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08553 (SFD)Building Address T4 hf, u P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address 49'200 Berwmdo City Zip Tel. La t "13t$ 1 92253 Contractor Address Zip & Classif. . Arch., Engr., Designer Address City( Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. _SIGNATURE - DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following i; reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, after,' lter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for "such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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, Buisness and ,i Professions Code: The. Contractor's License Law does not apply to an owner or property who builds or improves thereon and who does such work himself or through his own employees, provided that such 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 did not build or improve for the purpose or sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-. struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner or properly who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) i 0 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation_ Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. _ Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred,dollars ($100) valuation or less.) - I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance.of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. WING: TYPE CONST. OCC: GRP.. 08553 P. Number aaa% M-352-406 Description t Description L>at M of M Omnia Golf &atrtte* .#I Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation SM.000.00 PERMIT AMOUNT Plan Chk. Dep. 250-,,.00 Plan Chk. Bal. 955.00 Const. 1,329.00 Mech. 109.00 Electrical 24 f s Plumbing 331..50 S.M.I. 20.7 Grading 20.01D Driveway Enc. 20*00 Infrastructure 6.000.00 TOTAL 9,032.33 REMARKS voo ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE IWAR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES COLL. AREA 1ST FL. SO. FT. ® $ UNITS HEATING (ROUGH) 2ND FL. SQ. FT. FORMS YARD SPKLR SYSTEM DUCT WORK l0 �� MOBILEHOME SVC. BAR SINK POR. SO. FT. ® HEATING (FINAL) OTHER APPJEQUIP. GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GROUT DRAINAGE PIPING CAR P. SQ. FT. BOND BEAM WALL SQ. FT. GRADING Cu. yd. plus x$ DRINKING FOUNTAIN SQ FT ® N FRAMING ��-(� C% URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation VENTILATION FLOOR DRAIN MECHANICAL FEES ZONE ROOFING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 % c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ec HOUSE SEWER FENCE FINAL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUNIF UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANI(%, ROUGH WIRING DUCT WORK l0 �� ROCK STORAGE FOUND. REINF. GAS (ROUGH)'t' et t 4L. METER LOOP ` ll�� HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE P-? aO z GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. R! t 71-1 r ( FINAL INSP. Q / G $ GRADING Cu. yd. plus x$ =$ LUMBER GR. N FRAMING ��-(� C% ROOFING � oC CFIRE 17�-� (; j� d y < fJcLY�/� $ C, / L /O R MARKS: VENTILATION ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING L� MESH INSULATION/SOUND O� FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL :d DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 9/10/90 Type of Permit I La Quinta No. 10139 Permit # Log # Owner Name Lew Price No. 49200 street Fernando ` city La Quinta zip 92253 Study Area APN # 631-352-006 1 Tract # I Lot # 150 Square Footage 14100 Type of Development Single Family Residence No. of units 0 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, -detached accessory structures or replacement mobilehomes. It has been determined 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 Government Code 53080 in the amount of 1.58 X 4100 or $ 6,478.00 have been paid to D.S.0 S.D. 