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0007-063 (SFD),-' I N S P CTI0 N S JCM Inspections 39725 Garand Lane Suite F Palm Desert; CA 92211 Phone: 760.3454554 - Fax:. 760-772-3895 _- rN S P E C T I o N S EPDXY INSPECTION `:REPORT Date: _, : -n Projec-Mame:, Project No: Project Address: tozkIt.26 Tett. x.397 City: Title 24 AWS U C her: File # ❑`D 1:1 Client: Sub=Contractor: -two n Other General C ntractor: Cn Architect:, A Structural Enginesr: LAC,, J�Z.Anchor_Boits Epoxy Type:' Epoxy Shelf Life: - c0 Hole Cleaning Method(s):. _' - Rebar ® rt. A v_,e . - Weather:. u 1A. V)Pk Unresol d Items: R[None See, Below V. Description of Work Inspected: r Q e r a ci. a i - er om o. VJ, orVI.Ta a -S.Z5• rAQAj . g_- corn or – �-4k, e Q� r , r �14J DD w ' o n. 3 ►, Work complfes,with "written approval from Structural Engineer and ICBG Evaluation Report # I hereby certify -that I have inspected all of the above work, unlessi otherwise noted, and to, the best of my ability! have found this`work to comply with the approved pians, specifications _applicable building laws.. Final report issued at projectcompletion. Inspector: Ja k C Millin ICBG.0 ' t tion No: 084221.6-49 ctoee,119presen Copy 1 ' JCM Inspectibns Copy 2 Project Superintendent Copy 3/,overning,Agen' Page of 4 <,". B.G. STRUCTURAL ENGINEERING BRIAN GOTTLIEB CIVIL ENGINEER - Lic. No. C33047 45-535 Via Corona Indian Wells, CA 92210 (760) 568-3553 (760) 568-5681 Fax May 6, 2001 Mr. Mike Jacobsen 55-530 Cherry Hills La Quinta, CA 92253 RE: Jacobsen Residence — La Quinta, CA Dear Mr. Jacobsen: This letter,is to confirm that we have completed the structural observations for the Jacobsen residence. We observed framing, wall sheathing, drag straps and connections for conformance with the structural plans and notes on sheet S-1 and required by the 1997 UBC Section 1702. To the best of our knowledge and within the limitations of visual observation, all of the deficiencies noted have been corrected and the final construction is. in substantial conformance with the approved project structural plans. Please call me at (760) 568=3553 if you have any questions or would like to discuss this matter. Sincerely, Brian Gottlieb, P.E. cc: file GOT VP m No. C338 \oF CAL%V--5 VALID ONLY IF SIGNED IN RED 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 Prdfessionals Code, and my License is in full force and effect. License.# Lic. Class Exp. Date 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). O I am exempt under Section B&P.C. forthis reason Date' Signature of Owner-------•'"�. - r ..' .. ... '; v. 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 workerstiv 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 SeEtion 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: Cartier Policy'No. S'1.ATt TWID (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, 1 shall not employ any person in any manner so -as �p become subject to the workers' compensation laws of California, and aree 'thaflf I should become subject to the workers' compensation provisions �1:`S 'tion 3700 of the Labor Co e, I shall forthwith comply with those proV!sio!�s; {3 Applicant- Warning: Failure to secure Workers Comperfsation coverage Is un�awful an shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor'Code, interest and attorneys fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. r 1. Each person upon whose behalf this application is made & each pefsop at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnity & hold harmless the City of La Quints, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State•Ilaws,relating to the building construction, and hereby authorize representatives.,of this, City to enter upon the above-mentioned