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12-0446 (AR)P.O. BOX 1504 78-495 CALLE TAMPIC0 LA QUINTA, CALIFORNIA 92253 Tilif 4 4v QuMM BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 LQPERMIT Date: 6/26/12 Application Number: 12-0 0 0 7044-6 - Owner: . Property Address: 5286"0`AVENIDA—OBREGON MILLER, JAMIE T AM: 713-315-025-6 -000000- 52860 AVENIDA OBREGON " Application description: ADDITION - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL, '- Application valuation: 50000 .. p Contractor: • Applicant: Architect or Engineer. ' DANTOR MARTINEZ CO T UCTJUN ti �0�� J�JI� 81057 AVENIDA'ROME INDIO, .CA' •92201 �.� p • 77, (760) 702' 6209 CITY � ' qulN%0 Lic, No.'. 926128 FINANCEDEF>T. 1A - - LICENSED CONTRACTOR'SDECLARATION WORKER'S COMPENSATION DECLARATION .' .. I he�etiy affirm under penalty -of perjury that,„am hcensedunder provisions'of Chapter 9 (commencing with, I hereby affirm undei penalty of peijuryone of the following declarations: - section 7000) of Division 3 of the Bt iness and Professionals C6de,�and my License is in full force and effect. _ I have and.wjll'maintain.a certificate of corisent to self- insure for workers' compensation'as,provided §' License, Class: B- - _ ♦cense N 926128 ' - -for by Section _3700 of the Labor Codei,.for the performance of the work for which this permit is - ,., KDate: C��- Contractor.��. 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 LARATION ' O ER -BUILDER Atractor'g* insurance carrier and policy number are: - - I hereby affirm under penalty of perjury. that I am exempt from the State License Law for the Carrier STATE NTL INS Policy Number .19609972011 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 subject 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.s a Id become sub' t to thew rkers'. compxi�^sation provisions of *Section' License taw (Chaptei 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the Labor I sha forthwiomplyith tho pfovisions. 'that he;or she is exempt therefrom and the basis for the alleged exemption.' Any violation of Section :7031 .5 by '- ie!_ i.. • any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: Applicant: (_ 1 'I, as owner of the`property, or my employees, with wages as their sole compensation, will do the work; and �'•COMPE CATION - - _ the structure is not intended or•offered for sale (Sec. 7044, Business and Professions Code: -The WARNING: FAILURE TO SECURE. RKE COVE E IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AWEMPLOYER TO CRIMINAL' PENALTIES A D CIVIL FINES UP TO'ONE HUNDRED THOUSAND and who does the work himself' herself through his or her own employees, provided that the DOLLARS (5100,000)- IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN oded.or.offered for sale; If, however, the building or improvement is sold within . improvementsare not imen SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one: yeai of completion; the owner; builder. will have the burderc of proving that he or she did not. build or - .. .irnprove for the purpose of sale.). - APPLICANT ACKNOWLEDGEMENT 1, as owner oi.tlieproperty; 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, (_) 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 - of La.Quirita, its officers, agents and -employees for any act oromission relatedtothe work being - performed under or -following issuance of this permit. Date: Owner: 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 CONSTRUCTION LENDING AGENCY - permit to cancellation. -I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit.is issued (Sec. 3097, Civ. C.). city and county ordinances and, state laws relating to b i ing constructio ,and hereby utfiorize r msentail, es of this county to enter upon the above-mentioned pro ert for in pection purposes. ' lender's Name: .