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 Jack Clark, Jr. Name on the check Telephone By John D. Brooks w F-r, Associate Superintendent, Business Services Fee collected /exempted b D. p y Shelley DBennett '" =' :.,,,.�.-• `�� Piptnent,R:a,i �6ived, -. Signature No. 1443 Collector: Attach a copy of County or City plan check application _�Phack for •to iDwira_ct°copy. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting Sola oati CD Z O b W U' U Z _O b W U) Chi Z _O b W CO COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH AssiM PaMM No. ENVIRONMENTAL SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as Indicated on the attached check Ilat. A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of e00Pve;Fsiile.CApproval'of this application shall remain valid for a period not to exceed one year from date of approval. A L• VERIFY ITEMSDI,NISECTION FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG q ` f`6• r t recta, Contact�'$P—n r C L CLA1 -L -..11C , Phone 56�d X511 Address & Firm P.01 Loy 137 �>4 uflU7A Owner I W r'IZIa Phone 31 6q -A N4 Mailing Address Olq C IC- LOCC--1i .N2, Cfty 8LGCN1 FIEM H I LLS StateZip Job Property Address Legal Description Prop. (PM, Tract Lot) M1 86) q -ACV � 2iV LoT 5;D LA 0, e,. E. Lot Size Water Agency/Well Use of Permit P/P, CU, etc. Other Dwelling, MH She Prep, etc. Signature c plicant Date CATEGORY: ; REV CODE FEE CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238 ❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME (T*�� (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 a. 1 st 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) ! b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 ❑ \ Rerevlew (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) ❑ She Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area . 7348 $111.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. A. 7347 $ 87.00 INITIAL DATE Holding Tank Agreements Completed ❑ Yes No AA Jjo Certification of Existing S.D. System Required ❑ Yes I I No WOCB Clearance required. (Attach Form ❑ Yes 11 No DOH SAN 007, Santa Ana Region Only) Sills Percolation Report Required. ❑ Yes I I No Special Feasibility Boring Report Required. ❑ Yes No Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes No 011ier ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Date Sills boring report by f ` Pm,ject a Data IYV Soils Map Page Soll Type Approved by Deis No. of Syafsme Type of Syng Tan) ❑ Holding Tank ❑Existing Dwelling Units Unita (1) Septic Tank Soil Rate G Gr7:Gd L ;a Now ❑ Redacenr�t �'sre , n G.1 �/�, (2) Leach Llr j . Ft Sidewall allowance Install Lk*s) long wide with Le�ech�B�e�dd w;,4 Bottom area ft rock/ sq. R per running ft. ///tr min. inches . - dralnfnes aha ✓' L.eachlinse/bed special design for slope: (3) Pit Diameter No. Pita Pk Below Seepage Pit Total Depth Other. icable inlet (BI) (TD) Max.M lovable Depth I NSA Overburden facia �_ 49.,'S` 17 6 I L��r No. 2 System REMARKS: // Q tiCha 0P- 41 nfn 466/4 0 r ei4,VCA / /,)-/M/ S /r -6f- � This application i APPROVED ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accomparned–plot--p n, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area. t ) Septic tank and sewer lines must be 50' minimum from any wells Leach lines must be 100' minimum from any wells, including expansion area OPSeepage pits must be 1150' minimum from wells, including area �lany nexpansion � Signature of Health Official %:V, e !rt'" R1W0 L�ikir:l aAo1-0t 7 IM Die l/ RECEIPT NO. h U 7 Issued By J Date / f 1 - DISTRICT: ❑ Riverside, 9 Indio ❑ Hemet D Perris ❑ Rancho Calif. ❑ Blythe i .. DOH -SAN -122 (Rev. 3190) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records 45CEI.P.T NA. (] Issued By Date DISTRICT: �tN�DO ❑ Riverside, M7 Indio ❑ Hemet ❑ Perris O �F'ancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 3190) DISTRIBUTION: WHfTE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records GG tisai COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH A'eeeeOf' NO' . + ; ENVIRONMENTAL SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant, Submit this form with four copies of a scaled'plot plan (1-20 scale) drawn to County speculations as Indicated on the attached check IISL " •A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riveiside.