05-4873 (SFD)P.O. BOX 1504
Tit(t 4.4 "
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05-00004873 Owner:
Property Address: 61210 -RUBY C—T--- SHEA LA QUINTA ,
APN: 764-270-999-61 -300234- C/O JEFF MCQUEEN
Application description: DWELLING - SINGLE FAMILY DETAC E 8800 N GAINEY 'CENTER 350
Property Zoning: MEDIUM.HIGH DENSITY RES D S SCOTTSDALE, AZ 85258
Application valuation: 149689
�1�V . 16 005 Contractor:
Applicant:rchitect or Engineer- SHEA HOMES, INC.
��� FLA QUINTA 81260 AVENUE 62
IgJ CI:DE•LA QUINTA, CA 92253
(760)777--6005
Lic. No.: 672285
-
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7 00) of ivision 3 of the Busines and Profes 'on s Code, and my License is in full force and effect.
Lice ,1,C� s cense No.: 672285
M. ntractor:
.OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's State
License Law (Chapter 9 (commencing 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 notmoire than five hundred dollars ($500).: '
f _ 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
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself 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.). '
(_ 1 1, 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
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: Ira
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/02/05
-----------------------------------------------
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 workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this'permit is
issued.
1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for whichthis permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier AMERICAN .HOME Policy Nu r .1247619
I certify that, in the performange o he work or which this permit is issued, I shall not employ any '
person in any manner so as to be ome s je t to the workers' compensation laws of California;
4an agree that, if I should. 'qom subje idth rs' compensation provisions of Section
37 0 / he Lab o I al f rthwitmply with th rovisions. '
Ae' i
/ icant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION. COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is her 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, indemnify 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 oid if work is not commenced
within 180 days from date of issuance of such permit, or cess iqn of work for 180 days will'subject
permit to cancellation. fA� /
I certify that I have ad this application and state that t ' above 'nformati n is correct. I agree to comply with all
city and unty ordi antes and state laws relating to _ 'ng co ruction�and,hiareb ori a representatives
of thi y to ent r upon the a -mentioned ope y in - tion 6 rposes.
ate: ure (Applicant or Age 1:
r'
Application Number . . 05-00004873
PermitBUILDING PERMIT
Additional desc .
Permit Fee 814.5.0• Plan -Check Fee 132.36
Issue Date Valuation 149689
Expiration Date 5/01/06
Qty Unit Charge Per Extension
",BASE FEE .639.50
50.00 3.5000 THOU BLDG 100,001-500,000 175.00'
Qty
`,
Per.
Extension
BASE
FEE
r'
Application Number . . 05-00004873
PermitBUILDING PERMIT
Additional desc .
Permit Fee 814.5.0• Plan -Check Fee 132.36
Issue Date Valuation 149689
Expiration Date 5/01/06
Qty Unit Charge Per Extension
",BASE FEE .639.50
50.00 3.5000 THOU BLDG 100,001-500,000 175.00'
Qty
Unit Charge
Per.
Extension
BASE
FEE
15.00
2.00
9.0000
-EA• MECH
FURNACE <=100K
18.00
2.00
9.0000
EA MECH
B/C.<=3HP/100K.BTU
18.00
5.00
6.5000
EA-. MECH
VENT FAN
32.50
1.00
6.5000'EA
MECH
EXHAUST HOOD
6.50
Permit
ELEC-NEW RESIDENTIAL
Additional
desc .
Permit Fee
. .
83.40
Plan Check. Fee
5.21
Issue Date"
Valuation
0'
Expiration
Date
5/01/06
Qty..;Unit
Charge
Per
Extension
BASE
FEE
15.00'
1636.00
.0350
ELEC
NEW RES - 1 OR 2.FAMILY
57.26
557.00
.0200-.
ELEC
GARAGE OR NON=RESIDENTIAL
11.14
-----
----------------------------
-----------
Permit
. . .
PLUMBING
Additional
desc .
