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08-1591 (AR)Y R P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address`. APN: Application description: Property Zoning: Application valuation: Applicant: ee>­ 44R_, 08-00001591 55421 RIVIERA 775-153-003- - - ADDITION - RES'IDENTIAL LOW DENSITY RESIDENTIAL 150000 Architectt or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: HAGUE RESIDENCE 55-421 RIVIERA V�rl LA QUINTA, CA 9225(760)346-2856 Contractor: OWENS,,MICHAEL L 28402 AVENIDA PLACI SAN JUAN CAPISTRANO, (949)887-3335 Lic. No.: 376607 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/12/08 W U 1 Q CITY OF LA QUINTA nCDT CA 92675 r — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 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 Business and Professionals Code, and my License is in fullforce and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B License No.: 376607 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is - n Dated Contractor: _V%l //S !,d e2 issued. , _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor 7—'—'`�i Code, for the performance of the work for which this permit is issued. My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number EXEMPT 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 should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by - any applicant for a pefmit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: —Date:Applican_ t:. <%� (_ 1 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 Professions Code: The _WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 PENALTIES AND 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, 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 fora 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 pursuanttoany permit issued as a result of this application, 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 LaQuinta, 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 180days 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 county ordinances and state laws relating to building construction, and hereby authorize representatives of this co/+'u�ntt�y`/ttoo enter upon the above-mentioned property for inspection purposes. , __Datel�� [� Signature (Applicant or Agentl: `/ Aa � Application Number . . . . 08-00001591 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 814.50 Plan Check Fee 529.43 Issue Date 'Valuation 150000 Expiration Date 5/11/09 "Qty Unit Charge Per Extension BASE FEE 639.50 50.00 ----------------------------------------------------------------------------.. 3.5000 THOU BLDG 100,001-500,000 175.00 Permit . . . ELECT - ADD/ALT/REM. Additional desc . Permit Fee . . . . 33.34 Plan Check Fee 8.34 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/11/09 Qty Unit Charge Per Extension BASE FEE 15.0.0 524.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 18.34 Permit GRADING PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee". .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/11/09 Qty Unit Charge Per Extension ---------------------------------=------------------------------------------ BASE FEE 15.00 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 52.50 Plan Check Fee ". 13.13 Issue Date . . Valuation 0 Expiration Date 5/11/09 Qty Unit Charge Per Extension BASE FEE 15.00* 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 2.00 6.5000 EA MECH VENT FAN 13.00 1.00 ---------------------------------------------------------------------------- 6.5000 EA. MECH EXHAUST'HOOD 6.50 Permit . . ... . . PLUMBING LQPERMIT Application Number 08-00001591 Permit . . . PLUMBING Additional desc . Permit Fee . . .'