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04-3779 (CSCS)Tit r4#4 ������/ BUILDING/& SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 . LA QUINTA, CALIFORNIA 92253. INSPECTION REQUESTS•(760) 777=7153 BUILDING PERMIT Application Number 04-00003779 Date 4/28/04 Property Address;.. .78987 HIGHWAY 111 APN: 643-020-999-6 -30903 Application description NEW COMML - STORES & CUSTOMER SERVICE Property Zoning . . REGIONAL COMMERCIAL Application valuation 673843 Owner WASHINGTON 111 LTD C/O JOHN ANDERHOLT. P 0 BOX 1623 'PALM DESERT CA 92261 Contractor MOOREFIELD CONSTRUCTION, INC. 3415 S. SEPULVEDA BLVD. -LOS ANGELES CA 90034 (310) 390-9400 WCC: STATE FUND WC: 1686016 03/31/05 CSLB:. . 397892 02/28:/05 CCC: B -------------------------- Structure Information --------------------.----- Construction Type TYPE V - NON RATED Occupancy Type . . . �MERCANTILF, Flood Zone . . . . . NON -AO FLOOD ZONE'' Other struct info . . . . . CODE EDITION 2001 CBC FIRE SPRINKLERS YES MIXED-USE OCCUPANCY NO .00CUPANT LOAD 473.00 PATIO SQ FTG 1224.;00 ---------------------------- FIRST FLOOR SQ FTG 15034.00 Permit . . . ------------------------------------------------- BUILDING PERMIT Additional desc. .'' . •'MASONRY• WALLS & FOOTINGS ONLY 11 ..Permit Fee . . . . 2561.50 Plan Check Fee 16.64.98 Issue Date 1/05/04 Valuation 673843 Qty Unit Charge Per Extension BASE FEE 2039.50 174.00 3.0000 THOU BLDG 500,001-1,000";000 522.00 Special Notes and Comments 4/28/04 4:17:44 PM ISSUANCE -OF BUILDING PERMIT ONLY 'APPROVED FOR CONSTRUCTION OF FOOTINGS AND BUILDING PERIMETER MASONRY WALLS ONLY. (GB) I P.O. BOX 1504 /i • w VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0+3 _7? of Applicant: Applicant's Mailing Address: Date: -5­- Architect or Engineer:' XKL' Architect or En ineer's Addre 3S , 6o1- ds Ed 64 Lic. No.: A 770 BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S 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 Professionals Code, and my License is in full force and effect. 9"ense Gass Ueerise-No mete- Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (comrmencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 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 Contractors' State License Law does not apply to an owner of property who builds of improves thereon, and who does the work himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within 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.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason S•3•o�r u Date Owner L ' WORKERS' 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 workers' 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Cartier Policy Number I certify that, in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date r> -3,&Y Applicant 401 t/j K t // L/V WARNING:. FAILURE TO SECURE WORKERS' COMPENSATIO COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 C, %p I Lender's Address r G APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work Is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City. of La Quinta, 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 180 days will subject permit to cancellation. certify that 1 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 county to enter upon Bove -mentioned property for inspection purposes. Date 5-3-0V Signature (Applicant or Agent): Page 2 Application Number ----------------------------------------- . . . . . 04-00003779 Date 4/28/04 Other Fees ---------------------------- DIF CIVIC CENTER - COMM =------ 1428.23 DIF FIRE PROTECTION -COMM 481.08 STRONG MOTION (SMI) - COM 141.50 DIF STREET MAINT FAC -COMM 345.78 DIF TRANSPORTATION - COMM 25918.61 Fee summary • Charged Paid Credited Due Permit Fee Total 2561.50 .00 .00 2561.50 Plan Check Total 1664.98 1650.00 .00 14.98 Other Fee Total 28315.20 .00 .00 28315.20 Grand Total, 32541.68 1650.00 .00 30891.68 TANDrS INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED b - 12Ew1� L\ SAMPLE INFORMATION DATE 1-7- d� PHYSICAL ADDRESS PERMIT NUMBER Ti SAMPLED AIR TEMP SAMPLE SLUMP TIME IN MIXER TEMP JOB NAME TYPE OF STRUCTURE ARCHITECT 'V' ENGINEER E V.GFQ o wta�-o GENERAL CONTRACTOR SUBCONTRACTOR 00 4f:weLm I'j g 1 . PROCESS DESCRIPTION OF WORK INSPECTED s -S vzo r.