Permit Fee
146.25
Plan.Check Fee
9.14
Issue Date
Valuation
0
Expiration
Date
5/01/06
Qty;
Unit Charge
Per
Extension
BASE
FEE
15.'00
13.00
6.0000
EA PLB•FIXTURE
78.00
1:00
15.0000
EA PLB BUILDING SEWER
15.00.
- LQPERMIT
Application Number . . . . 05-00004873
Permit . . . . . PLUMBING
Qty Unit -Charge Per
Extension
1.00 7.5000 EA PLB WATER HEATER/VENT
7..50.
• 1.00 3.0000 EA' •. PLB WATER INST/ALT/REP
3.00
1.00 9..0000 EA PLB LAWN SPRINKLER SYSTEM
9.00
5.00 ..7500 EA- PLB GAS PIPE >=5
3.75
1.00 15.0000 EA PLB GAS METER
15.00
hermit . . . iRADIkG PERMIT
Additional desc "
Permit Fee 15.00 Plan Check Fee
.00
Issue Date . . . . Valuation
0
Expiration Date 5/01/06
Qty Unit Charge, Per
Extension
BASE FEE
15.00
-------------------------------------------------------------
Special Notes and Comments
--------
SFD - Plan 4210C Lot 61, 1636-S.F.
w/Casita (255sf), MBR Box Bay (26sf),
Ext Garage & Ext(177sf).
.(83sf) _Patio
Permit does not include block wall,
pool or driveway approach. 75%'
reduction to plan check fee due to
multiple issuance of same plan type.
Other Fees ART IN PUBLIC PLACES -'RES
20.b0
DIF COMMUNITY CENTERS -RES
74.00
DIF CIVIC CENTER - RES
480.00
ENERGY REVIEW FEE
13.24
DIF FIRE PROTECTION -RES
140.00
GRADING PLAN CHECK -FEE
.00
DIF LIBRARIES - RES
355.00
DIF PARK MAINT FAC -,RES
22.00
DIF PARKS/REC - RES
892.00
STRONG MOTION (SMI). - RES
14.96
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1666.00
. Fee summary Charged Paid Credited
Due
----------------- ----- - ----------------- ------ ----------
Permit Fee Total 1149.15 .00 .00
1149.15
Plan Check Total 152.34 .00 .00
152.34
Other Fee Total 3744.20 .00 .00
3744.20
Grand Total 5045.69 :00 .00
5045.69 .
LQPERMIT
APR -11,2006 14:26 BCI*TESTING,ril 000-000-00000 Page 1
CERTIFiCATE OF FiELD WRiFICATiON & DIAGNOSTIC" 1.ES ING (Nage 1. o[8) CF -411
Project Address TRILOGY AT LA QIJINTA- PIIASE 13B
ltuildcr Nalnc
61210 Ruby Court, La Ouinta CA
SHEA HOWIES
Builder Contact 'Telephone
Plant Notni1xr
Armando Ulloa 760-578-61319
4210
HERN Ruler 'telephone
$ample Group Nuotla-r
William Henson, CCN# CC2004076 760-772-2954
N/A
Compliance Melliod (Pr4r.4rdt ptivc)
Climate /kine 15
Certifying Ngrnattlre Dale
sa111p1C I Ioln (1,11) 1i1111111er
4/7/2000
61
Firm
HERS Prxr%ider
BCI TESTING
CALCERTS
Simel Address
(:11y:Wa1c.•'%.ap
77-760 Country Club Drive, Suite I'
Palm Desert, CA 92211
(:o ie% to: HUft,I)EK HERS YROVIURK :NU BUILDING DEP.MVIA11s1NT
HERS RATER COMPLIANCE STATEMENT
The hrnlse wns• In 'Tested ✓❑ Approved as part nt'mi"PIC testing. bill woS not lCStu(1
AN Illc 111J2N rater providing diagnostic, lusliug and lield verification, 1 curlify That the house identilied on (his rami complies with
the diagnostic testa( compliance ruplirunleltts aN checl•u) ✓ on MIN li°nl. •111e HERS rte1 nurNt u)rcck and that the ncwx
disirihutian system is fully ducted uud correct tape is used belbre u CFAR may he released on every tested building. —1w HERS
rater must nut release the CI -112 until a prorwriv completed and signed (:F -bit has been ieecived tiri 1110 s:n yle and tested buildings.