� Date:kat`Signature (Applicant. or Agent,: Lender's Address: ' LQPERMIT Application Number . . . . . 12-00000446 ------ . Structure Information 465SF DWELLING/446SF GARAGE ADDITIONS ----- other struct info . . . . . CODE EDITION 2010 # BEDROOMS, 1.00 FLOOD ZONE NO GARAGE SQ FTG 446.00 1ST.. FLOOR =SQUARE FOOTAGE • 4 6 SA 0 Permit BUILDING PERMIT Additional, desc . Permit. Fee 414.50, Plan Check Fee 269.43 Issue�,Date•Valuation' 150000"` ' Expiration Date 12/23/12 Qty,, Unit Charge Per Extension BASE FEE 252'.00 25 00;. 6,.'5000 THOU.._BLDG 25,001=`50,.000 162:50 :.Permit,. ELECT._.ADD/ALT/REM A _• dditonal desc . Petmit' Fee " 40:20 Pian -Check Fee 10-.05 :. Issue'Date' Valuation . . . . 0 Exg ratioft Date ... ,•12/23/12 :..Qty Unit Charge Per Extension BASE. -FEE 15 ..00 - 465.00 G350 ELEC NEW RES - 1 OR•2 FAMILY 16.28 :446`:00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 8.92.,.: Permit •. . . GRADING PERMIT Additional desc . Permit Fee . . 15.00 Plan Check Fee .00 ' Issue Date, Valuation . . . . 0' .-Expiration Date 12/23/12 Qty.. Unit Charge Per Extension BASE FEE 15.00 - Permit MECHANICAL Additional desc . • Permit Fee :. 35.00• Plan Check Fee 8.75, Issue Date . . . . Valuation . . . . 0 Expiration Date 12/23/12 Qty Unit .Charge Per Extension LQPERMIT Application Number . . . . . 12-00000446 Permit . . . . . . MECHANICAL Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00 1.00 6.5000 EA MECH VENT FAN ---------------------------------------------------------------------------- 6.50 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 42.00 Plan Check Fee 10.50 Issue Date Valuation . . . . 0 Expiration Date 12/23/12 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 6:0000 EA PLB FIXTURE 24.00 1.00 3.0000 EA PLB WATER INST/ALT/REP, 3.00 --------------------------------------- ------------------------------------ Special Notes and Comments 465SF MASTER BEDROOM AND'446SF TWO (2) CAR GARAGE ADDITIONS/VB/RES-3/CLASS-A [ENGINEERED] EXISTING SEPTIC SYSTEM APPROVAL BY RIVCOEH. COMPACTION AND PROPER'ABANDONED-CESSPOOL REMOVAL VERIFICATION,BY SLADDEN ENGINEERING. THIS PERMIT DOES NOT INCLUDE REMODELING OF THE EXISTING DWELLING, DRIVEWAY APPROACH OR BLOCK WALLS. 2010 CALIFORNIA BUILDING CODES. June 26, 2012 8:22:33 AM AORTEGA ---------------------------------------------------------------------------- Other Fees .. . . . . . . . . BLDG STDS ADMIN (SB1473) 2.00 ENERGY REVIEW FEE 26.94 GRADING PLAN CHECK FEE 15.00 STRONG.MOTION (SMI) - RES 5.00 Fee summary Charged Permit Fee.Total 546.70 Plan Check Total 298.73 Other Fee Total 48.94 Grand Total 894.37 LQPERMIT Paid Credited Due .00 .00 546.70 .00 .00 298.73 .00 .00 48.94 .00 .00 894.37 t BIR.