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RR (13-0509)4 P.O. BOX 1504 VOICE (760) 777-7012 78495 CALLE TAMPICO FAX (760) 7777011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 4/23/13 Application Number: 13-0000"0509 Owner: Property Address: 51888 AVENIDA MENDOZA VANASSELT PETER APN: 773-182-006-19 -000000- 42335 WASHINGTON F 113 Application description: RE -ROOF PALM DESERT, CA 92211 Property Zoning: COVE RESIDENTIAL (760)423-6070 Application valuation: 1275 Contractor: D Applicant: � Architect or Engineer: Owner APR 24 2013 CITY OF LA 108INTA 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 Professionals Code, and my License is in full force and effect. License Class: License No.: _�K6C,o�Intr�act/or: V - OWNER -BUILDER DECLARATION 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 '4nyy,applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 ]i 1 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.). 1 _ ) I am exempt under Sec. , B.&P.C. for this reason le 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 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 1 should become subject to the workers' compensation provisions of Section 00P of the labor Code, I sh forthwith comp) ith those provisions. N 4 D Applicant:' // 14-/- I 1- /— C% L� �/ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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 building con ruction, and hereby thorize representatives of this_co my to �nttee,r upon the above-mentioned prope or in ection purposes. ate: GS 9 ignatuican gent): Application Number . . . . . 13-00000509 Permit . . . RE -ROOF Additional desc . . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 10/20/13 Qty Unit Charge Per Extension BASE 'FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments RE -ROOF PERMIT APPROVED PER A.J.2010 CODES. -----------------------------------------------------------------------=---- Other Fees . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ----------------- Charged Paid -------------------- Credited ---------- Due Permit Fee Total 30.00 ---------- .00 .00 30.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 LQPERMIT /_1' . J 4--1ClI U -Prescri tive Certificate of Compliance: Residential Reroof CF -1 R -ALT -Re Project Address: Climate Zone Permit # 40 16 PAV em'Aa. Z ,_ U� Go:�is� ) P:� J ROOFING PRODUCTS (COOL ROOFS) §151(012 When the area of exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1,000 ff, whichever is less, fix I new roofing area must meet the roofing product "Cool Roof" requirements of §152(b)1Hi, 152(b)1Hii, or 152(b)1Hiii. Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof" requirements:: ❑ Cool roofs not required in Climates Zones 1-12,14, and 16 with a low sloped roof pitch (lessor 2:12 pitch). ❑ Cool roofs not required in Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weight less than 5/Ib/ftZ. Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch> 2:12) ❑ Insulation with a thermal resistance of at least 0.85 hr•ft2•`FBtu or at least a 3/4 inch air -space is added to the roof deck over an attic; or ❑ Existing ducts in the attic are insulated and sealed according to §151(f)10; or ❑ In climate zones 10, 12 and 13, with 1 ft2of free ventilation area of attic ventilation for every 150 ft2 of attic floor area, and where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or ❑ Building has at least R-30 ceiling insulation; or ❑ Building has radiant barrier in the attic meeting the requirements of §151(02; or . ❑ Building has no ducts in the attic; or ❑ In climate zones 10, 11, 13 and 14, R-3 or greater roof deck insulation above vented attic. Exception to §152(b)l Mil, Low -slope roof ( pitch <_ 2:12) ❑ Building has no ducts in the attic. Other Exceptions ❑ Roofing area is covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the Cool Roof criteria. ❑ Roof constructions that have thermal mass over the roof membrane with at least 25 Ib/ft2 are exempt from the Cool Roof criteria. NOTE. If anyone of the alternatives or exception is checked the Aged Solar Reflectance and Thermal Emittanreranidrpmantc fnr rnnfinn _J.._ r •• • J'/ a,c I lug C1VPAludu/e. uo nor nn rame Delow CRRC Product ID Number Roof Slope <- 2:12 > 2:12 Product Weight < 5lb/ft2 >- 516/ft2 Product Type 2 Aged Solar Reflectance'.4 Thermal Emittance Address: License: Olt SRI assist ❑ ❑ ❑ ❑ ❑4 9 d d ❑ ❑ F'a ❑4 b \ 3y 3ljr jOa 3 Note: If no CRRC- i label is available, this compliance method cannot be used, use the PA'rma' D proa__c% o §hpw compliance, 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Councils Rated Product Directory at www. coolroofs. ora/aroducts/search aha 2. Indicate the Type of product is being used for the roof top, i.e. single -ply roof, asphalt roof, metal roof, etc. 9. If the Aged Reflectance is not available_in_the_Cool _Roof Rating Councils -Rated -Product -Directory -then use-the-Initial-Reflectance-value-fromthe-same— — - - d nwtory and use the equation (0.2+0.7(p -t. — 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance. 4. Check box if the Aged Reflectance is a calculated value using the equation above. 