. 100.50 Plan Check Fee 25.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/11/09 Qty Unit Charge Pet Extension BASE FEE 15.00 11.00 6.0000 EA PLB FIXTURE 66.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 i. 0(i 3.0000' EA PJ,8 WNPER 1'NST/ALT/REP 3.00 3.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 9.00 - ---------------------------------------------------------------------------- Special Notes and Comments 524 SQ. FT. ADDITION, 492 SQ. FT. PATIO AND INTERIOR REMODEL. ---------------------------------------------------------------------------- Other Fees . ... . . . . . : ENERGY REVIEW FEE 52.94 STRONG MOTION (SMI) - RES 15.00 Fee summary Charged Paid Credited Due Permit Fee Total 1015.84 .00 .00 1015.84 Plan Check Total 576.03 .00 .00 576.03 Other Fee Total 67.94 .00 .00 67.94 Grand Total 1659.81 .00 .00 1659.81 Bin # P Permit # /j l Project Address:—L 2 City of La Quinta Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application anj Tracking Sheet U� Owner's Name: A. P. Number: 153 —003 Address: �5- Z �� Oelp Legal Description: Contractor: GvST�t�( 'V tLS� QI KJ( yL City, ST, Zip:`!C L �� Telephone: Address: El AG! Project Description: City, ST, Zip:5" ".."444it9 �%��}��� 7-0 Telephone: -9"' ] 7 e5t::) V State Lic. # 376 iV 7 City Lic. 0 o L Arch., �;CAS,L-4rry _ I i� / / �j Q �J 1 Address: lC)C>Sff a7>A '473 City, ST, Zip:FAt-# f S <& �Z Telephone: 6 Z��6 l/ 3 `% State Lic. #:1� Name of Contact Person:] t ���© x C —LTe Construe J V Occu Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: Stories: # Units: Telephone # of Contact Person:'] # Submittal Req'd 2856 Estimated Valuelof Project: COD APPLICANT: DO NOT WRITE BELOW THIS LINE Reed TRACKING PERMIT FEES Plan Sets pZ Plan Check Item Amount Structural Calcs. Truss Cates. Reviewed, read forco,--,---- Ian Check Deposit Called Contact Pe th ban Check Balance Energy Calcs. Plans picked up S S Q onstruction Flood plain plan Plans resubmitted lechanic 1141,j Grading plan 2"4 Review, ready for cMAU R Subcontactor List Called Contact Person Plum 'ng 1' 7 + Grant Deed Plans picked up H.O.A. Approval Plans resubmitted V rading IN HOUSE:- ''' Review, ready for correctionsfissue D eloper Impact Fee Planning Approval Called Contact Person A I.P.P. Pub. Wks. Appr Date of permit issue t School Fees Total Permit Fees �� R,6�/ ►�I eNA e � u is a�'. Ilk. ,4fX-YW� CERTIFICATE OF COMPLIANCE Desert Sands Unified School District. 47950 Dune Palms Road ¢ BERMUDA DUNES O RANCHO MIRAGE. Date 11/12/08 La Quinta, CA 92253 INDIANWELLS No. 30255 (760) 771-8515 dd P nuiN A "t' QINDIO y� 0 Owner Hague . APN # 775-153-003. Address 55421 Riviera Jurisdiction La Quinta City La Quinta Zip Permit # Tract # No. of Units 1 Type Residential Addition Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 55421 Riviera Unit 2 Unit 3 Unit 4 Unit 5 Comments 524 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for Irving, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. ° in the amount of $2.97 X 524 S.F. or -$1,556.28 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By CC/Bank of America - Mike Owens Check No. 423305110 Name on the check Telephone 949-887-3335 Funding Residentia: By Dr. Sharon P. McGehee Superintendent Fee collected /exem by S r cG" v y Payment Recd $1,556.28 �Oven!ude = Signature G NOTICE: Pursuant to Government