0 The installer has provided a cnpc Or CF -OR (lostvllAtiolt C0'I11iCalu)
® New Di:ltrihulion system is fully ducted (i.e., does not mse hllllding eaYllics as plenums of pl:lHurm iulut;Is til heti ol,ducl,).
0
New ,YSte1114 w1wrt; Cloth backed. rublh r adhesive duct tape IS installed, mustic and draw hands are usL-i is
combination with cloth backed, rubber adhesive duct lam to seal leaks at duct arltnu halm.
lZ NIINIMI:IN RI.QI'fltN:MEN1•S FOR DILVI' LEAKAGE REDG(-I'lON COMPLLVNCE CREDIT
Proceclun:s.forfrrld rrrificalion and diaq)zorlic• lestinq 1)f air cli.co ihuufna ..pctunr arc uvadabb: in RAC.1d.: l ppc<nrlar Rl V i
Duct Diannnstic Lenkane'1'cdino Rcrull.
NEN• COM RUC1•ION:
bd Yes
O No
Acesr• is provided for inspection. The procedure shall consist 4 visanl
yulilicatiun that the TXV is installed on lire system and installation of
the specific equipment shall he vcrihcd.
✓ ✓
rd U
�Fad
Measured
System 1
Duct Prcxsuriration'I'est Results (CIM (u) 2.5 11a)
vylliles
I
I•.11ICr TC31Cd I .caka c Mow• in CFM.
60
1'rrn I In c (::dcul:�lccl (Nonlin:d: 00mling ✓❑ I lealing) or
✓O Mcamircrl
1i11tef 'total ran Huw in UM.
1600
✓ ✓
i
P:INN iT Lr.:aka •a 1'cx:e nlalge 5 fi°� ( I ff) A I
(Lino .1 I),'
(Lice !12)1
3.750/6
Rlv.. ❑trail
Measured
Systcm 2
Duct Prcc.nrq:uuyn l'Cst Results WIN ((1125 Pit)
Valucs
I
1:111cr'I'cslcd Lcrkage Flo". III CIN:
Fan How: Culcululad (Nominal: ✓❑ Coo iuK
✓❑ Hudinte) or
✓❑ Malsured
2
Mier Tntal Fan Flow to CI M'
✓ Vol
i
PussilLea kage Perecnmgc<0% 1100xi
(Lind])'
(Liuu112)11
❑Pas, ❑I+ail
0 'I'llERMOS" 'ATIC 4:\,1N%[()N VALVE (1 V)
Prnre•dures Mr flehl t•rrilie!ulirue ufNarrrlu.eG.ncerr, r.r.rr„r r:rJe •.• r�rr• rr�•rr;G hl .e, ?,I('A� .1..><,,.If.• RI
Yes is n pass
bd Yes
O No
Acesr• is provided for inspection. The procedure shall consist 4 visanl
yulilicatiun that the TXV is installed on lire system and installation of
the specific equipment shall he vcrihcd.