5. Calculate the SRI value by using the SRI- Worksheet at httolAvww.enerav ca aov/title241 and enter the resulting value in the SRI Column above and attach atopy of the SRI- Worksheet to the CF -1 R. To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(1)4. Select the applicable coating: ❑ Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other NOTE: When a rnnl Rnnf is rl-M j;rcrr rhe -- - -�-•• •••�••.•••••y a.—mowul ands curnprete and submlr rhe 0-atf-tNv-ol for final inspeCtion. Declaration Statement "For n • 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is accurate and complete. • 1 certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. . Name: Signature: Company: Date: Address: License: ate/Zip: Phone: E assist a ce or queshons regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. t Bin. # City of La QuInta BAfing ar Safety EtWon P.O. Box 1504,78-495 Calle Tampico U Quinta, CA 92253 - (760) 777-7012 Permit Application and Tracking Sheet Permit # lj�Building ProjectAddrem: �j1�� OwncesName:. A P. Number. Q 6 . Address: ` j� Legal Description: Contractor. Qj,�— Cil),, ST, Zip: Telephone: l�� d Address: Project Description: City. ST, Zip: Telephone: State Lic. # : City Lie C. Arch., Engr., Designer. Address: City., ST, Zip: Telephone: State Lic. #: Construction Type:. oc upancy: Project type (circle ono): New Add'a Alter Repair Demo Sq.* FL: #Stories: It Univ Name of Contact Person: Telephone *of Contact Person: &q . ��' 3 `� Estimated Value of Project AD APPLICANT: DO NOT WRITE BELOW THIS UNE M Submittal Plpn Sets Req'd Reed TRACING PSRhIITFEES Plan Cheek submitted Item Amount Structural Cates. Reviewed, ready for corrections Pian Clink Deposit. . Truss Glu. Called Contact Pawn Pian Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmittM.. Mecharilcsl Grading plan 2`` Review, ready for correctionsrrssue Mectrieal Subcontactor List Called Contact Person Plumbing Grant Deed Plans plcktd up SALL H.O.A. Approval Plans resubmitted Grading IN 130USE:- 3" 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 r-9 RAW. P W—WA M=f P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits LW_QATANT► NOTICE TO PROPERTY OWNER Dear Property Owner. An. application for a building permit has been submitted in your name listing yourself as the builder of the property impr vcments specified at We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risks you may incur by halving this permit issued in your pun as the Owner -Builder. We will not issue a building permit until you have read, inWu4ed your understanding of eack providen, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OZ'S A NNOWLED T AND WR FICATION OF WPORWAMN D IREMONS. Read and initial each statement below to signify you undo3tard or verty dkis information. P1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personslky. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries- I am wtllfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on spy property. �2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. �3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my Own. PIV 4. [understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. t5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6. [ understand if I am considered an "employee' under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. PIT 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentia structures cannot legally build them with the intent to offer them for sale, unless all work is performed by license( subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performs under contract with a licensed general building Contractor. I understand as an Owner -Budder if I sell the property for which this permit is issued, I may be be'd liable. W. t—ancial or personal.iiquuiss sustainedby any subsequent owner(s) that result from any latent