RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO
F
Name
City Clerk
Street
City of Placentia
Address
401 E. Chapman Ave.
City &
Placentia, CA 92870
State
L
J
City Council Approval:
SPACE ABOVE THIS LINE FOR RECOROEITS USE
Free Recording Per Government Code Section 27363 & 6103 Deputy C,(y Clerk
NOTICE OF COMPLETION
Notice pursuant to Civil Code Section 3093, must be filed within 10 days after completion. (See reverse side for Complete requirements.)
Notice is hereby given that:
1. The undersigned is owner or corporate officer of the owner of the interest or estate stated below in the property hereinafter described:
2. The full name of the owner is City of Placentia
3. The full address of the owner is 401 East Chapman Avenue Placentia CA 92870
4. The nature of the interest or estate of the owner is: In fee.
N/A
(If other than fee, strike "in fee" and insert, for example, 'purchaser under contract of purchase," or "lessee ")
5. The full names and full addresses of all persons, if any, who hold title with the undersigned as joint tenants or as tenants in common are: NAMES ADDRESSES
6. A work of improvement on the property hereinafter described was completed on September 13, 2021. The work done was:
The renovation of the Koch Park Restrooms, CIP Project No. Ml The name of the contractor, if any, for such work of improvement was Garza Construction INC.
7. PO Box 993 Glendora. CA 91740 09101120201 _
(If no contractor for work of improvement as a whole, insert "none".) (Date of Contract)
8. The property on which said work of improvement was completed is in the city of Placentia County of Orange State of California, and is described as follows: Renovation of the Koch Park Reslrooms, CIP Project NO- 7103
9. The street address of said property is "none"
(If no street address has been officially assigned, insert "none".)
CITY OF PLACENTIA
Dated: 09/21/2021
Verification for Individual Owner
Signature of owner or corporate officer of owner
named in paragraph 2 or his agent
VERIFICATION
I, the undersigned, say: I am the _City Administrator _ the declarant of the foregoing ("President of', "Manager of', "Owner or, etc.)
Notice of completion; I have read said notice of completion and know the contents thereof; the same is true of my own knowledge.
I declare under penalty of perjury that the foregoing is true and correct.
Executed on , at Placentia California.
(natesfSfgfM-) (City where signed.)
(Personal signature of the individual who is swearing
that the contents of the notice of completion are
true.) -
NOTICE OF COMPLETION— WOLCOTTS FORM 1114— REV, 6-74 B pt. type or larger
ATTACHMENT