13-1668 (SFD)T&t 4
P.O. BOX 1504 40" VOICE (760) 777-7012
IWO 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
`• Date: 5/27/14
Application Number: 13-00001668 Owner:
Property Address: 50630 BREVA RMB CITRUS LLC.
APN: 776-330-009- - - 18 PEPPERTREE
Application description: DWELLING - SINGLE FAMILY DETACHED ALISO VIEJO, 92656
Property Zoning: LOW DENSITY RESIDENTIAL ALISO VIEJO, CA 92656
Application valuation: 323142 !jam "' `....
Contractor: t
Applican�� Architect. or Engineer: RAFFERTY, MICHAEL
18 PEPPERTREE MAY 2 7
ALISO VIEJO, CA 92656
(949)351-4200
C
Lic. No.: OOR SQUARE FOOT Lic. No.: 717431 MQF�QtJIN
4Nc✓FE oFPr
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the 8usi s and Professio C de, and my License is in full force and effect. _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class B i e No.: 717431 for by'Section 3700 of the Labor Code, for the performance of the work for which this permit is
1 issued.
Date: 4— Contractor: _ 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
OWNED L ER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that 1 am axer�Ipt ro the Contractor's State License Law for the Carrier STATE FUND Policy Number 909887414
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become su ct to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I Id become subj t 0 workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 00 of the Labo C , I sh II f rth c ly with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by {{�t
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate:!7 Applicant:
(_ 1 1, 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 WARNING: AILURE TO SECURE WORKERS' COMP A ON COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE D CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
l _ 1 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
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 rancellarinn.
I certify that I have read this application and state that thea ova information is rrect. I agree to comply with all
city and co my rdinances and state laws relating to bull
consHuction, 1 uthorize representatives
of this co ty t enter upon the above-mentioned propeAW
p
Date:�7 IS Signature (Applicant or Agent):
c
LQPERMIT
Application Number . . . . . 13-00001668
Permit
. .
BUILDING 2013
Additional
desc .
2.00
35.7500
EA
Permit Fee
. . . .
642.87
Plan Check Fee
00
Issue Date
. . . .
CONDENSER/COMP
Valuation . . .
. 323142
Expiration
Date
11/23/14
VENT FAN
95.36
Qty Unit Charge
Per
EA
Extension
EXHAUST HOOD
11.92
BASE
FEE
573.43
124.00
----------------------------------------------------------------------------
.5600
THOU BLDG
$200,001-$1M
69.44
Permit
. . .
ELECTRICAL
2013
. . . .
Additional
desc . .
Plan Check Fee
.00
Issue Date
Permit Fee
. . . .
239.30
Plan Check Fee
.00
Issue Date
. . .
11/23/14
Valuation
0
Expiration
Date . .
11/23/14
Per
Qty Unit Charge
Per
19.00
Extension
1.00
23.8300
EA ELEC
SERVICES
23.83
1.00
23.8300
EA ELEC
TEMP POWER POLES
23.83
1.00
143.0000
LS ELEC
NEW RES, FIRST 1 KSF
143.00
4.00
----------------------------------------------------------------------------
12.1600
EA ELEC
NEW RES, ADD'L 1 KSF
48.64
Permit
Additional desc .
Permit Fee . . .
Issue Date . . .
Expiration Date .
MECHANICAL 2013
250.28
11/23/14
Plan Check Fee . . .00
Valuation . . . . 0
Qty
Unit Charge
Per
Extension
2.00
35.7500
EA
MECH
FURNACE
71.50
2.00
35.7500
EA
MECH
CONDENSER/COMP
71.50
8.00
11.9200
EA
MECH
VENT FAN
95.36
1.00
---------------------------------------------------------------------------=
11.9200
EA
MECH
EXHAUST HOOD
11.92
Permit
PLUMBING
2013
Additional
desc . .
Permit Fee
. . . .
297.99
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . .
. 0
Expiration
Date . .