# CI .OI�JVW ButWtng`Bz Safety Division, :.. :; • P.O• Box ,1.504, 78�495,.Catte Tampko ' ta.Qirhlta, CA 92253 - (7150)•777-70:12 Building Perrriii,Applrca ion and,rTracking Sheet Permit # lot* Project Address: �2'—� (o Y ,`Owner's Nairie:.' OIwS.A e r A. P. Number. TTAddress: Legal Description: ;City, ST, .Zip: Contractor a, h 4 -o -v- &tar. -1 ,,AA Z Cc," S Vr� iC; . ;Telephone: Address:610 47 % A- V t1( G(A YQD vt,( r p. Project Description: City, ST, Zip: l -e S Telephone: %�o ZfG2--G2-o j. i^. State Lie. #: Ot 2 6 i 2 ejCity Lie, #; Arch., Eng-, Designer Address: 2 City., ST, Zip: Telephone: r Construction Type: Occupancy: State Lie. #: 3 Project type (c' a one): New Add'n Alter Repair Demo Name of Contact Person: �M•1 Sq. Ft : .: yy #Stories: # Unity: Telephone # of Contact Pea:''7. Q 7 O 2,- - 42-0 q Estimated Value of Project: q 0'a p APPLICANT: MO, NOT, WRITI ,BELOW THIS` INE N Submittal Plan Sets Req'd Reed pZ. y IgtACMG Y,7' P$IthIIFhEFS .Plan Cheek submitted '7 , llltei.�Amount Structural Calcs. Reviewed, ready for corrections Pla1 Chedi Deposit_ . Truss �1�• Called Contact Person `. ' lea Chick. Balance _ Title 24 talcs. Pians eked'uIm,1114 pl p Construction Flood plain plan - Plans resubmitted.. Mechanical„ Grading plan 2id Review; ready itorr ti Electrical Subeoatactor I:ist Called ContactPeison. b ;;; Plumbing Grant Deed Plans picked tip H.O.A. Approval Plans resubmitted.' :. 11i 1 ..nn� Grading DH HOUSE:- Y Review; readyfor correedon aN boA4Mjpiyploper Impact Fee Planning Approval Called Contact Person AXP.P. Pub. Wks. App Date of.permit issue School Fees To Permit Fees 8 y. Li 7/,Z4 ---:P 21A *1"s/$ VI - :�� j ?ort • wz b1k 120t2 Rj CERTIFICATE OF COMPLIANCE Desert -.Sandi ' Unified SclhooDistrict 47950 Dune -PalnisRoad ¢ BERMUDAI)UNM /� '=}- C rn RANCHO MIRAGE ci Date 6/25/12 La Quanta; Ca! 92153 . k�- INDIAN WELLS y rs. PALM DESERT No. 31315 ( 760) 7714515 , N4 v> UA'OUINTA�' INDIO y? Owner Jamie Miller APN4 7737315-025 Address 52860 Avenida Obregon Jurisdiction LaQuinta 'City La Quinta Zip P..erniit`# Tract # No of Units 1 Type Residential Addition Lot # No. Street S.F. ti. Lot #.. ,NO. Street S.F. Unit 1 52860 Avenida Obregon 465 Unit 6 Unit 2 `Unit 7 Unit 3 Unit 4 Unit 5 Comments ' :Unitl Unit,9 Unit `1'0 At the present time, the Desert Sands Unified School District does not,colled fees op, garages/carports, covered patios/Walkways, residential additions under 500 square feet, detached accessory structures (spares that do' not contain facilities forliving sleeping cooking, eating;or,. sanitation) or replacement mobile homes. It has been determined-tliat the�above-naih4owner is exempt from, paying school fees at thi§ ti!i 'due to.the`following reason: Residential Addition 500. Sq :Feet or Less EXEMPT This -certifies that school facility. fees imposed_pursuant to Education Code Section"17620 and Government'Code 65995;Et.Seq. in the amount of $0.00 X 465 S F. or $0.00 have been. paid foeAhe propeity Iigted,above and that building permits and/or -Certificates of Occupancy for. this squaie,footage in_thls proposed project may now be issued. Fees Paid By Exempt - Jamie Miller , ' Check No. Nam".n the -check '� T` elephone Funding:,Exempt . BY Dr. Sharon- P. McGehee Superintendent Fee collected /exempted W Sharon Signature 3ilvrey PaymentRecd_ :fiver/U6der NOTICE: Pursuant to Government Code Sedion'66020(d)(1), is Fserve to'notify you,that the 90 lay approval penod':in.whIch you may protest,the fees or other payment identified above will begin to run from theAate on which the building or installation pemiit_for this project is issued, or, from the.date on which those amounts are paid to the District(s) orto`another public ent' y.authorized,to�.`collecf tfiem onahe-Distrid('s).