS ;. '/ 1. NwM[ of D[c[D[NT-IIw[i IG-., 2. MIOOL. 3. -r--. ' Richard Glenn Crockett 4. DATE OF BIRTH M M I D D I C C Y Y 5. AGE YRS.aw IDA.[ L NOuwc 8. SCi 1 DATE OF DEATH M M I D 01 C C r Y 8. HOUR OMA. ;N,NM. 01/11/1951 50 MONTH;` M 07/28/2001 2103 DECEDENT 9. STATE OF BIRTH 10. SOCIAL SECURITY NO. 11. MILITARY SERVICE 12, MARITAL STATUS 13. EDUCATION -TEARS COMPLETED PERSONAL DATA NIM 562-80-4653 ® ElYEH NO ❑ UNIT Divorced 18 10. RACE 15. H NIC -SPECIFY I6. USUAL EMPLOYER White ❑ YE5 QX ND lf Emplo ed 17. OCCUPATION IB. -S HIND OF OUSIN E98 10, 11 -IH OCCUPATION Broker Real Estate 12 20. RESIDENCE-ISTRECT AND NUMBER OR LOCATION( Delmont USUAL .68817 RESIDENCE 21. CITY22. COUNTr 23...P CODE 24. YRS IN COUNT 25. STATEF-IGN COu"YRr Pinyon Pines Riverside 92561 12 C. CA 26. NAME, RELATIONSHIP 27, MAILING ADDRESS larwan ANO NU"111 OR wUwAL POUT[NUM[[ C -Ow 1011, aTAT[, IIP) INFORMANT Susan Crockett - Sister 54273 Avenida Bermudas, La Quinta,wCA 92253 28. NAME OF SURVIVING SPOUSE -FIRST 29. MIDDLE 30. LAST IMwIO6N NAMHI - SPOUSE AND 31. NAME OF FATHER -FIRST 32. MIDDLE 33. LAST 34.'SIw.. [TAT[ PARENT INFORMATION Howard Ranson Crockett N11 35. NAME OF MOTHER -FIRST 36. MIDDLE 37. UST (MAIDEN( 3B. wIwTN [TAT[ Dixie Irene Irons IL 39. DATE M M I D D I C C Y Y 40. PLACE OF FINAL DISPOSITION 015POSITIONI51 08/02/2001 Res:Susan Crockett 54273 Avenida Bermudas La Quinta CA 92253 41. TYPE OF DISPOSITIOH151 42. SIGNATURE OF EMBALMER 43, LICENSE NO. FUNERAL DIRECTOR AND Cr/Res 0. Not Embalmed 1 - LOCAL 44. NAME OF FUNERAL DIRECTOR45. U. -TIE NO. 46. SIGNATURE OF LOCAL REGISTRAR 47. OwTE M MID DIC C V Y REGISTRAR Wiefels 6, Son Palm S rin s FD 836 till' � 08/02/2001 101. PLACE OF DEATH 102. IF HOSPITAL SPECIFY ONE: 103. FACILITY DTHER THAM HOSPITAL 104. COUNTY PLACE Residence ❑ 1 CONV Res. F1 OCARE OOTN[w Riverside OF IP ERIOP DOA P: DEATH 105. STREET ADDRESS -I STnlET AND NUMBER Oq LOCATION( 106. CITY '68817 Delmont Pin on Pines 107. DEATH WAS CAUSED BY: (ENTER ONLY ONE CAUSE PER LINE FOR A, B, C. AND DI TIM[ INT 100. DEATH REPORTED TO CORONER N ONc[T AND DFAT1i © El IMMEDIATE YEe NO CAUSE IA' Atherosclerotic Vascular Disease yrs 20011-w4'177w 109. 810"61 PERFORMED DUE TO "'Diabetes vrs Y[S KI No CAUSE 110. AUTOPSY PERFORMED OF BEAT H DUE TO ICI Hypercholesterolemia rs yrs 01E5 N0 111. USED 'N DLT[RYINING CAUSE DUE TO IDI O Y.. NO 112. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO CAUSE GIVEN IN 107 None 113. WAS OPERATION PERFORMED FOR ANY CONDITION IN 'TEN 107 OR 1121 If YE5, LIST TYPE OF OPCOwTION AND DATE. No 1 14. I CERTIFY THAT TO THE BEST OF MY KNOWL 1 15 SIGNATURE AND TITLE OF CERTIFIER 1 I6. LICENSE NO. 1 I7. DATE M Y I D O I C C Y Y PHY51- AT E CADSHE HOUR. DATE ► EDGE DEATHSTATED FROM AND PLACE STATED IRON THE CAUSES STATED. n` ^ • �� L l� A 3 0 5 9 9 0 7/30/2001 CIAN'S DECEDENT ATTCXO[0 SINCC I DECEDENT LIST SEEN LOVE \\Y\ ` i"`'y1 CERTIFICA- TI°" MM ISOICCI i MM IDDICCYY' IIB. TYPE ATTENDING PHYSICIAN'S -AE. MnTtG App:ES}, Trell Dr C-108 07/01/2000, 07/27/2001 Paul Doherty, M.D., Pa m SDringS, CA ��262 I CERTIFY THAT IN MY OPINION DEATH 120. INJURY AT WORK 121. I"JURY DATE M M / O D I C C Y Y 122. HOUR 123, PLACE OF INJURY OCCURREDAT THE HOUR, DATE AND PLACE STAID FROM THE CAUSES STATED. O 1 119. MANNER OF DEATH YES NO DESCRIBE HOW INJURY OCCURRED (EVENTS WHICH RESULTED IN INJURY( 121, NATURAL ❑SUICIDE E) HOMICIDE CORONER'S PENDING COULD NOT 8[ [I USE ACCIDENTINVESTIGATION❑ OETERMIXED ONLY 125. LOCATION (STREET AND NUMBER OR LOCAT30H AND CITY, (IPI 126. SIGNATURE OF CORONER OR DEPUTY CORONER 127. DATE M MIDDICC Y Y 128. TYPED NwME, TITLE OF CORONER OR DEPUTY CORONER It• 1 STATE A B C O E F G H FAX N AUT. E CENSUS TRACT REGISTRAR 313255 CERTIFIED COPY OF VITAL RECORDS STATE OF CALIFORNIA I Ss COUNTY OF RIVERSIDE jp� This is a true and exact reproduction of the document officially registered and placed on file in the office of County of Riverside, Department of Health. Gary Feldman M.D. Local Registrar RIVERSIDE COUNTY, CALIFORNIA DATEISSUED 99/86 12001 This copy not valid unless prepared on engraved border displaying seal and signature of Registrar. .uii.L..i.,.i.Lwa.,.l.'