11/23/14
Qty
Unit Charge
Per
Extension
19.00
11.9200
EA
PLBG
FIXTURE/TRAP
226.48
1.00
11.9200
EA
PLBG
BUILDING SEWER
11.92
1.00
11.9200
EA
PLBG
WATER HEATER/VENT
11.92
LQPERMIT
Application Number . . . . . 13-00001668
Permit . . . . . . PLUMBING 2013
Qty Unit Charge Per
Extension
1.00
11.9200 LS PLBG GAS SYS, 1-4 OUTLETS
11.92
1.00
35.7500 LS PLBG GAS SYS, 5+ OUTLETS
35.75
----------------------------------------------------------------------------
Special Notes
and Comments
NEW SFD 3618
SQ. FT. WITH -OUT FAMILY
ROOM OPTION.
THIS PERMIT DOES NOT
INCLUDE POOL,
SPA BLOCK WALLS DRIVEWAY
APPROACH, FIRE
-PIT OR WATER FEATURES.
HOME IS FIRE
SPRINFLED PER 2010 CRC
CODES.
April 29, 2014
2:19:21 PM JJOHNSON.
----------------------------------------------------------------------------
Other Fees .
. . . . . . . . ART IN PUBLIC PLACES -RES
307.86
BLDG STDS ADMIN (SB1473)
13.00
DIF COMMUNITY CENTERS -RES
129.00
DIF CIVIC CENTER - RES
942.00
DIF FIRE PROTECTION -RES•
433.00
DIF LIBRARIES - RES
344.00
MULTI -SPECIES (MSHCP) FEE
1278.00
PLAN CHECK, ELECTRICAL
104.63
DIF PARK MAINT FAC - RES
40.00
PLAN CHECK, MECHANICAL
95.36
PLAN CHECK, SFD GRADING
143.00
PLAN CHECK, PLUMBING
281.30
DIF PARKS/REC - RES
2048.00
BLDG PC 200K -1M
1399.65
STRONG MOTION (SMI) - RES
32.31
TUMF: RESIDENTIAL
1837.44
DIF STREET MAINT FAC -RES
116.00
DIF TRANSPORTATION - RES
2842.00
Fee summary
-7 ---------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid
1430.44 .00
.00 .00
12386.55 1250.00
13816.99 1250.00
Credited Due
.00 1430.44
.00 .00
.00 11136.55
.00 12566.99
TRT 4 4 a"
P.O. BOX 1504
Building , 6 Y4 oo 4 _� 78-495 CALLE TAMPICO
Address VIf LA QUINTA, CALIFORNIA 92253
/ 3 � -/d 4(,: ; 0
APPLICATION ONLY
Owner
allelAus
3
BUILDING: TYPE CONST OCC. GRP.
A.P. Number—
Mailing;
Address
6ftiJkO,(�//
Legal Description
11
G ZOG GST
City -
Zip
Tel. _
�9
�Sn /ETO
��J�
3sl
Project Description
Contractor
}� (% t,
Address /F W&6
City
ZipeW6
Tel. M
Sq. Ft.
Size
No. " No. Dw.
Stories Units
State Lic.
& Classif. f, ¢3
City
Lic. #
Arc Engr.,
wigner I
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
55iAgj N uQ��
Address Tel.
Zo91 Jwtuibx.
Ci
L� r, F6-44g'L
Zip
GG d
State
Lic. #
i'
AX _ 3�/, ¢yea
LICENSED CONTRACTOR'S DECLARATION
I hereb that I am licens under provisions of Chapter 9 (commencing with Section 7000)
'
of Division ss P fessions Code, and my license is in toll fort d ffect.
G /
SIGNATURE DATE
ER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the fallowing reason:
�a/7 53a
(Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct,
AMOUNT
alter, improve,demolish, or repair any structure, prior to its issuance also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contrac-
tor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professions Code, or that he is exempt therefrom, and the basis for the alleged exemption. Any
Plan Chk. Dep.
/z s
violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
Plan Chk. Bal.