-, o iz v �S Q, I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. CC: /--<41Z �-- (� ��INBPECTORS SIGNATURE INSPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER Ti SAMPLED AIR TEMP SAMPLE SLUMP TIME IN MIXER TEMP LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. CC: /--<41Z �-- (� ��INBPECTORS SIGNATURE INSPECTORS CERTIFICATION AGENCY AND NUMBER TANDrS INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED I MIX NUMBER DATE I u6 SLUMP TIME IN MIXER q_36 PHYSICAL ADDRESS -- - -- PERMIT NUMBER LOCATION JOB NAME WELDING INFORMATION TYPE OF STRUCTUUR,E, WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER ARCHITECT y-�_ ' ENGINEER V;�:Q 1,- 1�� 1�"E�C �O GENERAL CONTRACTOR SUB CONTRACTOR N6apS1c Liv iJ o DESCRIPTION OF WORK INSPECTED b -2Uc� V — S 6►J -Co tV )C 7CS �►�i w .� T .5 _sem a-5 Pee- SAMPLE ee SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER TIME SAMPLED AIR TEMP STEMPE SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS c .. .� & ;, ,� Q ��� •— C' PC+i.� WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED WOR►(, 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. CC: ,,���Nlt�CTORS SIGNATURE L-rcZ3c'1 INPPECTORS CERTIFICATION AGENCY AND NUMBER r '1�p "i"i"ik SPECIAL INSPECTION DAILY REPORT TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 OFFICE/FAX 909.769.9717 PAGER 760.776.3339 DESCRIPTION OF WORK INSPECTED E 01C bAk13., 21r+�a J1v�C �ckTS roto ��/ito` LIzA"j S V !" 1ti113'v� 1 $N� L � 3f o.► — r +SN w zop'r �n� 2; SAMPLE INFORMATION SUPPLIER TYPE OF INSPECTION PERFORMED 7 DATE �.()O x 4 SAMPLE TEMP = b PHYSICAL ADDRESS PERMIT NUMBER 108 NAME TYPE OF STRUCTURE ZGE \ o \ • 0:)O • vk ARCHITECT ENGINEER ll GENERAL CONTRACTOR SUB CONTRACTOR C� f�c1�11 iJ DESCRIPTION OF WORK INSPECTED E 01C bAk13., 21r+�a J1v�C �ckTS roto ��/ito` LIzA"j S V !" 1ti113'v� 1 $N� L � 3f o.► — r +SN w zop'r �n� 2; I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED. AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS 8 APPLICABLE BUILDING LAWS. CC: Z4t� 44�PECTORS SIGNATURE PECTORS CE FK ATKMI AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER SAMPLED AIR TEMP SAMPLE TEMP SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED. AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS 8 APPLICABLE BUILDING LAWS. CC: Z4t� 44�PECTORS SIGNATURE PECTORS CE FK ATKMI AGENCY AND NUMBER `Sladden En in'eering � _ � _ ?S�qg? 02025 ,r� 6782 Stanton Ave.; Suite A 39-725 Garand Ln., Suite G -114-S. California Ave. r Buena Park, CA 90621 Palm Desert 92211 Beaumont, CA 92223 (714) 523=0952 Fax (714) 523-1369 (760) 772-3893 Fax (760) 772-3895 (951) 845-7743 Fax (951) 845-8863 Date q h� 16-- Job No. 21, 0 FIELD MEMO Project Name "4h/.c, c ►-, r enf /Z—. Client: - Site. Address <9 1 a <41 A-) c 40r n Job Phone Work Done Test Footings Ins Test !' No. Location Elev. Dry Density Moist % %Relative Compaction Ref. Max pcf Moist % CnmmantR lor L G/ Field Tech. Ser. or Agent - .. 24 hour, notice requested to schedule Field Technician. Thank you for the opportunity to be of service' TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED W ©-�ipJ� DESCRIPTION OF WORK INSPECTED DATE , I "7 PHYSICAL A/D�DRESSS�PERMIT NUMBER l / JOB NAME TYPE OF STRUCTURE ARCHITECT ENGINEER KLY-eI�taL6 - \� o"m(I CD GENERAL CONTRACTOR SUB CONTRACTOR I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. I" Z4;�_ �_. L—INSPECTORS SIGNATURE T�_-I30 1 IJ G cpa. 'L INPPECTORS CERTIFICATION AGENCY AND NUMBER DESCRIPTION OF WORK INSPECTED T -7OIr h LF -T ISJEL� - U� F z§ lreq_ AIR TEMP SAMPLED SAMPLE SLUMP TEMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS tA+,. W - o % a WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER �Ot�.'Oi..�� SAI:. C�Tvi �z►.�(6 35.71l0cP exp. sAl 66 I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. I" Z4;�_ �_. L—INSPECTORS SIGNATURE T�_-I30 1 IJ G cpa. 'L INPPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER AIR TEMP SAMPLED SAMPLE SLUMP TEMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS tA+,. W - o % a WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER �Ot�.'Oi..