property for inspectipmpurp�oses:? S nature (Owner/Agent)—­`­ �+\Date 11, / BUILDING PERMIT PERMT# / DATE VALUATION LOT Z1 1 fafi TRACT WA' VW�,3E3t� t QL JOB SITE APN ADDRESS ;r MILS, 54W (7M yq p( 775_1 -026 OWNER CONTRACTOR /DESIGNER / ENGINEER MR MRS :Eai Y.6 sAt,f.5F3M4' 0Wta$tr ill7:,UFR W/'` ORK MS t".OJW i 1.11 r"f WA 98006 USE'OF PERMIT 323tist3 E;FXIPUt...Y DWMILINq ;��1�>�'>wl MIT DUES N(.')Vf fWCl L.'VE HLOCir. i#'�9�t,I�' 01P -PA G i�J.PPR4��t,t�lf INRIV['aN� AYt CWTOM Cd j tlUYSEx1 uC'1°rt3rJ 4:511.00 ST CtP.f AGE 1,522.00 Sir PfJ4((:1•tM1 TIO 1126310 2F 5T1f4gAAb%0 i.r 1.!fY 4C '1.�LfAAgTJL iT 1_�4.J.2_♦A1V .Y�Y)et67R. �(��-�• gig � �y �[�y��d�J 1C �.I�,d71 1� N ]M �! 1.7.IIi,3.17 AP_Y CrE f43'!1.liC I01i1 % 101R000-418-000 PL111124 (:F&WK: FEE 101-400-4311-318 $1dDa.d� Y>s'Z Ii"a: SIT 101-000.439.5. 18 -51,250,04 MECHANIC—'AL FSE 101-000-42;-000 $4113.30 &Wr itCA1.1 ` 101,.W-420.000 $235,01 fpy'r 101-000-419-000 $3-%150 'TRO ) MOTKYN FIEF,.- RPSID 101.000.241.000 S39M 113RAtanacl FLZ a ` 101-000-423-000 'EVELOdTF?&1.1'1' PA,C".T HE $1,90.00 ART lid "P1101AC PLACF111- WIIP' 701 _000-755-ouo $44 5.26 KTIB-i'OTAL C01M'R Cn0f4 AWD P1,A14 CfrlJ_X $6.3.48.35 1: FUS PRE -PAID F -:3 411,250,00 s � 'L(�O 7f9rA1� Pk Wit' FKK6 D" �!:i''�+" lop or _ RECEIPT " DATE + BY D T FINAL Z PECTOR C,� I e t. , 1,. E' t ( it) OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILUNG APPROVALS MECXAN�CAL APPROVALS Set.Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel _ Combustion Air Roof Deck JIB— s q� 4. Exhaust Fans O.K. to Wrap 411 -5 -IX_ _ - d/ F.A.U. Framing _ // Compressor fnsulation s�—/�!a `�_�° Vents Fireplace P.L. Grills Fireplace T.O. Fans .$ Controls Party Wall Insulatlon Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final Final POOLS - SPAS LL��G1 L, QFFPR®VALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam_ _ _ Approval to Cover Equipment Location _ Underground Electric Underground Plbg. Test Final Gas Piping _ Gas Test Waste Lines _ /301 A _Electric Final Heater Final Water Piping _ Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans _ Q.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection�f�-j0/C04 Encapsulation Gas Piping Gas Test Appliances Final Final ,Utility Notice (Gas) ELL,ECY=AL 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) aao 0067- 06-3 P.O. BOX 1504 APPLICATION ONLY 78-495 CALLS TAMPICO Addrress © I L L % LA QUINTA, CALIFORNIA 92253 5 Owned , 4 BUILDING: TYPE'CONST. OCC. GRP. Mailing Address A.P. Number � Tel. Legal Description 7 — 17 2�0 r3et 51ALFT Contractor Project. Description ff `s "'V ;o %�L� `l^-^ Address City Zip Tel. State Lic. City & Classif. `Lic. fi Sq. Ft. No: No. DIN. ' Size/ a Stories Units Designs F_._, P_ I TC ����( "� New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Ad ress -rI -67z� EGL CT7C A' Tel. 76 City��,,rr Zip State 4 1'r`( 1�- �� �"j2 Z LIC. S LICENSED CONTRACTOR'S DECLARATION 1 hereby affi rm that I am licensed under provisions of Chapter 9 (commencing with Section of Ivlslon 3 of the Business and Professions Code, and my license Is in full force and effect. effect. SIGNATURE - DATE OWNER -BUILDER DECLARATION Estimated Valuation 'I, hereby affirm that I.am exempt from the Contractor's License Law for the following reason:.