Code Section 66020(d)(1), thisVorized notify you that the 90 -day approval period it which you may protest the fees o r other payment identified above will begin to run from the date onilding or installation permit for this project is: issued, or from the date on which those amounts are paid to the District(s) or to another public entityo collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting 10/24/2008 11:-46 7603462856 PITCHFORD DESIGN PAGE 01 lo/.15/2'006 08: 34 FAj 900 771 612.5 PGA WEST RES ONE X008 PGA WFS y:. page 1 of 2 W. ^ QENTASSOCU►710N; IN6; ; October 7.2008 Ma: Kelp Cl I 55421 Riviara : La Qlonta, CA 92253 Dear Ms, Hague, . . Tho A,xchit�rel C�mrmittce h>sa reviewed your plea• submittal for The proposed remadel of the unit n 4ta'additiotl, pool and apo, barbecue, routtya:d and =R' hardsce, existit — ".. landscgpe; irrigation and extaior noting. ne do=CWS received oto September 17, 2008 include • Shoets - ,A�, A2' and. A3 reviaod Septrem bar A. 2008; �A4, AS and Ab reviW- Saptembex 6, 2008; A? ievised sa*mber 7, 2009;.'M4 dated August 26, 2008; 6N1, X12, 6N3, 5N4 my d All` Shoats prepamd by Charles L Horrvell. . ti gR 20U$; MA dated. • Suets•– S11; S2,>53,:54 and S6 dated MY 18„2008; S_ dated August b. Dwm Savoie flat. �f' 2b08:. SWI. -dated jaauary 31, 2008. . All sheets pt Y Preemeopm Sheets Ll idated•July 28, 2008) L2 dated August 15, 2008_ All prepared by. Lands ape,. The following►oxtioPs of yet t-sibm1ttal package are approved subject to the conditions as listed that we applicable. 1,Teaovatia3l. of ibe exisling imit i�ateriors isapproved, buTIX t requires a copy of the City of La quanta• biulding Permit aad a copy of the 'city. . stacx�pea pians bof a `Notice %a irOGe . . igsll. ..' ” . 2,. a caslta itiddida0.,xoanl additions aad BOW ooi►rW patio arc appa'D**4 : �� a copy of the.City ofl:a QuidtA building pramit and a copy of the city apxd plans before A :`Notioc to. Piroceed' .is issued. 54 320 Southom Hliis: La Ctuinta. CeiiifOmfe 82263-5665, Telepnons 7$0-171-1234 FAX TW771-5125 TO : 3�Jbd UISNOD HpWc WOISfiD - 989Z68P606lT ^EZ:RR APIA 7.1J T/At I OCT -.10-2008 09:538 FROM:SOUTNLAND ENERGY 9494973210 TO:17603462856 P.1 S-0LIT HLAND energy consultants 1491 Glenneyre Street Laguna Beach, California 92651 • 949-497-3591 fax 949-497-3210 October 10, 2008 .RE: Casa Kel 55.421 Riviera, La Quinta, CA - Plan Check # Section G — Energv Efficiency 1) The Performace Method was used, Micropas v7. This approach does not require a WS -4R as, the same Information Is provided In the Fenestratlon section of the report noted as Existing,. - Altered, Deleted and New. This approach Is also exempt from glazing area maximums required under the Prescriptive Approach. 2) Duct location is specified as Attic, this is a worst case. Any other location may be used as this would be an improvement. 3) a. See Architectural plans. b. All altered or new glazing to have a minimum u -factor of 0.42 and shgc of 0.45. • c. Glazing types grouped by orientation. Totaling each window and door rough opening area will equal the totals under the Altered and New sections of the Fenestration section. Sincerely. A. D Lori Binder, CEA R05-04-602 - Southland Energy Consultants ' rr rr CA-B-Ec CalfomlaAssodal afBOftEnergyConsulMnis CERTIFIED ENERGY ANALYST LORI E. BINDER R 05-04.602 loft' CITY OF LA QUINTA. SUB -CONTRACTOR LIST ,JOB ADDRESS /C/ I//r_le4 PERMIT NUMBER OWNER KEl—e-y BUILDER This form shall be posted on thejob with the Building Inspection Card at all times in a conspicuous place. Onlpersons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response C6 . State Contractor s License Workeis Compensatron•Insurance ' Cit Business License' •. ad F 1 Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date le.g. A, B, G-8) (xxxxxx) (xxlxx/xx) le.g. State Fund, CalCompI (Format Varies) Ixx/xx/xx) (xzxxl Ixx/zx/xx) EARTHWORK (C-12) CONCRETE (C-81 / . G ' S UG 3 '3 FRAMING (C-5) b" SPS - /-. 