❑ 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 Profes-
Const.
sions Code: The Contractor's License Law does not apply to an owner of property who builds or
Mech.
improves thereon and who does such work himself or through his own employees, provided that
such improvements are not intended or offered for sale. If, however, the building or improvement
is sold within one year of completion, the owner -builder will have the burden of proving that he did
Electrical
not build or improve for the purpose of sale).
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the
project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply
S. M. 1.
to an owner of property who builds or improves thereon, and who contracts for such projects with
Grading
a contractor(s) licensed pursuant to the Contractor's License Law)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Infrastructure
MA
MI
Date owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's
Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑Copy is filed with the city. 0Certified copy is hereby furnished.
LAQ
CERTIFICATE OF EXEMPTION FROM
TOTAL
WORKERS' COMPENSATION INSURANCE
CONTACT INFORMATION
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less).
I certify that in the performance of the work for which this permit is issued, I shall not employ
NAME:
any person in any manner so as to become subject to Workers' Compensation Laws of California.
PHONE:
Date Owner
NOTICE TO APPLICANT.. If, after making this Certificate of Exemption you should become
ZONE:
Minimum Setback Distances:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Front Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued. (Sec. 3097, Civil Code.)
Rear Setback from Rear Prop. Line
Lenders Name
Side Street Setback from Center Line
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
Side Setback from Property Line
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
FINAL DATE
INSPECTOR
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-mentioned
property for inspection purposes.
Issued by:
Date Permit
Signature of applicant Date
Mailing Address
Validated by:
Validation:
City, State, Zip
WHITE = BUILDING DEPARTMENT YELLOW
= APPLICANT
PINK = FINANCE
CIF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET
P� B IC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
Vr % Form updated & effective 9/2512009
Green Sheet approvals are forwarded to the Building & Safety Department directly by Public Works. Please DO NOT
submit the Green Sheet. (Public Works Clearance) Packet to the Public Works Department until ALL requirements listed
below are complete. Incomplete applications7or applicalons whp ca�ot be prooessed wig be retumed to applicant.
Date: 1�/I Developer =
Tract No.:. �WTract Name:
The following are the requirements for
Building & Safety Department:
4.
Lot No.(s): ZZ
Phone
Phone Number.
Works Clearance to authorize issuance of a building permit from the
Attach Pad Elevation Certificates in compliance with the approved design .elevation for building -pad .(maximum
allowable deviation of +/- 0.1 foot). Pad Elevation Certificates must be current. (within 6 months of current date).
If apredse grading plan creates the pad for approval please withhold green sheet submittal until a Pad. Elevation
OCertificate can be provided. ,�,3 Attach geotechnical certification of graingEplan compliance indudin� WJ� reports -a 1144 Sdils
Engineer. Recently. rough graded residential developments which have a previously approved geotechnical
certification are exempt from this requirement. akk L -V
3. Attach recorded final map or title information/grant deed sho*ing proposed building locations are legal lots.
4. Complete the attached <1 acre per lot or infill project Fugitive Dust Control project information form, P10110. plan &
agreement or provide alternative & valid City approved PM10 plan set reference number or hard copy plan.
PM10 plans for.commercial & residential developments (beyond 1 lot) are submitted separately with grading plans
& are. subject to additional requirements. A current PM10 certification number is required..
5. Attach a copy of the rough or. precise. grading plan to the Public-Works.Department showing building locations)
for pad elevation verification. AO flood zone developments will require an approved flood plain development plan.
6. Attach supporting documentation for wall plan, monument sign, grease trap or spectal facility installations.
7. Complete and sign the. attached water quality management plan (MMP) exemption form, if applicable. PW
approved building construction projects require either a WOMP or a completed WOMP exemption form:
Approved maps/plans may be viewed at the following link:, http•//www la-guinta om/PienCheck/m search.asnx
1 have reviewed and confirmed the requirements listed above as presented and -find.the improvements to be sufficiently,
complete for construction of the proposed buildings/structures/walWsighs on the subject lot(s). Pursuant to my findings,
the above project may be released for building permit issuance.
This section completed by City staff.