• Approval of this application shall -remain valid for a period'nof to exceed one year from date of approval. rr VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # C /` L• ., .0 ; ; Agent Phone' Address & Firm Owner— Phone Melling Address" BLC10M !E) Ll state Zip rty Address Legal Deacriptbn Prop. (PK Lot) -S MI Df %, wt� ,.. lJt E. -'tAt �e " - ter Agent Use dP&AP/P, CU ud 4tit other •� 139 X //0 X /.0 ,!` llll� Sf • w ar o� ESrit �t°5 .tx� Dwelling H Site Prep, etc. _. �dt Signature oWpplicant Date - CATEGORY: REV CODE FE CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238 ❑ SiTE EVALUATION UPON REQUEST 7349 $ 43.00 m ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DMSION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 Z a I 1 at 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) Each Fame( after 4 7344 $ 24.0 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 Rereview (2nd review same parcel ox 7 �3% d EVALUATiON'(Attach DOH SAN 53) ❑ She Evaluation in Conjunction with""`' ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7 $111.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ She Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 INI TI DATE Holding Tank Agreements Completed ❑ Yes No CertMcation of Extorting S.D. System Required ❑ Yes I I No W 6B Clearance required. (Attach Form ❑ Yes I I No DOH SAN 007, Santa Ana Region Only) In Percolation Report Required. ❑ Yes 13 No Special Feasibility Boring Report Required. ❑ Yes No Detailed Contour Plot Plants Required (1 to 5 R interval) ❑ Yes No Other ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Dere r. Sella boring report by Date nPr�ojjeect /U II U Sella Map Page Sol Type Approved by / Deme �- No. d Syebma Systea) Type d m �ellkq Unhso� (1) Septic Tank So9 Rate Glrssee/Sar)d Z ❑ Holding'Tenk ❑ g f�W ❑ rivMoww Reple w„ �Bedroorrrs�tfelare�tinitr �JCXI'” 7`�M Sy t�_Gel W (2) Leech tike, . FL Bottom arae Sfdewall allowance it rocsq. W R Install Une(s) long R whh min. irxFree drelnihea or Leach tied d area ` per running ft NA Leachlines/bed special design for slope: (3) Pit Diameter No. PAs Ph Below Seepag Pit Total Depth (TD) ' Other. Applicable ti Inlet (BI) 9 U . Max. A(bwable Depth N/A Overburden factor /� f Vol, No. 2 System REMARKS: k#q Q c A-Pdj % � s wr Ck This application 1 P�PROVED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as Indicated on the accompan n, usl t nts set forth in SECTION C above. A buildin permit is necessary for the Installation of the z above -designed system. construction is permitted in the requir reserved 100% expansion are 0 <6D Septic tank and sewer lines must be 50' minimum from any wells d�� A Leach lines must be 100' minimum from any wells, including expansion res Seepage pits must be 150' minimum from any wells, including expansion ar lQ --�-t-z o (W r fW Signature of Health Official Date " 45CEI.P.T NA. (] Issued By Date DISTRICT: �tN�DO ❑ Riverside, M7 Indio ❑ Hemet ❑ Perris O �F'ancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 3190) DISTRIBUTION: WHfTE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records GG tisai r, Fes• �' +! � /.t f r , •.. ♦ •+ � ♦ � •, T.of �uMuc HEAii}i 2% - MViMIDE COUNTY DEP j j A LTH. S� � ' Food Cjl. ��tic %y'tk R "+ lYom Penh Sq. Ft, oa lxn-h 1 �1t,0 j &,6t,J ��/ I�bt9l, Apt, �l , �� MAS • � x yfL ,x6tp�"sa pit ( - •r , Corirladian to sw."r +whngns root dlsp�3 n-slh rego�tera3it + `= ,3ntrg dwAces trey bo arS;t ; •,� �'5� it3 the savr�sT gi'#rorsvxith etolCd rn:cR�t csrsnoo frct�a the t;r.:=r �° 6'�'ira:� t� ,� r•:�.: �urtx3.-C w,D. tii.^t!4n nt:t•.. t L� iarm Fu Pn .'.nb �'.ARb SOrV ritt.°st �fin�'ti!� vs ii'h f' EZ.