3T T- csss- ! - �9!� -�! STRUCT. STEEL (C-51) MASONRY (C-29) PLUMBING IC -36) jri r v G gad .2 — -09 xE/-Ipr LATH, PLASTER (C-35) �ARL5 .1,4r# d'-3�uy�__—_--t �'.j �IJS'� Sl ��/lam DRYWALL (C-9) LLU i • . Z- r_ /3 �y�S _.. VAC (C-20) ELECTRICAL (C-10) L L - D 3 ROOFING (C-39)`: _ T t L SHEET METAL (C-43) '. FLOORING (C15) GLAZING (C-171 i INSULATION (C-2)-1799' _ t SEWAGE DISP. (C-42) PAINTING (C=33) G ' O CERAMIC TILE (C-54) - CABINETS (C-6) FENCING (C-13) LANDSCAPING (C-27) Southwest Inspection and Testing, Iric. 441 Commercial Way, La Habra, CA 90631 .. (562) 941-2990 • (714) 526-8441 • Fax (562) 946-0026 REGISTERED INSPECTORS'S DAILY REPORT SWIG b Noa Z Date +O TYPE OF INSPECTION REQUIRED ❑ Reinforced Concrete ❑ Strcictural Steel Assembly ❑ Quality Control ❑ Post Tensioned Concrete ❑ Fire Proofing ❑ Other ❑ Reinforced Masonry ❑ Asphalt Job Addre City /1-1.0 Q n A; Job Name Permitjyp� Issued By Type of Structure Architect Material D scription (t e.ora ,source / Engineer Contractor Inspector(s) NameSubcontractor a !G TESTS PERFORMED TYPE OF SAMPLE SLUMP QUANTITY. IN SET ADDITIONAL REMARKS ON SAMPLES INSPECTION SUMMARY — LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC. INCLUDES INFORMATION ABOUT - AMOUNTS OF MATERIAL PLACED OR WORK PERFORMEC, NUMBER, TYPE & IDENT. NO'S OF TEST SAMPLES TAKEN: STRUCT. CONNECTIONS (WELD MADE H.T.BOLTS TORQUED) CHECKED, ETC. o c� GcJ 8 o / Wqo � I . /- >! �� I� ,r �� // •. z-� CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE OBSERVED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWIS . I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS,## PPL BLE SECTIONS OF TMeGOVERNIUG_flUILDINGoLAWS. SPECIALTY NO. AGENCY CONTINUED ON NEXT PAGE U PAGE OF FIN TIME OUT. REG. HOURS O.T. HOURS CYLINDERS Z: All inspections base on a mum of 4 hours and ov 4 hours - 8 hour minimum. . 1 Approved by Project Su WHITE - OFFICE COPY, CANARY - ACCOUNTING COPY, PINK - INSPECTOR'S COPY, GOLDENROC - JOB SITE COPY Southwest Inspection and Testing, Iric,, P g� 441 Commercial Way, La Habra, CA 90631 (562) 941-2990 • (714) 526-8441 • Fax (562) 946-0026 REGISTERED INSPECTORS'S DAILY REPORT SWIT Job No. 10 Date -06 TYPE OF ❑ Reinforced Concrete ❑ StreJctural Steel Assembly ❑ Quality Control INSPECTION ❑ Post Tensioned Concrete ❑ Fire Proofing n Other REQUIRED ❑ Reinforced Masonry ❑ Asphalt C >xX�j C�'✓It��.S Job Address5 S [1 ,f V r C1'rd P 6--A City 1 ' Job Na. ne Cl ��� A C(C 41 C Permit No. ��� Issued By t L) Type of Structureh SFY AArrcrhitect f� f G0 5'• 's"i 7 n se ur? l S U : >t e A - 4 7q 1 ,%N{ r i CLue I el 1117 ffAP:s Or< 0A ` C{''' 6L Moterial Description (type, grade. source) j�oEngineer Crd Contractor Inspector(s) Namer$we o', ,j i x 3j (��G K K Subcontroctor 111 V� 0(t C- r- 5 ' TESTS PERFORMED TYPE OF SAMPLE SLUMP QUANTITY IN SET ADDITIONAL REMAFMS ON SAMPLES Y" INSPECTION SUMMARY — LOCATIONS OF.WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBAEMS, PROGRESS, REMARKS, ETC. INCLUDES INFORMATION ABOUT - AMOUNTS OF MATERIAL PLACED OR WORK