(Sec. 703.1.5,Buslnesa and Profeaslans Cods: Any CaY or county wfilch regattas a pennll to construct, alter„ Improve, demo8an„ or repeN .any structure, pdor fo . Issuance also ropuirea toe epplkan1 !or auto vemrlf to Bis a signed stdrement that he !a lbenaed purouant to 'PERMIT `� V AMOUNT 'the provlalo. oY the Contrector$ !)cense Law; Chapter 8 (ooriyrienchig with Section 7000) o/ gNslon 9 of Me tivalnass Arid profeaslona Cada, or that. he !s exempt therelnxn, and fin bash / r ®_ �4 forme a8eged) exeiipfbn. Any vlolatlon of section '7031.5 ey 'any appllcari6 rot a varmjt Plan Chk. Dep: Z=:;;;�� suyec[a the appl cant to a clvll penalty oI not more loan 11ve tiundred dd/ara (5300). Plan Chk. Bal. L, 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, eulsness-and COnSt. Pro/esaions Code: The Contractor's License Law does not apply to an owner of' property who builds or improves thereon and who doss such work himself or through his own employees. provided that such improvements are not Intended or offered for sale. If, howa"var, the building Mach. or Improvement is sob within one year of complsfion, the ownerbuilder will have the burden Electrical of proving that he did not build or Improve for the purpose of sale.) I I; as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing strut, the project: (sec. 7044. Business and Proresslons ,Coder The Contractor's License Law does not apply to on owner of property who builds or Improves thereon, and who contracts for S.M.I. such projectswitha contractors) licensed pursuant to tha�Contrector's License Law.J Grading 17 1 am exempt under Sec. B. 6 P.C. for this. reason Driveway Enc. Date. Owner infrastructure WORKERS'COMPENSATION, DECLARATION I hereby affirm that I have a certificate of consent to self -Insure, or a certificate :of Worker's Compensation Insurance, ora certified copy thereof, (Sec. 3800,.1abor Code.) Policy No -Como any n Copy is filed with the city. , ❑ Certified copy is hereby fumished. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed 8 the perms is for one hundred do8arar ($100) vahmtbn or less.) I certify that in the performance of the works lowwhich this permit Is Issued, I shall not employ any pparson in any manner so. as to becomwsubject to,the Workers' Compensation Laws•of California. Date owner NOTICE TO APPLICANT. n, alter making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions Of the . Labor Code, you must forthwith comply *#.such p ovisjons or this permlf shall be:desmed revoked. Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION' LENDING AGENCY Side Street Setback from Center Line Ihereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Coded Side Setback from Property Line Lender's Name Lenders Address FINAL DATE INSPECTOR This is a bullding permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 100 days, I certify that I have read this application and state that the above Information is correct Issued by: Date Permit I agree to comply with all city and county ordinances and .state _laws relating to building construction, and hereby authorize, representatives -of this city to enter the above• mentioned property for inspection purposes. Validated by: Signature of alfplicant Date Mailing Address Validation: City, State, Zip WHITE= FINANCE YELLOW a APPLICANT PINK a BUILDING DIVISION Coachella Valley UnW',d School District P.O. Box 847, Thit.mal, CA 92274 (760) 399-5137, Ext. 235 This Boz For District Use On DEVELOPER FEES PAID AREA: AMOUNT RCPT W. CK e: CASH: HTIALS: DATE CERTIFICATE OF COMPLIANCE (California Education Code 17620). Project Name: Date: 10-11 —00 Owner's Name: Mr. b Mrs Mike Jacobsen Phone No. 771 -- Project Address: 55-530 Chefry Hills. Project Description: single dtealUss 4511r-squszs.foet� APN: 775-170-026 TractA Lot #'s: 0007-063 Type of Development: Residential ffi Commercial Total Square Feet of Building Area: 4511 sq. ft. Industrial Certification of Applicant/Owners: The personsigning certifies that,the above.info tion i orrect and makes this statement under penalty of perjury and further represents that he/she is author' si elf of er/developer. Dated: O -If -Gb 