90201-249 (SFD)LICENSED CONTRACTOR 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 # Lic. Class Exp. Date
881y'1/2(
/Date ° '-- Signature of Contractor
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 1 ^ 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
�ection 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:.
Carrier 0OL'f, IRN i�.AOI ¢, W. Policy No. Nwel-5411068-03
(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
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
-Date::-r Applicant --'Y')", , ,+ ,ri •; 1 !��
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 3
for a permit subject to the conditions and restrictions set forth on his -
application.
1. Each person upon whose behalf this application is made & each person �t
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.
ignature (Owner/Agent) Date
I®
BUILDING PERMIT PERMIT//
ID,d,1.
DATE DATE VALUATION LOT .,. �.1-+-,-- d � TRACT
r
JOB SITE} _
ADDRESS x7^.'''8; xF� JCSJ'.
APN
1 iS-1 ,�.)!-00
OWNER
CONTRACTOR/ DESIGNER/ ENGINEER
MINAIRY VINTAGE Rc' m
'iti 17URY CRt')WjE'.i L.CO,AUI-ril`r
3538 VQ1" O M.'RZE1', S.iR 6200
P 311 Ax�i1 CA' 92AORW
13FIR IRD190 C -A 9V408
r,909)381.6007 Clw''Uf 212.0
USE OF PERMIT
} q �y y� y p ry� _
E4a.:J.0 1AILS�.lJ� a r.1.F' O
SITt MP%�1Of'T MDCL
.t�R�L:�4
NOT NOMVD�.� BW0XW .L )RVZWA.Y
CUSTOM, CC RSTi UCT30N X700.00 up
i'i RCRA ATIO HrI.W +1+ t
SIAiY�4i1?icgla%I�?T'P *634 UP
> i
yrn' m cosr of c(3x"iu.t venox
30 3,044.90
CONS` ROC'i ION ISLE 107.4kJO 416.000 5053.50
PLAN CHOCK 1,12 101-000-4-39••318, s1,d119S.07
ME MPOSI. C. 101.000.415,318 1$1,D00,96
M.ECHANICAJ, ME $101.0
E1. VOTRIC'AX� 1 -?1:1; 1 a1 �000.4�C?=Utlt3 <1%.715
P ILUIV5SIND FES 101-000-419-000 $202,50
`1'1'I oNG MIDI .TON Wrg • W II~' 101,0001-24) -000 0 0.3li
C"RADrM31 FE02 101 _00019.23-000 '01211-00.
AIRT IN PUR'I.IL' PLA. :.SS -• RI qq 270-000.445,000 $.tfi9.6
u1.1i'.40LAL COWIRMIi.1101 AA1+11,3MAM CHECK
$5,10.61�"..
# e 1..1'►SS i' �:k:L�^.3.�1�'L��?.�R-03
D Qom• ~'
-;lt1,C)C11�.E3i3
MAY. 2 0.2002
CITYOFLAQUINTA
F1NAtdCEDEPT _
-BY`•-.:!
RECEIPT
DATE f�i :1•
DATE F ALED
IN E
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
Return Air
Steel
V
Combustion Air
Roof Deck
Exhaust Fans
O.K. to WrapJJA
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
i41012—
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
6ZB/ Z
Encapsulation
Gas Piping
Gas Test
Appliances
��
Final
COMMENTS/:
/
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
Final
Utility Notice (Perm)
LICENSED CONTRACTOR DECLARATION
Thereby 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 # Lic. Class Exp. Date
714188 B
Date Signature of Contractor
OWNER -BUILDER DECLARATION
10/31/2(
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 & Pe6tessionalS U00a).
( ) 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 workers' compensation insurance carrier & policy no. are:
Carrier GOLDEN EAGLE INS. Policy No. NWC-544068-03
(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
workers' compensation laws of.California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 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 his
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 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.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT" —"%
0201-249
DATE VALUATION LOT TRACT
$303,844.90 7 25397
JOB SITE
APN
ADDRESS 55-420 PEBBLE BEACH
775x170-007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENTURY VINTAGE HOMES
CENTURY CROWELL COhEvIUNTTIES
1535 SO, 'D° STREET, STE, #200
1535 SO, "D° STREET, STE, 0200
SAN BERNARDINO CA 92408
SART BERNARDINO CA 924.08
(909)381-6007 CBL4 2120
USE of PERMIT
SINGLE FAlAILY DWELLING
SFD & (GUEST SUITE) AS PER APPROVED PLANS ONLY. PERMIT DOES
NOT INCLUDE BLOCKWALLS/DRNEWAY APPROACH/POOL
CUSTOM CONSTRUCTION 3,700,00 SF
PORCH/PATIO 197.00 SF
GARAGE/CARPORT 663.00 SF
ESTMIATED COSI' OF CONSTRUCTION
303,84490
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $1,353.50
PLAN CHECK FEE 101-000-439-318 $1,098.07
FEE DEPOSIT 101-000-439-318 -$1,000.00
MECHANICAL FEE 101-000-421-000 $101.00
ELECTRICAL FEE 101-000-420-000 $217.76
PLUMBING FEE 101-000-419-000 $202.50
STRONG MOTION FEE - RESID 101-000-241-000 $30.38
GRADING FEE 101-000-423-000 $20.00
DEVELOPER IMPACT FEE $1,907.00
ART IN PUBLIC PLACES - RESIL 270-000-445-000 $259.61
SUB -TOTAL CONSTRUCTION AND PLAN CH=
$5,189.82
LESS PRE -PAID FEES
-$1,000.00
TOTAL PER= FEES DUE NOW
$4;189.82
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
_ ., .T .•4rf! i2. r• i �T�. yam.