�'l�'�i2:+s."r C� C�:J�� .. n/� taar (�� t til ,nu": 'Zo 4:: y u ��L d:ttiei4 6r t.:�lr� M czsooss ' Y}',zr itila"•'ost do tiaa �c'.w oval 'h s ttM 0h-t:`3d flam. t#ta iZ.,g el ..COi �ruc:;cn ml %MUM atv Oat the mot. -MA 0mv C. 7001., tksxcrhm trust be 50 St- ` well3+ IndudinZkate �x tis, � Frogs. 411E. i) Y rs Pft ca UA bo. mirtltnum Pram DATA OF r ROMA, m..00 ` 1111IOIls• U�� �Q,,� . , -'`'•per. - 'j%O l 'xi •i . � �, a.R - /•• p♦7.• !..♦ •ti ... R � iS (�1f♦_Q L �'•^'M+ .� �Qi L• � l� • / ' V �D �/ t �� ' SC t- rytf ,J n :��''`Rr ,r1•vxJ.Y;,rf:2 :t:.e.''•�cf�•,•,'.s�ti�7c+.lijj �`* �..�,/v �-�-,•�%._�' /• - ..� t / t . J _ pper �,�y C' 3 i'i�gti} - Yi .f vw.,1 x � - �•.,�1`i��' iY•� 6 r}b..rf,:.ui ��� �, ft ,h i/� ley tt Lt''• j rrj'r r .'y.• '.� �I� /lM/'.nn mow— i�f'�'+4,,� i � � �" � '� ^Si $'Y,t�vir �. {-t�T � 3 1 iIe/j � , � i�e ^��y\��•G�Iv, f 1 +j 1'.; I - 0.-.... i.J �f�. �r•+'�i°d �1 JIT' t '�li iR:7iG l •` vl .,�, 0 • LAN>'`•x.A expo b 'Pv<>g. \ �• cbr+� PAV NO% wST '^ foo WALL 1 � SToNE $oKDER � ��• � L. cora. 'enNOF•��R; Aa --- � t ie�. , !flKFL ELEV Safl,g�� 3 o Hlod .sjucca.drpN, Le 54.P. KYf�€b PAVING .Flo +i5 --_ ,'f ��`•� �j INCy �G'o IiICoNyfAll ��" FbUL /" LAY6Vf R91 N", T�lr.. G. c . To FiLp V�(11 F riaT, fir uV� ►IANC;' " No SEj aAc�s ^ vlolpti SLP TO 6o Ti�xTL�N ---( �-- H,GdWEU, - -_ - - — - -.� ` j ,r %-'EX{S75EF7' 1 InC. P ,hfG --tmcrTH'FI StiCtNC,NZ. "rwlI .�I• Vit% ( �oN6� , �—r,t' ' � 1' 'C-� .AAV ING scara�Tnc�>r •: • �� SaPr ! w Aotuc, rF CXZNec WPY IN La Quinta GolfEstates Community Association P.O. Box 162 La Quinta, Ca 92253 619/564-2177 September 4, 1990 CITY OF LA QUINTA Planning Department P.O. Box 1504 La Quinta Ca 92253 RE: Architectural Committee Approval New Construction - Lot #150 MR. & MRS. LEW PRICE Gentlemen: The Architectural Committee of La Quinta Golf.Estates Community Associ- ation has reviewed the plans submitted for above referenced residence. The Committee has approved these plans and contractor, Jack Clark, has assured us that the owner will be responsible for any damage to streets or adjoining properties which might occur during construction. If you have any questions, please contact the office. Sincerely, J A ROBERT C. MONROE •+�;�� •�•,:r et:q: �.;'.•�jl�kl'' ,";�"'$�41R"��h�'•.�.�•p},�h. off^' �1„'» Ali., '.: ,, .: c:'�'. 0 Buena Engineers, Inc. 79-811 B Country Club Drive Bermuda Dunes, CA 92201 • (619) 345-1588 r 1�- DATE �36J. 5 , I(Rqo _ JOB NO. 97 21120 i3 PROJECT FIELD TESTING REFERENCE CURVE MOISTURE LOCATION MAXIMUM C�\- N FcOPTIMUM CONTRACTOR TEST LOCATION - OWNER ;sj f NUMBER WEATHER TEMP. o at AM C L E A. `1Z DENSITY Ibs.%Cu.ft. ° at PM PRESENT AT SITE MOISTURE CONTENT CLIENT REPRESENTATIVE SIGNATURE FIELD REPORT TECHNICIANS SIGNATURE E C 4 O C _ "., • f FIELD TESTING REFERENCE CURVE MOISTURE DRY MAXIMUM MAXIMUM+ FcOPTIMUM TEST,- TEST LOCATION - LOT ;sj f NUMBER NO. ELEVATION CONTENT % DENSITY Ibs.%Cu.ft. DRYDRY DENSITY DENSITY MOISTURE CONTENT Ibs./cu. ft. /. (• �f��.� 1 (� w t 1 ... ! . e u. •. i :i fY e ,r - .A �, w REMARKS: ( t� a�� 9� k TIE 1;;' 1 GA • r CLIENT REPRESENTATIVE SIGNATURE FIELD REPORT TECHNICIANS SIGNATURE E C 4 O C CIT}' "rAJON TANDY _ f7AR 1 D 7 REC 37630 Medjool Ave. BUI`Uj� C. Palm Desert, CA 92211 Office (760) 772-7192 SPECIAL• Fax (760) 772-7193 Pager (760) 776-3338 REGISTERED INSPECTOR'S WEEKLY REPORT TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER ❑ REINFORCED MASONRY ❑ FIRE PROOFING JOB LOCATIO '/ IjA , ` Jp /� �U LL N S REPORT SEQUENCE NO. TYPE OF SCTURE ` � n � ` YAvrin PERMIT NO. DATE � J DAY Of WEEK MA'TERIA DESPTION_ l JL 1/D SO v ARCHITECT INSP CTO 11)1-117 HRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION GENERAL SUB DATE COTRACTOR �<A G� C[ t CONTRACTOR G d � ts'i2liL� �� c r► 4 �/ � 6 C( y COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE 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. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. ��fl SIGNA URE OF REGISTE D INSPECTO �i 12. - .tea ,21-7s DATE OF REPORT REGISTER NUMBER