.LLW.L.L.LLQ.,.LLL..L,.��L,.,...,..,,.....,..,,., ............................ ........._.___.. ... .. _ _. _. N 9EoSFRj►R -VI`fliL '- S�T4T,ISTICS ;. '/ 4.3 Trusts for Minor Beneficiaries and or Remote Descendants. 4.3.1 Distribution of Principal and Income. The -ustee may distribute from time to time to or for the benefit of Beneficiary so much of the net income and. principal of such >neficiary's trust as in the sole discretion of the Trustee may be >quired for such Beneficiary's health, support or education until such Beneficiary attains age twenty-one. The Trustee shall accumulate any income not so distributed and add it to the principal of such trust. In so doing, the Trustee may consider or disregard, to the extent the Trustee deems advisable, such Beneficiary's other income or property or the duty of anyone to support such Beneficiary. When a Beneficiary attains age twenty-one, his or her trust shall terminate and the Trustee shall distribute the entire balance of such Beneficiary's trust estate to such Beneficiary. 4.3.2 Distribution on Death. Should a Beneficiary die before attaining age twenty-one, the Trustee shall distribute the entire balance of such deceased Beneficiary's trust to such Beneficiary's estate. 4.4 Alternate Distribution. The Trustee shall distribute the affected trust estate passing pursuant to this Section 4.4 to the then living heirs of the Settlor, such heirs to be determined according to the laws of the State of California then in effect relating to succession to separate property not acquired from a predeceased spouse. 5 Trustee. 5.1 Successor Trustees. If Richard G. Crockett becomes unwilling or unable to act, Kristy Ann Brady shall act as Trustee of the trusts established by this document. If both Richard G. Crockett and Kristy Ann Brady are or become unwilling or unable to act, Susan R. Crockett shall act as Trustee. No bond shall be required of any Trustee named in this trust, whether acting jointly or alone. 5.2 Resignation. Each Trustee shall have the right to resign by. delivering written notice of his or her resignation to the successor Trustee. If no successor Trustee is willing and able to serve, a Trustee may resign by petitioning a court of competent jurisdiction for the appointment of a successor Trustee, at the expense of the trust and not of the Tj�-.ustee. Upon approval of his or her final accounting by those entitled to it and acceptance of the trust by the successor Trustee, the resigning Trustee shall be discharged. 5.3 Compensation. Each individual Trustee (other than the Settlor) shall be entitled to reasonable compensation for services rendered. A corporate Trustee (if any) shall be entitled to 3 C Certificate of Occupancy City of La -Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following:, BUILDING ADDRESS: Use Classification: SFD Occupancy Group: R-3, U-1 51-545 AVENIDA MARTINEZ Bldg. Permit No.: 0111-084 Type of Construction: VN Land Use Zone: RC Owner of Building: SUSAN CROCKETT Building Official Address: 54-273 AVENIDA BERMUDAS City: LA QUINTA CA 92253 By: KIRK KIRKLAND Date: 3/26/2002 POST IN A CONSPICUOUS PLACE rr