`behaff, whichever is earlier: 4. NOTICE: This Document NOT VALID`without embossed. seal," Embossed Original -.Building Department Applicant ;Copy = Applicant/Receipt Copy - Accounting TR/PW` ` Cot No APN: ASSESSOR'S PARCEL-NUMBER LAND USE APPLICATION �sr��. L:'G� 1-� .:- "j�. ON# IN# LMS# EHS # DA 43 ... AGENT, CONTRACTOR ... a� P (. �� ir1,,�:e, _ ADDRESS CITY/STATE /. ZIP T �� .) 7 y�KtC a -lQo►n T'. t-6_ . TELEPHONE #'-':: 176 162J 2G QOWNER" ADDRESS ; 'CITY /STATE /ZIP '•, TELEPHONE #. . F- JOB PROPERTY ADDRESSCITY /STATE / ZIP Thomas Brothers:@ Map # i W LOT-SIZE WATER"AGENCY/WELL USE.OF PERMIT V. Vk �,4 T f vr- * FINANCIAL RESPONSIBILITY NOTE: Pertaining to Deposit-Based fee Payments - Fees placed on deposit are intended to pay -for System, review including approval and installation. The project owner or applicant named in Section. B will be subject to billing requests for additional monies should fees deposited;to that point be insufficient. At finalapproval, the pr 'ect owner or applicant named will receive a'-final statement and notice of any final.fees due or refunds due. (as applicable).- pplicable):ROP ROPFees: For Alternate Systems, renewable operating permit (ROP) fees will be due upon finalization of the project. ROP fees will be issued to the project owner or. Z .applicant.named in Section B. H _SEND ALL BILLING MATTERS TO THE CLIENT OR ENTITY LISTED BELOW: L) _ --R -RESPONSIBLE CLIENT/ ENTITY AME WCn. MAILING ADDRESS CITE STATE /ZIPELEP, ONE # Applicant Signatures Date:. 57�Z3- Z Below — For Office Use Only CHECK BOX IF REQUIRED If any. box is checked, this application shall be considered rejected until the information.is.provided and the fees paid. Re-submittals later than 90 .. days after date noted below may require repayment of fees. U . ❑ Holding Tank Agreements Required ❑ Floor Plan and/or Plumbing Layout Required Z'-❑ O Certificate of Existing.OWTS Required ❑ Special Feasibility Boring Report Required F.. ❑ WQCB Clearance Required ❑ Detailed Contour Plot Plan Reqwred (1 to 5 foot intervals)_ V W ❑ Soils Percolation Report Required N PRE SITE INSPECTION REMARKS INITIALS & DATES G NLA 1-6 %.Gu/ � W 1 f} � �i�(?�ari►� L yr 4 rr�t' Soils Percolation / Boring report by. Project # Date Type of System: ❑ New ❑Replacement ❑Existing # Fixture units " Septiclank Cap. Soil Rate ❑Pump ❑ Addition ❑ ATU ❑Connect to Sewer # Bdrms Sq. Ft. Bottom Area Total Linear Ft. Sidewall allowance - ft Rock/ sq ft running foot. Tested Depth Maximum Trench Depth Z O H Install Lines ft long ft wide with min. inches rock below drain line, or ❑ Plastic Chambers U W N Leach Lines / bedspecial design for slope Applicable ❑ N/A ❑ Overburden Factor: Pit Diameter No. Pits Pit below Inlet (BI) Pit Total Depth Max Allowable Depth Well Review Approved by: (Signature) CONSTRUCTION / INSTALLATION INITIALS & DATES 05/2 J;. . ib :l£7 `, 7/.T1A9 'r1•r.r.er.: , � . H V V V 4 J'J, 1 1 i i..l'•.ii i Qin DEH -SAN -122 Rev: 11/07 Distribution: WHITE - Office File; YELLOW — Applicant; PINK — Bldg. Dept.; GOLDENROD — Plans/Records This.Application iso@ Approved ❑ Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements.sef_- forth in Section D above. A building permit is necessary for the construction of the above designed system. 7; No construction is permitted in the required reserved 100% Expansion area.''