J
r �2
Iding
Mailing
Address /5-31
City
SQL' lL1211 l?.111 r h-
Contractor
Address
-, ., : s + k _ _ x„- ; ...-.,�—. ,.� S Kr �[Y+.ir.rr';i-meq ,.r ;.�7u9�.p�.n�• �-�.'m-c-w- .1,. .. q —W"Kp — .
uu�c�
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
ILA QUINTA, CALIFORNIA 92253
Zip Tel.
f
City lZip I Tel.
State Lic. Q City
& Classif. A I/ ' � Lic. #
Arch., Engr., _
Designer
Address I Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3,of the Business and Professions Code, and my license is in full force and
effect. �---.1` /4- i --h i? -, f-f,!'.�wU f - -.% C! ,
SIGNATURE/ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, 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 Contractor'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 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).
[] 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or 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 not build or improve for the purpose of sale.)
1'1 I, as owner of the property, am exclusively. contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
i J 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' 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
n Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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 any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
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
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and slate that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant —Date—
Mailing
ateMailing Address
City, State, Zip
i3
BUILDING:
TYPE-CONS•TT.-- :F �1 CCC. GRP
b7—�D 07A727J-�J!/
—
Legal
Description
Project Description
Sq. Ft. 22_ No.
Size o� '° Stories
4
Newm: Add ❑ Alter ❑
imateo Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
No. Dw.
Units
Repair ❑ Demolition ❑
AMOUNT
0-0 iia .
ZONE: BY:
Minimum Setback Distances:
Front Setback Iron Center Line
Rear Setback Irorr Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
IN 3PECTOR
Issued by:--Date—Permit
Validated by:
Validation:
WHITE = FINANCE ,. YELLOW = APPLICANT
PINK=. BUILDING DIV':SION
Coachella IValley•Un, *School District
P.O. Box 847, The mal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT: R• 1 M
taC N . G45H
INITIALS: + DATE:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Date: Maw 17. 2002
Owner's Name: Century Vintage Homes Phone No.. 1909)'381-6007
Project Address: 55-420 Pebble Beach, La Quinta CA 92253
Project Description: J Dwelling
APN: 775-170-007 Tract #: Lot #'s:
Type of Development: Residential.
XX ' Commercial
Industrial
Total Square Feet of Building Area: 3,700 Sq ! Ft
.Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and fiuther represents that he/she is authorized to sign on behalf of the owner/dLveloper.
Dated: ' • May 17, 2002" -
Signature: '
I.
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
i
Note:
' Number of Sq.Ft. 3,700
Amount per Sq.Ft. S 2.16
Amount Collected S 7,992.00
Building Permit Application Completed: Yes/No ,
By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services
Administrator in Charge
El sa F� Esq Ueda .
Certificate issued by: Facilities Analyst Signa e•
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of
any other requirements as described in section -66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This .
Certificate of Compliance is valid fol- thirty (30) days from the date of issuance. Extension will be granted only for good case, as determined by the School
District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compdiance.
MV:c/mydocs/devfees/certificate of compliance 07/24/01
f
41
-'r(EQUESTED BY
P. OCCHIUTO , ESQ .
ANO WHEN RECOROED MAIL TO:
LAW OFFICES OF
JOSEPH P. OCCHIUTO
^� P.O. BOX 33140.
cN
Zoo
I RIVERSIDE CA 92519
GO 86A 10
pOC . is 2000-056?28 _
Conformed. Copy 0211612000
COPY Gary L Orso
Assessor-Ccunty Clerk -Recorder
J I SPACE ABOVE THIS LINE FOR RECORD:_R'S USE
Grant Deed
THIS FORM FURNISHED BY TAUSTORS SECURrY SERVICE
The undersigned Grantors) declare(s) under penalty of perjury that the following is true and correct:
Documentary transfer tax is S Not of Public Record
❑ Computed on full value of prioperty conveyed, or
❑ Computed on full value less value of liens and encumbrances remaining at time of sale.
