9511-039 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the BusinessProfessionals Co
and de, and my
License is In full force and effect. 69540.5__1 9/3ii96
License #_ Lic. Class W. Date
Date Signatureof Contractor
OWNER -BUILDER DECLARATION
I hereby affirm 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).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
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.
( ) 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 & policy no. are:
-Carrier Policy No. nee nWIn -
(This section ot 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,
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: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and 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 attorney's 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.
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 agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit isfued as a,resuft of this application becomes null and void if
_
work is not commenced �WWt n,lti0 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 laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
'above-mentioned property for inspection purposes. .
+,,Signature (Owner/Agent) Date
A""
BUILDING
PERMIT'PERM
IT
DATE I / 1`.,t -
VALUATION ;*111,097:57
:1
TRACTij),�,{y , 7
JOB SITE ADDRESSAPN
:12•-295 MVIE. JUAW
173-242-016
OWNER
CONTRACTOR c
'W7r,,i;371.M ELWIN WRAN
WII.I ANI F & .T —RNIA DORKAN
1224 Iff. 252 S'1'1:,EE'T .
1224 W. 252 Sl'.
HARBOR C rl'Y CA 90710
HARBOR CI 1Y CA 90710
(619,,-,64.2t►18 CIFY0 3330
DESIGNER/ENGINEER
USE OF PER1%1 J;,q4 F• LE FAMILY ]MV 131 ' IMC
t%i i AVI' MMES T�{(.Yl' INCJ: UD6 BLOCK WALLS Olt POOL. -
FEE DESCRIPTION
FEES
'I`RAC1' COMMiic:T'iON 7,026,00 &F
W:�kt.if/d'.A77L) 126.00 N
'('. "1^ • �' • •1f•'I:- thl��� 19 /�h t�('.•�•II`s YtIYA•'tl 1
s, .��lIATIA1..i) ..OST �.asr F�l1i:V�>.� oc+Jt as,€ iti
- 1 •O /^
G s E;(�n i is
014, 1NUT FEESUMMARY
FRE DEPOSIT-Ss9(t.fli►
Y'L AISI CHECK FEE 101-11420-433-318 5592.95
COM'I.` UCT1013 FEE 101-000-418-000 3709.50
iw K'NAN[CAL FER 1014W.421 000 x;62.00
ELECT RICAL V:Iffi- ,: 1.01.-000-420-000 314161
pLLT i811q M 1.01-000419-000
S T 0.NO MOTION rEE -1:13S[O 100.000-241-000
OI AMNG F"fi E 1014W-4-23-000
PRECISE PLAN 101-000441-345'7,,//r:@6aS.tifO
Ad�cc y��c��7�
A.R,i t I'um.l`• lea t ems - iuCF. m ! oi-000-2..s5- o
I2�3-vi-143.32ILad�(
i113 TOTAL CONSTRUCTION AND PLAN SCK
$4,407.42
LESS 1YR&PAID 3•,{ ES
r 4250.0()
TOTAL P,f.Ri Iff FEES VUE NOW
$4,1.57.42
TOTAL IARaJ.6ECl PORMI T FRES
4,407.42
RECEI T
�.
DATE j ' L ,.
`
BY �(/� DTE RNALED
�,'
INSPECTOR
INSPECTION RECORD:.
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs (/A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing G
Compressor
Insulation /
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS -
SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines /
Heater Final
Water Piping t
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL 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 f
Utility Notice (Perm)
r
P.O. BOX 1504 APPLICATION ONLY
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253 t
�
Owner ` A,/1 On I? /� Ads
l - BUILDING- TYPE CONST. 1? ► S OC&/GRP.
Mailing
Address / Z W. S Z S / A.P. Number
City _ Zip Tel. po - j X3/3
Legal Description C `/
Contractor Project Description O A (/ r A A IZ)5' Z
NAIM o r?AY -
Address
SM r.
City Zip Tel..
State Lic. City •,
8 ateClassif. _ a ! Lic.,# OL Sq. Ft. No. No. Dw.
Arch., Engr., Size 2Q Stories >/ Units
Designer 12A 0 4) 1 New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
13,5_2
City ZipState
n 1 CA -1 7 G ,6 Lic. #
LICENSED CONTRACTOR'S DECLARATION
-
I hereb affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of �ivision 3 of the Business and Professions Code, and my license is in fL.I1 force and
effect.
SIGNATURE ""��� c� DATE\
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which- requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file 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 of Section 7031.5 by any applicant hr a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
!7 1, 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, Ruisness and
Professions Code: The Contractor's License Law does not apply to an owner of 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 of sale.).
I 1 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 of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
7 I 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 zertificate of
Worker's•Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labo. Code.)
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FR%Q�
WORKERS' COMPENSATION INSURAYICE
(This section need not be completed if the permit is for one hundred dollars ($700) 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, alter making this Certificate of Exemption you would 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
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) •r
Lender's Name
Lender's Address
This is a building permit when properly tilled out, signed and validated, anc is subject to
expiration it 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 enlei the above.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
Estimated Valuation,
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
•Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL +
REMARKS
I(q, 724.00
ZONE:
BY:
Minimum Setback Distances:
Front Setback
Rear Setback
Side Street Se
Side Setback
FINAL DATE
-
Issued by:
Da at
Validated by:
Validation:
1
AMOUNT
�tiz .gs
a V
a O0
l LF'Z, b/
2656,08
Cent e
Re ine
( from Center Line.