✓ ✓
rd U
�Fad
iaJ I11(:11 EI(It AIR CON DiTIONER
l'rrx:rfiorr..c thr iv elficfarn,r fere fnvfilubL• in U,111/ rl nnroulir Nl
1 PJ Yes ❑ No a..R vuulcs ofinstalled systems match the CF -i R
2 0 Yes ❑ No For split NYNIt:m, indoor coil is matched to ouldoor coil ✓ ✓
3 ❑ Yes 0 No 'Tinte Uuluy Reltiv Vurilicd (il'Ruyuirud) hd ❑
Yee to I and 2: and i (11' K uired) is u pass Pass Fail
Mesifien/in( ('omplinnce rorn?s �)1 I Alwil 21105
-EX -7-7-7- 00;41
APR- 11,2006 14:26 BCI*TESTING,ril 000-000-00000 Page 2
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 48) CF -41t
I'rttjmI Address TRILOGY AT LA QL11NTA- PHASE 13B
Builder Name
612.10 Puby Court, i. a QUin(a CA
Si IEA HOMES
I Wilder Contact Tcicphnnc
I'Inn Nnmhcr
Armando Ulloa %60-5'18-6819
4210 Casjta
IIM Ruler Telephone
Sample Group Number
William Henson, CCN# CC2004076 760 772 2954
N/A
(enol thamx: Methyl (I'rcv.iihhvc)
Climate Lune 15
CerlifyinpSignature Dale
Sample Housc(Lat)Nnnther
/ (YA--1 4/7/20)0
61 Casita
Pant
HERS Provider
BCI TESTING
CALCERTS
~tree( Address
Otv•Slale-zip
77-760 Country Club Drive, Suite I
Palm Desert, CA 9.2211
C'u ioi to; BUILDER, HERS PROVIDER _\:`ll BU1LU1NC DEPAR'1'JIE,\ 1'
iIERS RATER COMPLIANCE S1'ATCMEN•1'
'['lie house was: ®'Tested ✓❑ Approved as Ixtrt at'svnplc testing. but oris not tested
As me HERS r:,lcr 1110YR1111K dM-mrstic Ie.Ahmy, and field u:rific.doon, I certify that Ilit: hnuvc idculitict) nn Ihi� 1b"m t; meplics with
the diagnostic tested compliant reyuiremenu as checked ✓ on this; form. 'I'hc HERS rater must e h a k mid %ci ilj tuft] 111U 1%U%%
distribution ;vslemt is fully ducted and correct talx is used bribre u C):4R may be released on every tested building. '{'Sc I IP.RS
ralcr Imod not rcIL•9.w II1l: CU -112 unlit :1 properly colmplcted ;IIld kilned C :—OR h:is hct:n rcccie•cd I'm- the ,;maple and Ic,.{ed buildings.
lid The in.taflu• h,ls Im-11vdcrl a copy ut,CV-(,R (111slallalum Ccttitic:4e;)
EI New Distribution system is fully ductal (i.e.. does not use huildinµ ulvilics as plenums or pl:uliorm reluron; in lieu otdneas)
[Ji New sysh:nik whrxc ('10th hM:keJ. nlbl>ei adhesive duct tape is iuslulled. atuslie: and draw bunds are uscdlitt
combination with cloth backed, rubber adhesive duct tale: to ;=I leaks at duct cooneolnlits.
® AIINIA•11'nl RVQI: lit EM ENTS FOR 1)1'01' LVAK• GP, W.DUCTION COMPLIANCE CUDI'1'
Pro,Wures irrf e•ld vcrifie•ulitm urid diur{rru.,lie reslir{v r./'uir,/i.YlrJ„drun ..r•.Yr,:r w arse nvurlrihic i,i K: I('11, ; I ppmuli.iii RC -0.
Duct DiuPnoslic IaukugrTcsliFIg Results
NI(N' CONKYRI'('1'ION!
NJ Yt
Ascus is pro�'Ided tilt IIt Ri>CCtIOn. I'hC procatllre sltnll CYnikir:T iii VikuuI
❑ No writitmttuu that tllc'I"XV is irmtullal au the system and inslallation of
the specific txptipnlent shall be t:orltied.
✓ V/Ycs
® q
Wisured
Svsicm I
1)uct I'res;uriration Test Rcsults (('PM !ut 7.i Na)
I
Iimler,Icktrd I.cakagc Flow In CAW:
34
Uml Fh,YY. C:IlculAcd (Nominal: El Clwline ✓❑ heating) or
✓❑ M. -Kilted
2
Gdct Totut hue lluw in CPM:
800
✓ ✓
3
Pass If Lett):: a Percentage 5 0% l 1 OU % I (Linc,, I) /
(Lille ill)
-_25%
01"L" ❑boil
Nk-a!all-ed
System 2
IDuct Prrs8uriutliun Test Rxmiulls (CFWa125 Put
Jalues
I
lFriterTwilml leakage Plow in C:FM:
I;in blue('• 011cubticd (NnrnimiF ✓O 0wiling ✓❑ heating) or
✓❑ N!mmirod
2
biota Total Fun Iluw ill (JFM.