Recommended by: Date: / Z � /
Public Works Distribution: ( Green Sheet to Building.& Safety
( ) Green Sheetto Planning Department
Declined for approval for reason(s) as follow(s), please correct and resubmit:
,T %Check" - r-- 6 APPkBW W -ns & WKaSmaNGREEN SHEET cover & PM10 less Clan 1 Acre Revised &25O9.doe
�r
Clmla HOMEOWNERS ASSOCIATION
Mr. Michael Rafferty
Hearthside Homes
20201 SW Birch Street. Ste. 170
Newport Beach CA 92660
Re: Third Submittal for Architectural Improvements
Mr. Rafferty,
April 18, 2014
I am writing this correspondence to confirm the actions by the Architectural Committee concerning
your Third Submittal (survey report).for Architectural Improvements on Breva Lot #9 and #11 in the
Citrus.
The Architectural Committee is in receipt of all the survey report you submitted electronically on
Friday, April 11, 2014, enclosed. On April 17, 2014, the Architectural Committee motioned,
seconded, and voted to accept the statements on the report that the staked foundation of the dwelling
units and other improvements identified in the working drawings of the Second Submittal are located
within the building envelopes.
You may begin construction on Breva Lot #9 and #11 in strict accordance with the approved
working drawings from your Second Submittal.
Please be aware, any deviation from the approved plans, (working drawings, precise grading plans,
landscape plans) must first be submitted to, and subsequently approved by, the Architectural
Committee before the changes can be made.
Failure to submit changes and receive approval for changes to the approved plans as listed above,
could subject you to fines, compliance assessments, and any other compliance enforcement actions
available to the Board of Directors.
This letter shall serve as notification to you and Hearthside Homes that the Third Submittal, as
required by the Restated Architectural & Landscape Rules, Standards, and Guidelines has been
accepted and approved by the Association. The Citrus community looks forward to the timely
completion of your project.
On Behalf of the Architectural Committee and the Board of Directors,
G [9eCotten
Association Manager
P.O. Box 12920 Palm Desert, CA 92255 * 41-865 Boardwalk, Suite 101, Palm Desert, Califomia
760.346.9000 * FAX 760.346.9997 * www.citruscoursehoa.com
PIANNE RS I ENGINEERS I SURVEYORS
..Offices located in
Irvine B Palm -Desert
April 11, 2014
City of La Quinta
Public Works Department
78495 Calle Tampico
La Quinta, CA 92253
Rough Grading Verification
Tract No. 32068, Lots 9, 11 and 12
City of La Quinta
We have field -checked the lots referenced below and find them to be in substantial conformance to
the approved Rough Grading Plan, dated approved July 15, 2005, City plan set no. 05106, and the
latest Precise Grading Plan (not yet approved), submitted February. 7, 2014.
In addition, we have surveyed and placed offset building corner stakes, for all four sides of the
proposed buildings on Lots 9 and 11, in accordance with the building locations shown on the Precise
Grading plan, and listed below.
Lot #
Plan Elev.
As -Built Elev.
Variation
9
34.1
34.1
0
11
33.4
33.5
+0.1'
12
32.9
32.9
0
Building Setbacks:
Lot Number
Front
Side
Rear
Lot 9
19.8'
7' and 7'
55'
Lot 11
25'
7' and 7'
82.7'
xf"
Stan'fey C. Mors
R.C.E. 20596
Expires 9/30/15
SCM:bib
Stanley C. Morse
J.R. "Skip" Schultz
41-865 Boardwalk
Suite 218
Palm Desert, CA 92211
C. *0P
No. 20598
EV. 9-30-15
�qrF
OF C .AAL`FpQ�
-
VOICE: 760-674-5776
www. m dscon su Iti ng.net
G:\85800\bldg corners 4-11-14.doc
LARRY W. WARD Recorder
P.O. Box 751
* - * COUNTY OF RIVERSIDE Riverside, CA 92502-0751
x
ASSESSOR -COUNTY CLERK -RECORDER (951) 486-7000
website: www.riversideacr.eom
DOCUMENTARY TRANSFER TAX AFFIDAVIT
WARNING
ANY PERSON WHO MAKES ANY NIATERIAL ;tIISREPRESEN'I'A'I'ION OF FACT FOR THE PURPOSE OF AVOIDING ALL OR ANY PART
OF THE DOCUMENTARY TRANSFER'l-AN IS GUII.TY OF A MISDEMEANOR UNDER SECTION 5 OF ORDINANCE 516 OF THE COUNTY
OF RIVERSIDE AND IS SUBJECI' TO PROSECUTION FOR SUCCI' OFFENSE.