construction defects in th.i. workmanship or materials. lb -9. I understand I may obtain more information regarding my obligations as an "employee' from the Internal, Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cshb.ca gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: V__11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a Ikenw,,the Contractors' State License Board may be unable to assist you with any financial loss You may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be is civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, You will be responsMe for verifying w ether or not those Contractors are properly licensed and die status of their wotkers' coruOsation iasurauroe ooverage. Before a building permit can be issued, taus form must be completed and signed by the property owner and returned to the agency responsible for issafag: de perm[. Note: A capy of dw property owner's di*er's Hensel faun notaraMbrn; or other veriftcadon acceptable so the agency is required to be presorted when ike permit is iss"A to verify the pMperty owner's signature. Signature of property owner r D. y Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder - AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHA _F Excluding the Notice to Property Owner, the execution of which I understandis my personal responsibility, I hereby authorize the following persons) to act as my agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): r' Project Location or Address: _ k N \) , Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the abovt information and certify its accuracy. Note: A copy of the owner's driver's tieense, form notarization, or other verification acceptable to the agency is required to be prestanted when the permit is issued to verify the property owner's signature - Property Owner's Signature: Date: Property Detail Report 51888 AVENIDA MENDOZA, LA QUINTA CA, 92253-3134 Page 1 of 1 DIGITAL Iifi14P,��yon�rtop�r� PRODUCTS Owner Information: Owner Name: BOTELLO,FIDEL A & IRMA C Mailing Address: 52120 CALLE CAMACHO, COACHELLA, CA, 92236- 2888 Vesting Code: HUSBAND AND WIFE Phone Number: 7603982569 Location Information: Legal Description: LOT 19 BLK 119 MB 018/079 SANTA CARM.ELITA AT VALE LA QUINTA NO 12 County: RIVERSIDE FIPS Code: 06065 Census Trct/Blk: 0451113/3 APN: 773182006 Alternative APN: 773182006 Map Ref: F1-879 Twnshp-Rnge-Sect: -- Legal Book/Page: 773-18/ Tract No: Legal Lot: 19 Legal Block: 119 Subdivison: SANTA CARMELITA AT VALE LA QUI ,x Last Market Sale Information: Sale Date: 02/21/1997 Sale Price: $30,000 1St Mtg Amount: Sale Doc No: 0000057852 .Price Per SgFt: $32 1St Mtg Int Type: Transfer Doc No: Price Per Acre: $272,727 2nd Mtg.Amount Multi/Split Sale: 1St Mtg Doc No: 2nd Mtg Int Type: Sale Type: Deed Type: Title Company: NORTHERN COUNTIES TITLE Lender: Seller Name: HUD Property Characteristics: Building Area: 927 Total Rooms: Construction: Living Area: 927 Bedrooms 2 Heat Type: Garage Area: Baths: 1.0 Air Cond: Basement Area: Fireplace: Roof Type: Parking Type: C 0 No of Stories: 1 Roof Material: COMP SHINGLE Yr Built/Effective: 1955/ Quality: Style: Pool Code: Tax and Value Information: Assessed Value: $38,122 Assessed Year: 2011 Est Market Val: Land Value: $12,705 Property Tax: $1,006 Assessor Appd Val: Improvement Value: $25,417 Improvement %: Total Taxable Value: $38,122 Tax Exemption: Site Information: Assessor Acres: 0.11 Zoning: R1 Land Use: 163 Assessor Lot SgFt: 4,792 No of Buildings: Land Use Desc: , SFR' Assessor Lot W/D: / Res/Comm Units: 1 County Use Code: R1 Calculated Acres: 0.1114 Sewer Type: Calculated Lot SgFt: Water Type: http://maps.digitalmapcentral.com/production/citygis/v07_O3_001/index.p7.aspx 4/23/2013 RECORDING REQUESTED BY: TICOR TITLE RIVERSIDE. MAIL TAX STATEMENTS TO WHEN RECORDED MAIL TO: PETE VAN ASSELT 42335 WASHINGTON it -113 PALM DESERT, CA 92211 ORDER 147935 -7f,ja 020-0-2-1 DOC # 2013-0118226 03/11/2013 03:41 PM Fees: $18.00 Page 1 of 2 Doc T Tax Paid Recorded in Official Records County of Riverside Larry W. Ward Assessor, County Clerk & Recorder —This document was electronically submitted to the County of Riverside for recording— Receipted by: CTOLOSSA SPACE ABOVE FOR RECORDER'S USE ONLY GRANT DEED W -A / _ S� IN. -773—/8Z -09(o TITLE OF DOCUMENT MAIL TAX STATEMENTS TO ABOVE ADDRESS RECORDING REQUESTED BY: TICOR TITLE RIVERSIDE MAIL TAX STATEMENTS TO WHEN RECORDED MAIL TO: PETE VAN ASSELT 42335 WASHINGTON F-113 PALM DESERT, CA 92211 ORDER 147935 dip