❑ Unincorporated area: ❑ City of , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
SANTA ROSA DEVELOPERS, LTD., a California Limited Partnership
hereby GRANT(S) to
181815
CENTURY CROWELL SANTA ROSA, LLC., a California Limit,E!d
Liability _ompant
the following described real property in the County of kiverside State of California:
As set forth on Exhibit "A", appended hereto.
Dated December 30, 1.999
State of California
County of Riverside
On December 30, 1909
before me � lAz 7:3
SANTA ROSA DEVELOPERS, LTD. ,
a California Limited Partnership
tiy: Santa Kosa Jeve opers, Enc.
a California corporation
its President
personally appeared Jeff Troesh
personally known to me (or 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 e-cecuted the same in
his/her/their authorized capacity(ies), and that by his/heritheir 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
Signature
r Susan J. Howard
/U Comm X1147611 ^
NOTARY PUBLIC - CALIFORNIAv'
RIVERSIDE COUNTY 0
„�a • Comm Exo. July 20. 2001
Title Order No. Escrow, Loan or Attorney File No.
MAIL TAX
STATEMENTS TO: Century Crowell Santa Rosa, LLC. , 1535 South "D" StreEt•, San Bernardino
NAME AOORESSCITY,STAI'c ZIP
Ca 92408
PARCEL l:
LOT '6 OF TRACT 25397, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE
OF CALIFORNIA AS PER MAP RECORDED IN BOOK 218, PAGES 20-25 IhiCLUSIVE OF
MAPS, LN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY.
yf P11, Y
J 3b. ? t
vin
t' x3 tthe assessor's parcel number for each property for which you are claiming an
ex-cusionvIf.additional space
is needed, attach a separate page. If you Carnot provide
c
F ;r'>• e `above information please
call the assessor's office at (909) 955-6215 for further
�.}�. structions., DO'NOT MERELY ATTACH A LEGAL DESCRIPTION. • - -
mstf
h
UNIT
TRACT ASSESSOR'S PARCE-_ NUMBER
r4ry
76 9 6,2o
+.,
53r1 % 7A-9
n'STATEMENTS:
I am the owner of the property described•above. I will commence construction on
this property on l S �d0 D (start date.)'
_
4, r-,•: � ,2.. 1 currently offer, or intend to offer, the property for sale or other change mownership
and do not intend to rent, lease, occupy,.or otherwise use the propert/, except as
model homes or other use as is incidental to an offer for a change of ownership.
3. 1 request exclusion from supplemental as
of the new construction that is
to be erected on the real property described herein, in .accordar�e with the
R• provisions of Section 75.12 of the California Revenue and Taxation Code..
4. 1 understand that the construction exclusion shall apply only to the s.ipplemental
assessment regarding new construction on this property and shall not oreclude the
reassessment of any such property on the Assessment Roll for succeeding January
1 lien dates or apply to any other supplemental assessments on this property which
may occur at a later time.
5.: 1 understand that should the real property on which the exclusioni is allowed undergo
a partial or complete change of ownership during the course of the new
- construction, the value of the transferred newly constructed real property would be
". subject -to a supplemental assessment. If the transferee of that real property
U
esires and. qualifies for an exclusion •from supplemental assessment for new
construction subsequent to the transfer, separate application must be made prior
to the commencement of the additional new construction:
OWNERSHIP INFORMATION - Only the owner or a co-owner of the claimed orooerty or
legal reoresentative may sion. If you are buying this orooertv under an unrecorded contract
of sale-vou must attach •a coov to this claim.
l certify (or declare)-under'penalty of perjury, under the laws of rhe state of
California, that the foregoing is true and correct.
Executed at this day of,ig7tc+�ygyy , year26
,
Signature: Telephone#(9109) 3�/="007
17
'Print Name of Contact Person
`.SR 740-05 (REV 03/98)
YOUNG ENGINEERING SERVICES
f
Letter of Transmittal
Date:
Project:
Attn: 6L W. 0.:
Tel No.: Tract No.:
We are forwarding: By Messenger By Mail Your Pickup
No. of Copies Description:
Comments: l�( 5 / f]'Pl�P/JV/'73! �
This Material Sent for:
Your Files Per Your Request
.r
Your Review Approval
X Checking At the request of ,
Other
By: Marcell McElroy'
Phone # 342-9214
47-159 Youngs Lane • Indio, CA 92201 • (760) 342-9214
'
-Bron Young •
T -d LSOT:-bTS-606 3S OWIN33WIJW3 swno. e60=60 20 BO JCIU