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 Note: Number of.Sq.Ft. 4511 Amount per Sq.Ft. $ 3.26 Amount Collected $ 1 & _ 7n s _ Rf, Building. Permit Application Completed: Yes/No By: Foch'"rut" Pensis. Assistant Superintendent Administrative Services Administrator in Charge Certificate issued by: MerA %'19 SBA Signature: KI -111 V1*As) W11joyAld 4-4,41013 1-01"o J_�Wvv *3 Section 66020 of the Government Code asserted by Assembly 111113081, effective January1,1997, requires that this District provide (1) a written notice to the project appdtant, at the time of payment of school.fees, midpdon payment or other exaction ("Fess"), of the 90 -day perlodto protest the Imposition of these Few and (2) the amount ofthe fees. Therefore, in accordance with secdoa 66626 of the Government code and other applicable law, this Notice shall serve to advise you that the 9041ay protest period In teprd to such Fen 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 coda Additiouaily, the amount of the fess. imposed Is a herein,setforth. whether payable at this time or in whole or in pan prior to Issgaoceof a Cerdfleste of Occupancy. As In the latter. the;90 days starts on the date hereof This Certificate of Compliance Is valid for thirty (30) days from the date of issusuca Extension will be panted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time a this Certificate expire, If a buildingpermit has not been issued for the project that Is the subject of this Certificate, the owner wlllhe reimbursedall fen that were paid to obtain this•Cerdfieate of Compllaom Rev. 09/27/99 Oct 06 00 10:19a MIKE JACOBSEN 10/06/00 FRI 09:53 FAX 1 760 388 9610 PACIFIC COAST A. R"'CrLiFiQM(3 t�011E8iED �: `�:.i AND WHEN RECORD®, MAIL TO. Jacobson gnCerpriae6, Inc. 5017 Lakehurst Lane Bellevue, Kh 9e00.6-2649 Y� 425 747-5890 p.2 0 002 i; 1 t_ ift"y AgeESSOR'6 PARCEL NO..,769-620-OZ6- 8 The undersigned Grantors) declare(s) that ft DOCUMENT TKMbPkK TAX 1S: TITLE ORDER NO.: 5990204 i 92 _ SO County 6 C" �segowrto:: sa"e99-Q0� computed on the hill Value of the interest of property wwayed, or — co nputed on the full Value less ft value of (lens or encumbrances GRANT DEED —ate � o ��� efollowIn9reason: FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acbwwledged, Michael Brownfield, a married man hereby`GRANT(8) to Jacobson Enterprises, Inc.. a Washington corporation all that nal prop q situated In the . City of La Quina County of Riverside . 6tete of Caivornla, described as: Lot 26 of Tract 25397 as per may recorded in Book 216, Bag®s 20-25 inclusive of Maps, in the office of the County Recorder of Riverside County, California Dated_ March 30, 1999 WATE OF CAUFOiRNI& • G 1 COUNTY OF ss. p . before me Nollwyblic, personally appeared ep, 0 Michael Brownfield , � k'12V L -A. I j C ". r'_1 - Itathleen S. Brown cid personalty known to me (or proved to me on the ,basis of Ssiaetori .evidene) to be the permo�(V whose name) cBROOK .MAtISRALL WbWsubscr ed ro the within tpiVwwnt and ac edged Comm, f 1.145409, t me that executed t came In i he f tftW � WTAw N"-CpwoM � authorized c aty(Ies), artd that by( her dr nature(lj , cz. the Instrument the person); or t e, entlty upon behalf of 1*9 Comm which the person(pj,acted, mcutedthe instrument WITNESS myTW9"A.W i Signature rr1r. rn fw oNkld nen.y �! MAiLTAX STATEMENTS Tp: SAM 'AS ABOVE - lIAhAE ADOA6,1S Gi,1', 3iA7E a iw IF F PGA WEST RESIDENTIAL ASSOCIATION, INC. July 5, 2000 Mr. and Mrs. Mike Jacobsen c% Jacobsen Enterprises Inc. 50.17 Lakehurst Lane Bellevue, WA 98006-2649 Dear Mr. and. Mrs. Jacobsen: Your request for an architectural variance has been approved by Mr. Don Adolph, Architectural Committee Chairman. You have the approval to construct a custom home on your 55-530 