` W Z (1) Septic tank must be 100' minimum from any. wells. O (2) Leach lines must be 100' minimum from any wells including expansion area. ~(3) U Sewer lines must be 50' minimum from any wells. J W (4) Seepage pits must be 150' minimum from any wells including expansion areas. , EHS Signature: Date: f2 Environmental Resources Management Office Locations EnGir nmental Health --ERM Division Environmental Health — ERM Division Environmental Health — ERM Division Riverside Permit Assistance Center Palm Desert Permit Assistance Center South County Permit Assistance Center 4080 Lemon Street, 2nd Floor 38686 EI Cerrito Road 39493 Los Alamos Riverside, CA 92501 Palm Desert, CA 92211 Murrieta, CA 92562 RIVERSIDE 951 955-8980 PALM DESERT 760 393-3390 MURRIETA 951 600-6180 Qin DEH -SAN -122 Rev: 11/07 Distribution: WHITE - Office File; YELLOW — Applicant; PINK — Bldg. Dept.; GOLDENROD — Plans/Records r � � �a-v�tor Martinez Construction ya,,-. i7444d License # 926128 Riverside County Environmental Health 47950 Arabia St # A Indio, CA 92201 Re: Miller Proposed Addition 52-860 Avenida Obregon La Quinta, Ca 92253 To Whom it May Concern 81057 Avenida Romero Indio. Ca 92201. Phone(760)762-6209 Fax 1760) 775-4097 ,z I am writing this letter in response to City of LQ request to hook up property noted above to city sewer in lieu. of staying on existing Septic system in place. I am certifying that although square footage will be added we are not installing any new water -or waste lines. Our Proposed addition includes a new. master bedroom and enlarging secondary bath using all existing water and waste lines that were there prior to any work being done If you should have any further questions with regards to this- matter,, please do riot hesitate to call me at 760-702-6209 Thank You, Daniel Martinez Dantor Martinez Construction, Inc. THIS APPROVAL GRANTED BY THE DEPARTMENT OF ENVIRONMENTAL HEALTH IS VALID FOR ONE (1) YEAR FROM DATE OF APPROVAL COUNTY OP AIVEA81 fie, HEALTH SERVICES AGENCY DEPARTMENT OF ENVIRONMENTAL HEACTH tA VED �'` DATE: 0 on-si a reg:.: -_r.,,. ,g _. v system herewith with(,ut clearance 'from the Water' Quality Control Board. Water supply scry r.- ns'al,':ation must:be f. -)m en ap0r6vad sjurce.. All sewage dish s ":gin rr-_t conf rm w:;h rcgaira.ments of .current Uniform Plumbing'Code. Any cutting, }r • - cx�:_,s: of fou, (4) fcet will nul"ify'swage disposal approval. :.: .. Approval has ; _::a .. from therl:Egional -Water Quality Control Board for installation of the sew- age disposa system. .is .is to certify that the riverside County Department`ofRublic Health approves for e6oeq, construction installation the item(s) checked above. ka:." /JV`Ae ( CL JNq/pNJ( 5 L7 Jry I R E C• E! V E D ,y� APR 2 '1983 :� tY'of 'La Qu+nta .Ij THI'8-- APPROVAL GRANTED BY THE 0 P'ARTNIEN•T OF PUKIC HEALTH I a VALi)FOR OivE .., (1 YEA'i� ,... FROM D#E •OP APPROVAL. kiVERSIDE-COUNTY;•.®EPARTMENT OF PUBL'IC,;HEALTH DIVISION OF ENVIRONMENTAL HEALTH z. ' �"• Sewage Disposal Food Establishment Trailer Park Lyra%' - hest S� Gel. Septic Tank . Line '�— Motel, Apt., Hotel Sq. Ft. of •Leadh 6 ". x io' Seepage Pit v Dwelling Commercial Building a, Connection to Sewer ... Swimrn.nc Pogl Ix N t ' w,',r s ftening' dev des may be di arged, into the individual sewage disposal 0 on-si a reg:.: -_r.,,. ,g _. v system herewith with(,ut clearance 'from the Water' Quality Control Board. Water supply scry r.