✓ ✓
:f
Pass it' Leakage I'crectimp <_ (l°dl I 101) j (Linc +I)
(Line 112)I I
❑Pea ❑r�;1
0 'i'I11;RNIOST.)V IC EXANSION N ALS E (INY)
Prr,cr•Jgnr.Y /i,r %rely( rr•rr�crdanr a%I/r<:nrn,,t7alrc e.��,cursiu�r valves err rn uilnfi/e ire f(.a('A/. ,dpp�rrdix KL.
is a pass
NJ Yt
Ascus is pro�'Ided tilt IIt Ri>CCtIOn. I'hC procatllre sltnll CYnikir:T iii VikuuI
❑ No writitmttuu that tllc'I"XV is irmtullal au the system and inslallation of
the specific txptipnlent shall be t:orltied.
✓ V/Ycs
® q
E� lll(al FasR:\!R (:ONDh1'll)!VMat
Pruaclums fin• ve•rifiruliau are uvui/uble M R 40..•11, Appendix R1.
1 E1 Yes ❑ No ETH vaulcs rd'inslaltl rl kv:etcgh m:dch Iltc GF. I R
2 Ei Yc" ❑ No For split sYsicm. indoor coil is matched to outdrxlr coil ✓ ✓
3 ❑ Yes El No Time Delus Relay Verified (If Required) rA ❑
Yes to I and 2: and t (If Required) is a Ixxism fuss Pail
Residential Compliemice /'arms April 2110.5
Page 1 of 1
CERTIFIED:
JC nEpections supplies the service
of compression strength test results only.
Per ASTMC39 {
JCM Inspections
39725 Garand Lane Suite F
Palm Desert, CA 92211
INSPECTIONS Phone:
760-345-5554 - Fax: 760-772-3895
INSPECTIONS
COMPRESSION STRENGTH TEST RESULTS'
Client: Shea La Quinta, LLC
Date: 3/13/06
Project: Trilogy @ La Quinta - Shea Homes
Project No: 02-1109
81-260 Avenue 62
La Quinta, CA 92274
Set ID Structure
Age of Test
Compression Strength
JCM ID Location
Date Cast Cylinder ID
(days)
(psi)
Set A Phase 13B - Lot # 4061 Slab on Grade
12-22-05
Concrete
273-648 Den
Required psi: 4000
2153
7
3380
2154
28
4860
2155
28
4800
Page 1 of 1
CERTIFIED:
JC nEpections supplies the service
of compression strength test results only.
Per ASTMC39 {
JCM Inspections
39725 Garand Lane Suite F
Palm Desert, CA 92211__I_
=9
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895
INSPECTION s
PRESTRESSED CONCRETE INSPECTION REPORT
Date:
Project Name:
Project No:
Trilogy @ La Quinta - Shea Homes
02-1109
Project Address: City:
�✓ IBC
81-260 Avenue 62 La Quinta, CA
F-] Title 24
Client: Sub -Contractor:
Shea La Quinta; LLC Sun Coast Tensioning
Other:
General Contractor: Architect:
Structural Engineer:
Shea Homes for Active Adults Bassenian Lagoni
Borm & Associates, Inc./ Suncoast Post Tensi
Weather:
Size and Type of Tendons: 1/2" Diameter Seven Strand Stress -Relieved Tendons
Jack Machine Calibration:_ Received Sheet from Sun Coast -Gage Pressure in psi to Machine Load in kips
Unresolved Items:
�, None
!S y Oo psi to 33.04 kips/33,000 lbs
❑ See Below,
Calibration Date: Machine # Jam) y o – (A _ O�r'-
Phase Lot# 4 b (cI Product Plan L1a O G (0191 O IZ U�3 M CAVA_
Description. of Work Inspected:
Actual Elongation (in)
Specified Complies within i%+/- of specified elongation.
Lot # Location Tendons Elongation (in)
Reference 11 h/SN2.
Ll0(0I
Yes
No
1p,
El
TJ
' one
Ail—
El
tornU1 !k Ci r eco �.t\c�Sin..