Cherry Hills lot. Prior to commencement of work you must submit a $1.0,000.00 deposit payable to PGA West. Residential Association, Inc. and your contractor's license number. We reserve the right to make a final inspection of this change to make sure that it matches the original request. An approval is based. only on the aesthetics of your proposed plan and should not be taken as any certification as to the construction worthiness or structural integrity .of the proposed change. We appreciate your cooperation in submitting this request for approval. If I may be of further assistance, please contact me at the HOA office, (760) 771-1234 extension 1,5. Sincerely, Kel cGalli z Operations Manager cc: Architectural Committee P.O. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125 OWNER/ BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such.a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors -are required by law to be. licensed and bonded by the State. of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware. of the following information for your'benefit and protection: If you employ or otherwise engage -any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you ;may bean employer. If you are an employer, you must register alith the State and Federal Government as an employer and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carryout these obligations, and these risks are especially serious with respect to worker's compensation insurance. For morrspecific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law,.contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community.or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued, until the verification is returned. Very truly yours, CITY OF'LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760)'777-7012 FAX: (760) 777-701.1 OWNER'S SIGNATURE/DATE PROPERTY ADDRESS 00 (;�3 PERMIT NUMBER(s) P.O. Box 1504 78-495 CALLS TAMPICO (760) 77`7-7000 LA QUINTA, CALIFORNIA 92.2'53 FAX (760) 777-7101 Mr. & Mrs. Mike Jacobsen_ 5017 Lakehurst Lane *Bellevue, WA 98006 October 30, 2002 Dear Mr. & Mrs Jacobsen, On October 11" 2000, the City of La Quinta issued a Single Family Dwelling permit #0007-063, located at 55-530 Cherry.Hills,, contractor of record as Owner/Builder. Our records. do not reflect a final inspection recordation. Please contact me directly at (760) 777-7027 as soon as possible to reconcile the open permit op file, thank you r. Building inspector it dpc cc 55-530 Cherry Hills Now Hov 14 02 09. 1,2a MIKE AND MOLLY JACOBSEN 55-530 CHERRY HILLS LA QUINTA, CA 98853 760-770-0091 760-771-0660 FAX CITY OF LA QUINTA ATTENTION: DANNY CRAWFORD RE: FINAL HOME INSPECTION PERMIT #0007-063 DANNY, ON JANUARY 25, 2002 WE HAD OUR FINAL INSPE(.'TION FOR THE POOL AND HOME. THE INSPECTOR WAS A VERY NICE, OLDER GENTLEMAN. HE INDICATED THAT HE WAS "FILLING IN" AND THIIN HE WAS FROM RIVERSIDE OR'RIVERSIDE COUNTY. WE PASSED BOTH INSPECTIONS AND PROCEEDED TO MOVE INTO OUR HOME A FEW DAYS LATER I HAVE LOCATED THE POOL INSPECTION CARD THAT SHOWS HIS SIGNATURE BUT HAVE BEEN UNABLE TO FIND ANY OF THE ORIGINAL HOMEDOCUMENTS. I WILL CONTINUE MY SEXICH FOR THE HOME INSPECTION CARD BUT HOPE THAT THE FOLLOWING COPY OF THE POOL INSPECTION WILL HELP YOU TO LOCATE THE IN AND/OR THE NECESSARY PAPERWORK. THANK YOU, MOLLY JA S p.1 REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 7721-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑ ❑POST TENSIONED CONCRETE ❑ ASPHALT THER ❑ REINFORCED MASONRY ❑ FIRE PROOFING 1 REPORT SEQUENCE NO. TV < TjUCTURE PElljr(I`•X -063 s - REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 7721-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑ ❑POST TENSIONED CONCRETE ❑ ASPHALT THER ❑ REINFORCED MASONRY ❑ FIRE PROOFING J08 LOCATION o�/, � U v i�� REPORT SEQUENCE NO. TV < TjUCTURE PElljr(I`•X -063 D1 I© b DAY OF WEEK MATERIALDESCRIPTION ^ ^�� ARCHITECT /fit` / 4o A 1r Cf C_/`� 'INSPECTOR IT /� HRS._CHARGED G -� (J .