ba7-71008-�
ASSESSOR'S PARCEL NO. 776 -- 330 -- ooq-9,011-0; I declare that the documentary transfer tax for this
Property Address: _ Vacant Land, La Ouinta 011,.-1 transaction is: $ 825.00
If this transaction is exempt from Documentary Transfer Tax, the reason must be identified below.
I CLAIM THAT THIS TRANSACTION IS EXEMPT FROM DOCUMENTARY TRANSFER TAX BECAUSE. (Tire
Sections listed below (ire token from the Revenue and Taxation Codc. Please Check one or explain in "Other".)
I . __Section 1 191 1. The document is a lease for a term of less than thirty -fire (35) years (including options).
2. Section 11911. The easement is not perpetual, pennanent, or for life.
Section 11921. The instrument 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 atrustor to a beneficiary, in lieu of foreclosure, and no
. additional consideration was paid.
7. _ Section 1.1926. 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 cases, the Transferor (donor/grantor) may be
required to file Form 709 (Federal Gift Tax Return) with the Internal Revenue Service.
10. _ Section 11930. The conveyance is to the.grantor's revocable living trust..
11. _ Other (Include explanation and authority)
I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUEAND CORRECT.
executed this 5 day of June 12013 at Newpor! Beach CA
City State
Randy Saldana-Title Assistant
r�natur I Afliam Primed Name ol'Aniant
Fidelity National Title 13 0 Dove Stree( Stole 3j 0, Newl oI rtkac.b. _._
Name of Firrn (if applicable) Address of Affiant
949-221-4723
Telephone Number of Afliant (including area code)
This form is subject to the California Public Records Act (Government Code 6250 et. seq.)
)"or Recorder's Use:
Aflix PCOR. Label I'lere .
ACR 52111-AS4ENO (Rev. 11,120 10) Available in Altemativr. Formats
4.
Fidelity National Title Company
1300 Dove Street, Suite 310, Newport Beach, CA 92660
Phone: (949) 622-5000 • Fax: (949) 477-3600
DATE: June 3, 2013
ESCROW NO.: 23029889-010-VR2
PROPERTY ADDRESS:
Vacant Land, La Quinta, CA
RECORDING DATE:
DOCUMENT NO.:
ASSESSORS PARCEL NO: 776-330-007-7,776-330-
008-8, 776-330-009-9, 776 -330 -011-0
76-330-007-7,776-330-
008-8,776-330-009-9,776-330-011-0 and 012-1
STATEMENT OF TAX DUE AND REQUEST THAT SAID AMOUNT NOT BE MADE PART OF
PERMANENT RECORD IN OFFICE OF THE COUNTY RECORDER.
DOCUMENTARY TRANSFER TAX $825.00 CITY TAX $$ 0.00
X COMPUTED ON FULL VALUE OF PROPERTY CONVEYED, OR
COMPUTED O nl, VALUE LESS LIENS AND ENCUMBRANCES
REMAINING T ON AT TIME OF SALE
Signature of declarant of agent determining tax -firm name
Riverside Recorder Office
The amount of remittance below is in full payment of the Documentary Transfer Tax for the document attached and
described below. When the payment is verified and after the permanent record is made, attach this request to the
document pursuant to Section 11932 R & T Code.
Grantor: Sierra Ranch Properties, LLC
Grantee: RMB Citrus, LLC
Amount of Remittance: $