SPACE ABOVE FOR RECORDER'S USE ONLY C) 2D go GRANT DEED I* �! � � -^ ___. / 8 Z �/ TITLE OF DOCUMENT /, K� MAIL TAX STATEMENTS TO ABOVE ADDRESS tl . J RECORDING REQUESTED BY: Ticor Title Company of California AND WHEN RECORDED MAIL TO: Pete van Asselt 42335 Washington F-113 Palm Desert, CA 92211 I Nib SNACE FOR RECORDER'S USE ONLY: Title Order No.: 147935-993 Escrow No.: 130089 -TB 02-0 ---02-1 GRANT DEED THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX is $104.50 [X] 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 [X] City of La Quinta AND FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Fidel A. Botello and Irma C. Botello, Husband and Wife as Joint Tenants hereby GRANT(s) to: Pete van Asselt, A Single Man the real property in the City of La Quinta, County of Riverside, State of California, described as: Lot 19, in Block 119 of Unit No. 12, Santa Carmelita at Vale La Quinta, in the City of La Quinta, County of Riverside, State of California, as shown by map on file in Book 18, Pages 79 and 80 of Maps in the office of the County Recorder of Riverside County, California. Also Known as: 51888 Avenida Mendoza, La Quinta, CA 92253 AP#: 773-182-006-8 DATED February 27, 2013 STATE OF CARNIA COUNP( F j V t2i'dlo , On before me, A Notary Public personally app d Fidel A. Botello and Irma C. Botello 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(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. 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 MAIL TAS idem I A. Botello got Pl�v Irma C. Botello JUDITH ROGERS Commission # 1942391 Notary Public - California z Riverside County My Comm. Expires Jul 24. 2015 (Seal) IF NO PARTY SHOWN; MAIL AS DIRECTED ABOVE: 30E -502-A (P1) REV. 11 (07-10) 'RELIMINARY CHANGE OF OWNERSHIP REPORT To be completed by the transferee (buyer) prior to a transfer of subject property, in accordance with section 480.3 of the Revenue and Taxation Code. A Preliminary Change of Ownership Report must be filed with each conveyance in the County Recorder's office for the county where the property is located. Please answer all questions in each section, and sign and complete the certification before filing. This form may be used in all 58 California counties. If a document evidencing a change in ownership is presented to the Recorder for recordation without the concurrent filing of a Preliminary Change of Ownership Report, the Recorder may charge an additional recording fee of twenty dollars ($20). NOTICE: The property which you acquired may be subject to supplemental assessment in an amount to be determined by the County Assessor. Supplemental assessments are not paid by the title or escrow company at close of escrow, and are not included in lender impound accounts. You may be responsible for the current or upcoming property taxes even if you do not receive the tax bill. SELLER/TRANSFEROR ASSESSOR'S PARCEL NUMBER Fidel A. Botello and Irma C. Botello 773-182-006-8 solely spouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.). BUYER/TRANSFEREE BUYER'S DAYTIME TELEPHONE NUMBER Pete van Asselt n O 0 99 -// / (o STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY This is a transfer between: ( ) parent(s) and child(ren) ( ) grandparent(s) and grandchild(ren). ( ) D. 51888 Avenida Mendoza, La Quinta, CA 92253 Within the same county? ( ) YES ( ) NO MAIL PROPERTY TAX INFORMATION TO (NAME) This transaction is to replace a principal residence by a person who is severely disabled as defined by Revenue and Taxation Code Pete van Asselt F. This transaction is only a correction of the name(s) of the person(s) holding title to the property (e.g., a name change upon marriage). ADDRESS 1 CITY � j) +. Palm Desert T:7-4( If YES, please explain: STATE CA ZIPCODE 92211 H. This transaction is recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest (e.g., cosigner). If YES, please explain: ( ) YES NO This property is intended as my principal residenceif YES, please indicate the date of occupancy MO DAY YEAR or intended occupancy. 1. to/from a revocable trust that may be revoked by the transferor and is for the benefit of [ ] the transferor, and/or [ ] the transferor's spouse [ ] registered domestic partner. 