� �� ENGINEERGr ASSISTANTS NRS. CHARGED INSPECTION GENERAL f S' W `rA DATE CONTRACTOR ���©��{� CONTRACTOR cz L, S ilia f -Se -l2 e.l ftou--e 4a - j e Loo ,k -b- IID-po ftCkjX .-.4- G'OLs 4A44, -A . ."'Q-0— �-'rr►'Te-A 4oL ( A t 15- his C L +C +* 6s' Co - I e -L-0 tj C t -"i N &XA- Le Ljw-�L-4t o tZz"OljlO"Ie us �ku 4-9 COPY' SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE 0—rPAGE OF CERTIFICATION OF COMPLIANCE 'HEREBY CERTIFY THAT I HAVE INSPECTED 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. SIGN E OF R GISTERED IN TOR 16,11 a �oa DATId OF REPORT REGISTER NUMBER Job game: . to. sop � °�� and nage: t� s a I'll D • S.P. • Kip. • Pau M P ASAI ®atFmxma-I � � t n1etg t C%UW�) , !YE 8u"M PCO 06361 D no. SYee Ram (1O IS (A= E (=) 1 E (MUDate) (Yate) 9wo /AW 61�!C s.aims moo MIN M,, HN I M113 721 mom 111111 11119 moo mom MWES s.aims moms Oucul M,, wmml I M113 721 1 11HOMM mNMI si M,, room ME 111111 11119 In mom 1111110111111us ROM 1=1 11111111 11HOMM M,, 1511111111 - 11A W-:- Ace- ar�s� AAs S.4 SAS . 'Materials and weldments "confostis to plans and specifications and aISC, and AWS D1.1 SMPPzng bark Special Depuzy Cusp. 905 sum INLAND INSPECTIONS & CONSULTING PMB-283 - 231 E. Alessandro Blvd., No A - Riverside, CA 92508 (909) 776-1981 - FAX (909) 776-1982 REGISTERED INSPECTOR'S DAILY REPORT Date: o ( Page % of 3 Type of Inspection: alf�u C"I.t , C _ Job No.: 1005'r,4 Clierl�v�yrdr• �w 6se.1 � t it Palfdt NoJbsMd By Job Address cltyt' , Twe of SisrnatumArdd tmt mate" DeudPdon Stebopecw Er9lneet ContraeLor 14 Type of'sanos/.�T� °rah, In 3 slow AdcOba el Rernmks on Samples CERTIFICATION OF COMPUANCE I hereby certify that I have.inspected, 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, spedgicallions, and applicable sections of the goveming,biAding laws. Signature of Registered Inspector Specialty No. Agency ;� INLAND INSPECTIONS SC CONSULTING PMB-283 • 231 E. Alessandro Blvd., No A o Riverside, CA 92508 (909) 776-1981 - FAX (909) 776-1982 M TRASONIC TESTING REPORT Client; �,,, y T.p, Date: I Job No Project: Cl,.,-,- AAS' Fabricator.:l,/�;t�s 5*ems% Technician: A/. Welding Process:,VChu/ Surface: C fccu.r` Equipment: Probes: [ ]Normal [(]Angle Calibration: MSound Path [ ]Projected Distance Couplant: [ ]Oil .. ib4751 14 - Invoice No.: Report No.: Reviewed By: Code: AWS 131..1 ASNT level: II [X]High Energy [ ]Normal Energy [ ]Grease [X]Paste [ ]Glycerine [ ]Other: c CV O Item Identification a _ m ac 3 a C I O z Decibel Reading Defect Location oma' X 3 _ m y • 3 _ m o� c O acs :' a a a v_ _ m a o o� m Oa aw c o ave �9 �- m- o a l %/r A 41 rip F 70 M-2- Seo � z H A/& 3 r ply Y/ i f f- 3 6 So. 4/ row FY. x I• 6 xib 7 Te Plr 3 eo�Ph- x 3 Lowt r le -"'00.6f Ft X /o f! X X All,loft /3 La..wik....Sd. Cel T P! /`1 F �` rs ! Aft - t16 141 &# X /7 A%, Co To � x 's 3%4 mar i 8 &ff x S� IIREMARKS: 1 —/,(, m.ow►:c.�i- �/`a�cS,tLt/�eat /eoo�rC Qecyb/c 000.r0..a 45 C7 INLAND INSPECTIONS & CONSULTI.NG PMB-283 • 231 E. Alessandro Blvd., No A - Riverside, CA 92508 (909) 776-1981 • FAX (909) 776-1982 Ji L---'TRASONIC TESTING REPORT -tient: `ra,y �•,a0. Date: Job No project; =abricator:. !,//,;,�s St eG� Technician: !✓• G fw� k . Nelding Process: xc*&,/ Surface: C gra-4-, quipment.cklrb Probes: [ ]Normal [X]Angle -alibration: [Sound Path []Projected Distance Couplant: [ ]011 Invoice No.: Report No.: Reviewed By: Code: AWS D1..1 ASNT Level: 11 [X]Hlgh Energy [ ]Normal Energy [ ]Grease [X]Paste [ ]Glycerine [ ]Other: Item,._ Decibel