PERFORMEC-, NUMBER, TYPE & IDENT. NO'S OF TEST SAMPLES TAKEN: STRUCT. CONNECTIONS (WELD MADE H.T. BOLTS TORQUED) CHECKED, ETC. �) p l��ery-c c( �,,� �r�s c. *✓J ��te � �c�_�� >nfr�G� oE' a t e ( d ugbN 1S �e,%f rrjo wA Adcll '('} �- (,t5. }'j t"1•' ��� �f' f � GG � 1� � hs.Y I• t0, aiJ �4'S, I%� CGti i'-� :� I C�G�1✓F �� � '�{' f'�Vt �)¢c,� ��rtYSI��') a t\C�. /iGCLe'C(.S E ►�1 �E l� EJr� 41�� Vl r 7/ SEX 11) 1 �, f 1 ;VG A: A �iG�f'5 A1r; �d I.LEv'C !"ilC' i,[` av% IJtalGtf �G 9,0 Tr 5 r� '1:,12` :4ii$ ?SE� 5 i1 Y' � 1+ I ,1 All tt,r\,)�1 L"G•, V 1� A .�i1i4Li rs "Vt: bI1 ! ��:G jk'Nl1 'r AI)L 1`.-.1 A Li.'. r �'l.,,I� + !e, �V1lt \ CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE OBSERVED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. J7/ ^ l : L(•&L' SIGNATUREAF REGISTERED INSPECTOR 1�v33i/-�i9 SPECIALTY NO. AGENCY CONTINUED ON NEXT PAGE U PAGE OF TIME IN TIME OUT REG. HOUPS O.T. HOURS CYLINDERS G;v0 !a; v o If - AII inspections based ona minimum d 4 hours and over 4 hours - 8 hour minimum. 1� 1% Approved by 7 Project Superintendent WHITE - OFFICE COPY, CANARY - ACCOUNTING COPY, PINK - INSPECTOR'S COPY, GOLDENROD - JOB SITE COPY Southwest Inspection and Testing, Inc. 441 Commercial Way, La Habra, CA 90631 (562) 941-2990 - (714) 526-8441 - Fax (562) 946-0026 CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE OBSERVED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, E SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. 07 SIGNAT RE REGISTERED INSPECTOR 00 SPECIALTY NO. AGENCY CONTINUED ON NEXT PAGE IJ PAGE OF TIME IN F TIME OUT I REG. HOURS I O.T. HOURS I CYLINDERS 10900 I Las -00 I It I I All inspections based o minimum of 4 h urs and over 4 hours 8 hour minimum. Approved by Project Superintendent WHITE - OFFICE COPY, CANARY - ACCOUNTING COPY, PINK - INSPECTOR'S COPY, GOLDENROD - JOB SITE COPY SWIT Job No. Date te REGISTERED INSPECTORS'S DAILY REPORT TYPE OF ❑ Reinforced Concrete ❑ Strcictural Steel Assembly ❑ Quality Control INSPECTION ❑ Post Tensioned Concrete ❑ Fire Proofing M Other REQUIRED ❑ Reinforced Masonry ❑ Asphalt eY(!'K (owgts Job Address ,s'� q /� l/� vi erg, r° �✓ City u, J�j /1 VIss , Permit No. �S� ued By! Job Nome t4 a1p,(,(l �S A 4� c -e- { . 1 I �✓ Sw/7!.`tp.Gv rico �w��P7 Type of Structure Architect Mater'QI escri tl n (type. gr de, source) Engineer . I IL` IT So a A' kd � s=v' Contractor yyl , , yl r, l -'r �� ,,yvj(, Subcontracto Inspectors) Nome ja,.gg'i q, s r ft QULeYbS ����11 [[�� TESTS PERFORMED SLUMP QUANTITY IN SET ADDITIONAL REMARKS ON SAMPLES TYPE OF SAMPLE INSPECTION SUMMARY — LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC. OF MATERIAL PLACED OR WORK PERFORMED, NUMBER, TYPE & IDENT. NO'S OF INCLUDES INFORMATION ABOUT - AMOUNTS TEST TAKEN: STRUCT. CONNECTIONS (WELD MADE H.T. BOLTS TORQUED) CHECKED, ETC. `SAMPLES i ®l4 YV'�� �l!✓U�l 11 5 p� e. i&C` yV)4 6V g!A e i,,, 4 epvwl vyti holes r;ll�d���� ( t( r S c ALI CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE OBSERVED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, E SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. 07 SIGNAT RE REGISTERED INSPECTOR 00 SPECIALTY NO. AGENCY CONTINUED ON NEXT PAGE IJ PAGE OF TIME IN F TIME OUT I REG. HOURS I O.T. HOURS I CYLINDERS 10900 I Las -00 I It I I All inspections based o minimum of 4 h urs and over 4 hours 8 hour minimum. Approved by Project Superintendent WHITE - OFFICE COPY, CANARY - ACCOUNTING COPY, PINK - INSPECTOR'S COPY, GOLDENROD - JOB SITE COPY