- ns'al,':ation must:be f. -)m en ap0r6vad sjurce.. All sewage dish s ":gin rr-_t conf rm w:;h rcgaira.ments of .current Uniform Plumbing'Code. Any cutting, }r • - cx�:_,s: of fou, (4) fcet will nul"ify'swage disposal approval. :.: .. Approval has ; _::a .. from therl:Egional -Water Quality Control Board for installation of the sew- age disposa system. .is .is to certify that the riverside County Department`ofRublic Health approves for e6oeq, construction installation the item(s) checked above. ka:." /JV`Ae ( CL JNq/pNJ( 5 Structural Plan Review Time =1.25 Hrs. This Material Sent for: ❑ Your Files ❑ Your Review ❑ Checking Other: ❑ By: John W. Thompson Rancho Mirage Office: ® (760) 834-8860 Other: ❑ ® Per Your Request ❑ Approval By ❑ At the request of: 71--:780 San :Jacinto Dr. Ste. E2, Rancho Miragp;..C& 92270 ph. (780) 834-8860 fax (760) 834-8861 Letter of Transmittal To: City of La Quinta Today's Date: 6-20-12 78-495 Calle Tampico City Due Date: 6-21-12 La Quinta, CA 92253 Project Address: 52-860 Avenida Obregon Attn: Kay Plan Check #: 12-446 Submittal: ❑ 1st ❑ 4 t ❑ 2nd ❑ 5th ® 3`d ❑ Other: We are forwarding: ® By Messenger ❑ By Mail (Fed Ex or UPS) ❑ Your Pickup Includes: # Of Descriptions: Includes: # Of Descriptions: Copies: Copies: ❑ Structural Plans ® 1 Revised Plans ❑ Structural Calculations ® 1 Revised Struct. Calcs ® 1 Truss Calcs w/Stamp ❑ Revised Truss w/Ltr. ❑ Soils Report Update ❑ Revised Soils Report ❑ Structural P/C Comments ❑ Approved Structural Plans ® 1 Redlined Structural Plans ❑ Approved Structural Calcs ❑ Redlined Structural Calcs ❑ Approved Truss Calcs ❑ Redlined Truss Calcs ❑ Approved Soils Report ❑ Redlined Soils Reports ❑ Other: Comments: Structural content is approvable. Structural Plan Review Time =1.25 Hrs. This Material Sent for: ❑ Your Files ❑ Your Review ❑ Checking Other: ❑ By: John W. Thompson Rancho Mirage Office: ® (760) 834-8860 Other: ❑ ® Per Your Request ❑ Approval By ❑ At the request of: - JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211. INSPECTIONS Phone: 760=275-5020 -. Fax:.760-327-8907. ..... _ INSPECTIONS EPDXY. INSPECTION REPORT Date:--� Project Name: `` Project No: L4 LA Project Address:. Comity: .°�0a\1Qn�0.`D� Ori of �rCA ClientsS b-Contractor: )WR4 K�+ C3 1 bA General Contractor: Architect: Structural Engineer: ' Anchor Bolts Rebar Epoxy Type: i MSon �� F O Epoxy Shelf l-ife: eD� acre p�� f Hole Cleaning Method(s):�`owt�C�eQ F] Other: 24 Other: Unresolved Items: [lone See Below Description of Work Inspected: S o W e 4rQ(1CSL. C✓) �\t il '�R� �f � fl: � B r�k e e e' 1 Qr�► n (�� i C s� Q�J ar�� n (a.'� � 1 �t � a� o � � r c-a e /a.e o e:, e?�• � V Work complies with written approval from Structural Engineer and ICC Evaluation Report #c% I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans,.specifications _applicable building laws. Final report issued at project completion. Inspector": Sladden Buena Park (714) 523-0952 Engineering Coachella Valley (760) 863-0713 IIUNM Rp 1X%1 -11T-1?71 .1 ill, 11' aa 56830 Beaumont Hemet 845 7743 (951) 766-8777 Date S� 7— 7 / -2-- FIELDMEMO Job No. R -40A- Client Project Name Site Address Job Phone 1 F Work Done O6((VVez). too �-. 2„i ` � . Uri: o f/�r� OA,104 tr 10/1 nell)1_0 A7) 011-4ja Test Sum mary Footings Inspected un n hl *0 a h1 -p Test No. Location Elev. Dry Density Moist % Relative Compaction Ref. Max pcf Moist % c. 0. A(6 0, MI) I/ i 0 Ro V*et )-5 -3- AAW ANIO Ohmij J I Comments: 012M t.14 6/z) Ic IA I i -AA 11 140&J7!dt -OV- Kelkwll e bat//�,ts;f - n, .J Ukd ./e, -F-ield.Teeh., S_L-1per-.9rrAgent 4 -hour notice requested to schedule Field Technician. Thank you forthe opportunity to be of service.' REV.08/10