�� SAI:. C�Tvi �z►.�(6 35.71l0cP exp. sAl 66 I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. I" Z4;�_ �_. L—INSPECTORS SIGNATURE T�_-I30 1 IJ G cpa. 'L INPPECTORS CERTIFICATION AGENCY AND NUMBER SPECIAL INSPECTION DAILY REPORT TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED t::7PQXL( SAMPLE INFORMATION SUPPLIER DATE f --�-moi- c�L1 PHYSICAL ADDRESS p HYICc), PERMIT NUMBER W JOB NAME OF*nyl_r `be7 C -OT - q $ TYPE OF STRUCTURE ARCHITECT ENGINEER ►�- C-�c� O�-� vtno�0 GENERAL CONTRACTOR SUBCONTRACTOR WELDING INFORMATION DESCRIPTION OF WORK INSPECTED cp fv _ Cl ED 902- '— w flu. 0..) fh 1 HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. CC: ,�IIASPECTORS SIGNATURE INSPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER TIME SAMPLED AIR TEMP STEPPE SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER 1 HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. CC: ,�IIASPECTORS SIGNATURE INSPECTORS CERTIFICATION AGENCY AND NUMBER SPECIAL INSPECTION DAILY REPORT TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED DATE n TICKET NUMBER MIX NUMBER AIR TEMP SAMPLE SAMPLED TEMP PHYSICAL ADDRESS PERMIT NUMBER l�A- goypi O A -3 JOB NAME TYPE OF STRUCTURE ARCHITECT " ENGINEER E 6th GENERAL CONTRACTOR SUBCONTRACTOR b '�c`-o ev NS DESCRIPTION OF WORK INSPECTED 'Pox of L' jxkXXA a- r,4 S O T tea- laft k'(-1 3 _ 16,!' S.� I HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. CC: i PECTORS SIGNATURE TO( 101SPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER AIR TEMP SAMPLE SAMPLED TEMP SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. CC: i PECTORS SIGNATURE TO( 101SPECTORS CERTIFICATION AGENCY AND NUMBER 0n/,19/24004 10:34 6267968735 WE ARCHITECTS PAGE 02/02 14 07114/2004 14: 10 71444421.22 KEN OVAMOTO ASSOC PAGE 02 ®7/14/2004 13:41 5267968735 KKE ARCHITECTS PAW 82/02 Cl Ci 1tEW8�L2) • OfVSTBtgJCTt£7�0, 11�. REQUEST FOR INFORMATION RR Aft! 167 `9 t. vA "PJ@ to QFF3- MIN AR qg1 QUINTA, CA ®2253 I•.• _._ AWIN Pl-7a 1CATED Q: ■ C CMN Tm* abana RagraR W lgft utas mwkmm aItffleap" n" phom dotimom 00AalWao4 km eo "Mp%% omWt<wcom by tM mandmW *"Wloo daft- Vaf*w los mwpo*Wr4 OWN WM ft AW wdendM eemplfdkm etas. Yew prampe dholom to appn*AW, W14M TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF TION PERF ED SAMPLE INFORMATION SUPPLIER TICKET NUMBER DATE MLY� SSo 31343%% MSLUMPS=PLED I IS -1 -1 - PHYSICAL ADDRESS PERMIT NUMBER W L o, Q: NINN PROCESS , ©E c` e)� Q Jho 1�� � �W'\� � CON�CTUR: M ARCHITECT ENGINEER I' ejrN GENERALCONTRACTOR SUBCONTRACTOR MOOS �� fAo- r DESCRIPTIONOF •- 11 • .ate:' ►� � • � • � .. I HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFK:ATIONS & APPLICABLE BUILDING LAWS. CST -03i olls, PEC ORS SIG URE IC INSPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER �AIRMP TI TIME IN MIXER SSo 31343%% MSLUMPS=PLED I LOCATION . WELDING INFORMATION PROCESS , WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFK:ATIONS & APPLICABLE BUILDING LAWS. CST -03i olls, PEC ORS SIG URE IC INSPECTORS CERTIFICATION AGENCY AND NUMBER TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INS ECTION PERFORMED SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER DATE t Ll PHYSICAL ADDRESS SAMPLE PERMIT NUMBER TIME IN MIXER' IOB NAME ` TYPE OF STRUCTURE LOCATION ARCHITECT ENGINEER GENERALCONTRACTOR PROCESS SUBCONTRACTOR WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER DESCRIPTION OF •' � au I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: 1 INSPECTORS S NATURE 4 INSPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER TIME SAMPLED AIR TEMP SAMPLE SLUMP TIME IN MIXER' LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: 1 INSPECTORS S NATURE 4 INSPECTORS CERTIFICATION AGENCY AND NUMBER .�. low/�j,r . .,_. .�--....,,.•r p,l�,r.»..ns, „ ---'W�.,9,;f1,�!'/�'1.k..,•x. ,. y , SPECIAL INSPECTION DAILY REPORT e . t I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, I 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. cc:. r, r i ;• r TANDY'S INSPECTION INC. 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