2. to/from trust that be by PART 1. TRANSFER INFORMATION Please complete all statements. YES NO ( ) ( ) A. This transfer is between solely spouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.). ( ) ( B. This transfer is solely between domestic partners currently registered with the California Secretary of State (addition or removal of a partner, death of a partner, termination settlement, etc.). ( ) C. This is a transfer between: ( ) parent(s) and child(ren) ( ) grandparent(s) and grandchild(ren). ( ) D. This transaction is to replace a principal residence by a person 55 years of age or older. Within the same county? ( ) YES ( ) NO ( ) l E. This transaction is to replace a principal residence by a person who is severely disabled as defined by Revenue and Taxation Code section 69.5. Within the same county? ( ) YES ( ) NO F. This transaction is only a correction of the name(s) of the person(s) holding title to the property (e.g., a name change upon marriage). If YES, please explain: G. The recorded document creates, terminates, or reconveys a lender's interest in the property. H. This transaction is recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest (e.g., cosigner). If YES, please explain: I. The recorded document substitutes a trustee of a trust, mortgage, or other similar document. J. ✓) This is a transfer of property: ( ) ( 1. to/from a revocable trust that may be revoked by the transferor and is for the benefit of [ ] the transferor, and/or [ ] the transferor's spouse [ ] registered domestic partner. 2. to/from trust that be by a may revoked the creator/grantor/trustor who is also a joint tenant, and which names the other joint tenant(s) as beneficiaries when the creator/grantor/trustor dies. ( ) (✓� 3. to/from an irrevocable trust for the benefit of the ( ) X [ ] creator/grantor/trustor and/or [ ] grantor's/trustor's spouse [ ] grantor's/trustor's registered domestic partner. 4. to/from irrevocable from ( K. an trust which the property reverts to the creator/grantor/trustor within 12 years. This is to lease property subject a with a remaining lease term of 35 years or more including written options. L. This is a transfer between parties in which proportional interests of the transferor(s) and transferee(s) in each and every parcel being ( ) M. transferred remain exactly the same after the transfer. This is transfer low-income ( N. a subject to subsidized housing requirements with governmentally imposed restrictions. This transfer is to the first building purchaser of a new containing an active solar energy system. 'If you checked YES to statements C, D, or E, you may qualify for a property tax reassessment exclusion, which may allow you to maintain your previous tax base. If you checked YES to statement N, you may qualify for a property tax new construction exclusion. A claim form must be filed and all requirements met in order to obtain any of these exclusions. Contact the Assessor for claim forms. Please provide any other information that will help the Assessor understand the nature of the transfer. THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION 30E -502-A (P2) REV. 11 (07-10) PART 2. OTHER TRANSFER INFORMATION 4. Date of transfer, if other than recording date: B. Typ> f transfer Check and complete as applicable. ( �) Purchase ( ) Foreclosure ( ) Gift ( ) Trade or Exchange ( ) Merger, stock or partnership acquisition (Form BOE -100-13) ( ) Contract of sale. Date of contract ( ) Inheritance. Date of death: ( ) Sale/leaseback ( ) Creation of a lease ( ) Assignment of a lease ( ) Termination of a lease. Date lease began: Other: Please explain: Original term in years (including written options): Remaining term in years (including written options): ( ) C. Only a partial interest in the property was transferred? ( ) YES (•'f NO If YES, indicate the percentage transferred % PART 3. PURCHASE PRICE AND TERMS OF SALE Check and complete as applicable., A. Total purchase or acquisition price. Do not include closing costs or mortgage- insurance $ �, Down payment: $ Interest rate: % Seller -paid points or closing costs: $ Balloon payment: $ ( ) Loan carried by seller ( ) Assumption of Contractual Assessment' with a remaining balance of: $ An assessment used to finance property -specific improvements that constitutes a lien against the real property. B. The property was purchased: (� Through real estate broker. Broker name: e � 1` Phone number -lea 90h.