3 t 1
IT 4 Q Li
u
❑
+
nn . (`c\ •1 �I
I.��G1'L4,^t\v^J�.StCX�-air
1
El
.ls 4-1JifY'1
LJ
-
of .
❑
Co
❑
sk)t,. 0 m
Li
❑
❑
❑
❑
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: Jack Millin ICC CerEifcattion N�o^s}0842216-89
IContractoes'RWresents
JL
N -„J c.v-c- — I
Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Goveming Agency - Page of 1
JCM Inspections
d 39725 Garand Lane Suite F
a Palm Desert, CA 92211
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
REINFORCED CONCRETE INSPECTION REPORT Dates: Noted Below
Project Name: Project No:
Trilogy @ La Quinta - Shea Homes 02-1109
Project Address: City:
81-260 Avenue 62 La Quinta, CA
�✓ IBC
Title 24
Other:
Client: Sub -Contractor:
Shea La Quinta, LLC DCCCC
General Contractor: Architect: Structural Engineer:
Shea Homes for Active Adults Bassenian Lagoni Borm & Associates, Inc./ Suncoast Post Tensi
Slump (inches): Supplier: Superior
Time Sampled: q °,- a v,� Mix Design: D83625P
Time in Mixer (min.): SV Specified Strength (PSI): 4000
Water Added @ Jobsite (gals.):Addmixture: POZZ 322N
� (),,Lo
, ra�
Concrete Temperature (F): `'1 Truck #:a (n Ticket #: r _,,-
Ambient Air Temperature (F): (� L) Field ID Marking: Set A - 4 cylinders
Weather: '
Unresolved Items:
� None
❑ See Below
Location of Sample: t c\32� ej ^ c ,r f\ _ 1.o Amt
❑ No Samples Taken
Description of Work Inspected: Phase 3 L Lot# C) (0 ` Product '1, Plan qcA:, In c-,
(41 - I o 6Z mob, C��7 -
-,q rvz-
1) Received mill certifications for rebar and tendons placed.
2) Typical exterior Footings including Garage Footings/Door (11,12,13/SD-1), Tie Beams (20/SD-1), Typical Interior Footings/Rib including step (15,18/SD-1),
Seven Strand Tendons (4,10,12,13,16/SD-1), Simpson Strong Walls (24/SD-1), Anchor Bolts and Holdowns (6,7,8/SD-1), Pad Footings and additional
rebar placed as per these details and as noted on ,_ L-
...�/�.\Cr')fl. c� l .l \C1� ��1 �� 17 (i 'fw C'�!4\ � \\'��f\t� e... �C't C. f'!' i.3 f�l�,'f A;("af'�..•
Also, typical details 2, 3/SD-1 and Notes on SN -1 apply. Checked rebar for grade, size, placement, coverage and splices. Rebar and tendons were
securely tied and supported off the earth. Accepted for concrete placement.
LaZ—0,4 --h<::z-
1) The placement of concrete for areas noted above except Garage Interior Footing and Slab on Grade. Total cubic yards placed: approx-11'
A mechanical vibrator was used to consolidate the concrete. Approved #4 rebar slab dowels were placed @ 18" o.c.
2) Molded 4 cylinders for compression tests with breaks at 7 days (1), 28 days (2) and one for holding purposes.
1) The placement of concrete for Garage Interior Footings and Slab on Grade Total cubic yards placed: approx),. Verified correct mix design.
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.
s
Inspector: Jack C. Millin ICC CertifcatiolrfNjo: 0842216-80
Contractor's R p e�sentave:
Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agerny Page —t— of
03/24/2006 10:44 FAX PARAGONPSCHIMIO 1@002/013
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Tltle 24, State of California, in the building at
62.210 RUBY COURT, LOT 4061, PHASE 13B, LA QUINTA, CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-33
WALLS:
TYPE: BATTS MANUFACTURER: BORATE THICKNESS: W-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY, TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221.517
bY• ht=r't 4 c9' TITLE: ACCOUNT REPRESENTIVE , DA—E: