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CITY OF SANTA ANA <br />Planning and Building Agency <br />CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT <br />A notary public or other officer completing this certificate verifies only the identity of the indi, <br />document to which this certificate is attached, and not the truthfulness, accuracy, or validity of t <br />State of California <br />County of Los Angeles <br />Approved <br />FOR PERMIT ISSUANCE <br />IVIL CODE § 1189 <br />atevho signed the <br />document. <br />On before me, Amanda Lee Borgstrom, Notary Public <br />date Here Insert Name and Title of the Officer <br />personally appeared h�J <br />Name(s) of ner(s) <br />who proved to me on the basis of satisfactory evidence to be the person(s) whose name <br />r(sj <br />subscribed to the within instrument and acknowledged to me that he/�f%/,tf'Sey executed the same in <br />his/l &/their authorized capacity(iep�), and that by his/�/Weir signature on the instrument the person <br />or the entity upon behalf of which�i the person`) acted, executed the instrument. <br />certify under PENALTY OF PERJURY under the laws <br />of the State of California that the foregoing paragraph <br />is true and correct. <br />WITNESS myUand official seal. <br />�MANDA LEE DORGSTROM <br />Notary 1`uDiic - Callfornla <br />i" Los Anfeles County <br />Commission M 2449e21 — Sinature <br />My Corm. Expires Jun 10. 2027 g <br />Signature of tgd& <br />Place Notary Seal Above <br />OPTIONAL <br />Though this section is optional, completing this information can deter alteration of the document or <br />fraudulent reattachment of this form to an unintended document. <br />Description of Attached Document <br />Title or Type of Document: <br />Number of Pages: <br />Document Date: <br />Signer(s) Other Than Named Above: <br />Capacity(ies) Claimed by Signer(s) <br />Signer's Name: <br />❑ Corporate Officer — Title(s): <br />❑ Partner — ❑ Limited ❑ General <br />❑ Individual ❑ Attorney in Fact <br />❑ Trustee ❑ Guardian or Conservator <br />F-1 Other - <br />Signer Is Representing: <br />Signer's Name: <br />❑ Corporate Officer — Title(s): <br />❑ Partner — ❑ Limited ❑ General <br />❑ Individual ❑ Attorney in Fact <br />❑ Trustee ❑ Guardian or Conservator <br />71 Other: - <br />Signer Is Representing: <br />©2014 National Notary Association - www.NationalNotary.org - 1-800-US NOTARY (1-800-876-6827) Item #5907 <br />