- 5 ( ) Direct from seller ( ) From a family member �IZO r ( ) Other: Please explain: C. Please explain any special terms, seller concessions, financing, and any other information (e.g. buyer assumed the existing loan balance) that would assist the Assessor in the valuation of your property: PART 4. PROPERTY. INFORMATION Check and complete as applicable. A. `Ty`pe of property transferred (� Single-family residence ( ) Co-op/Own-your-own ( ) Manufactured home ( ) Multiple -family residence. Number of units: ( ) Condominium ( ) Unimproved lot ( ) Other. Description: (i.e., timber, mineral, water rights, etc.) ( ) Timeshare ( ) Commercial/Industrial B. ( ) YES ( NO Personal/business property, or incentives, are included in the purchase price. Examples are furniture, farm equipment, machinery, club memberships, etc. Attach list if available. If YES, enter the value of the personal/business property: $ C. ( ) YES ('X) NO A manufactured home is included in the purchase price. If YES, enter the value attributed to the manufactured home: $ ( ) YES NO The manufactured home is subject to local property tax. If NO, enter decal number: D. ( ) YES /(�(} NO The property produces rental or other income. If YES, the ir{co?ne is from: ( ) Lease/rent ( ) Contract ( ) Mineral rights ( ) Other: E. The condition of the property at the time of sale was: ( ) Good ( ) Average 7X Fair ( ) Poor CERTIFICATION I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information hereon, including any accompanying cinInman/c nr rfnrumnnln � fr e 4 ----# f.. 01— 1.,...� ,.r ..... �...-...'_,-._ . __ _ _.._ ____ __ _.. ._._...__ _ _.._ __.._.. ....-.._..........v...•a.....v. SIGNATURE OF TRANSFEREE OR ORPORATE OFFICER v.. caa,.f affY'Vwry YU Craransreree. DATE NAME OF BUYERlfRANSFERE /LEGAL REPRESENTATIVE/CORPORATE OFFICER (PLEASE PRINT) TITLE E-MAIL ADDRESS _..------. _... .. ..... ......................o......,....a.,.,,..�ya�..f��y una L101MOcuun. LARRY W WARD Recorder P.O. Box 751 * * COUNTY OF RIVERSIDE Riverside, CA 92502-0751 > ; ' ASSESSOR—COUNTY CLERK -RECORDER (951)486-7000 Website: www.riversideact.com �aRK DOCUMENTARY TRANSFER TAX AFFIDAVIT ANY PERSON WHO MAKES ANY.MATERIAL MISREPRESENTATION OF FACT FOR THEPURPOSE OF AVOIDING ALL OR ANY PART OFTHE DOCUMENTARI' TRANSFER TAX IS GUILTY OF A MLSDEMEANOR UNDER SECTION.5 OF'ORDINANCE SI6 OF THE COUNTY OF RIVERSIDE AND IS SUBJECT TO PROSECUTION FOR SUCH OFFENSE: ASSESSOR'S PARCEL NOW -- �� 2_6`66 I declare that the documentary tax for this Property �Addr ss '�i � � r nsaction ist $_��/�( % If this transaction Is exempt from Documentary entary Transfer�he reason =mbust be identified entified below. I CLAIM THAT THIS TRANSACTIONIS EXEMPT FROMDOCUMENTARY TRANSFER TAX. BECAUSE. (The Sections listed'below are taken from flit Revenue and Taxation Code. Please check one or explain in "Other".) L _ Section 11911. The document is a_ lease for a term -of less than"thirty-five (3 5) years. (including options). 2. Section 11911. The easement is not perpetual, permanent, or for life. 3. Section 11921. The ins.truiuent was given to secure a debt . '4. _ Section 11922.' The conveyance is to a governmental entity or political subdivision. 5. _ Section 11925. The transfer is between individuals and a legal entity, or between legal entities, and does not change the proportional interests held. 6. _Section 11926. The instrument is from a trustor to a beneficiary, in lieu of -foreclosure, and no additional consideration was,paid. 7. _ Section 11926._ The grantee is the foreclosing beneficiary and the consideration paid by the foreclosing beneficiary does not exceed the unpaid debt. 8. _ Section 11927: The conveyance relates to a dissolution of marriage or legal separation. 9. _ Section 11930. The conveyance is an inter vivos gift* or.a transfer by death. *Please be aware .that information stated on this document may, be given. to and used by governmental agencies, including the Internal Revenue Service. •Also,•certain gifts in excess of the annual Federal gift tax exemption may trigger.a.Federal Gift Tax. In such oases, the Transferor (donor/grantor) may be required to file Form 709 (Federal Gift Tax Return) with -the Internal Revenue Service. 10. _ Section I] 930, The conveyance is.to the grantor's revocable living trust. 11. T Other (lnclude'Explanation and authority) I b.ECLARE U V DER PENALTY OF PERJURY TRAT THE FOREGOING IS TRUE AND CORRECT. Executed this I day of 1. 20La , city 71 State (Z Signature of Affiant Prinied Name of Affiant TICOR TITLE o' -f � 5-4e130 — , G4 Name of i � Address of Affiant gZ 5 Telephorie Number of Affiant (including area code) 'This form is: subject to the:Califo.r..nia "Public Records Act (Government Code -6250 et. seq.) . For Recorder § Use: Affix PCOR Label Here ACR 521P-AS41iX0 (Rev. 11/2010) Available in Alternative Formats