P590,gYvLi Ile -f "
CONSTRUCTION ESTIMATE I NO, I ELECTRICAL FEES I NO. I PLUMBING FEES
1ST FL. SO. FT. 4i ill
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. SQ. FT. @
WALL SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
0 l'
r
JnUMOBILEHOME
/
UNITS
SVC.
POWER OUTLET
A.C. UNIT
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
SLAB GRADE
NOTE: Not to be used as property tax valuation
BONDING
HEATING (ROUGH)
STORAGE TANK
FLOOR DRAIN
SEWER OR SEPTIC TANK
MECHANICAL FEES
DUCT WORK
ROCK STORAGE
FOUND. REINF.
WATER SOFTENER
METER LOOP
VENT SYSTEM FAN EVAP.000L HOOD
OTHER APP./EQUIP.
SIGN
GAS (FINAL)
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GROUT
WATER HEATER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
LAUNDRYTRAY
LUMBER GR.
AIR HANDLING UNIT CFM
FINAL INSP,
FRAMING
FINAL INSP.
KITCHEN SINK
ROOFING
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
REMARKS:
WATER CLOSET
VENTILATION
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
FIREPLACE
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
GAR. FIREWALL
BATH TUB
LATHING
SQ. FT. @ c
MESH
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1'A c
70
SEWAGE DISPOSAL
FINISH GRADING
SQ.FT.GAR @ 2/.c
HOUSE SEWER
CERT. OCC.
FENCE FINAL
GAS PIPING
PERMIT FEE
PERMIT FEE
GARDEN WALL FINAL
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
L 1,00
PL.Cf EE
5'b
CONST. FEE
7v9•�°
ELECT. FEE
�2, /
SMI FEE
PLUMB. FEE
C3Z3
STRUCTURE PLUMBING ELF•CTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP,
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 111/8/95.1 Type of Permit La Quinta
No. 113848 1 Permit #
Owner Name William Doran Log
No. 52285 Street Ave. Juarez
City La Quinta Zip 92253 Study Area 112
APN # 773-242-016 Tract # I Lot # 0 Square Footage 12026
Type of Development I Single Family Residence I 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 1.72 x 2 026 or $ 3,484.72 have been paid to D.S.U.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
William E. Doran
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature 1�1 A A I ? AA 0P\& Ax AA .QW .
TelephdfibT)f;
• ✓• F t�
f `
Payment Received r r' -
4
$3,484.72 Check No. 1673
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
Recording Requested By,
First-Arnahc`ann Jitle,Insurance Company
Order No.
Escrow No.
Loan No.
WHEN RECORDED MAIL TO:
Mr. &- Mrs. William Doran, Trustees
,-,MAIL TAX STATEMENTS TO:
�. .
Same as above
ao
O
Z
0
i
a
YAC h-ABOyE, THIS LINE FOR RECORDER' USE
1'
DOCUMENTARY TRANSFER TAX $.....`.. �....................
.. CLtyomputed on the consideration or val �propenseyed; OR -7/
...... Computed on the 6oasideration or value less liens or encumbrances
' reiiiiining at time of sale. = --i•--__ _ »' .
Signature of Declarant orAgent determining tax—Firm Name
'Amp" ,
GRANT .DEED.
FOR A VALUABLE CONSIDERATION, receipt of which is hereby actino .ledged,
o
JAMES W. HINES, JR. and LOIS L.HINES, TRUSTEES UDTSEPTEMBER' 14, 19,87
hereby GRANT(S) to WILLIAM E. DORAN and VERNA H. DORAN., T S ES OF THE DORAN- FAMILY
TRUST dated 09/10/81 ,
the real property in the City of La Quints
County of Riverside State of California, described as -
Lots 4 and 5 of Block 7 of Santa Carmelita at Vale La Quinta , Unit No. 1 as shown
on a map thereof recorded in Book 18, Page 46 of Maps, in the Office of the
County Recorder of said County.
Dated October 22, 1993
STATE OF CALIFO }ss.
CO Y OF
U1. . l__ 4 "664
me,
I .-
personally appeared
personally known to me (or proved to me on the basis of satisfactory
evidence) to be the person(s) whose neme(s)is/are subscribed to the within
instrument and acknowledged to me that4WsWthey executed the same
in4ieler/their authorized capacity(ies), and that by his/her/their Signa-
ture(s) on the instrument the person(s) or the entity upon behalf of which
the person(s) acted, executed the instrument. j
WITNESS my band and official seal.4 f
IN
Ja s W. Hines, Trustee
Lois L. Hines, Trustee
OFFICIAL SEAL
_ CAROL FELLBAoO
UM
PRINCIPAL OFFICE IN
ORANGE COUNTY
My CommiWon Expires Nov. 18, 1995
� � n
Signature ! Ln-� ~ (This area for official notarial sea])
U
a dUj
cc
o
CL � 8
L06
a CID
5 Q
-- _
W
-
ao
O
Z
0
i
a
YAC h-ABOyE, THIS LINE FOR RECORDER' USE
1'
DOCUMENTARY TRANSFER TAX $.....`.. �....................
.. CLtyomputed on the consideration or val �propenseyed; OR -7/
...... Computed on the 6oasideration or value less liens or encumbrances
' reiiiiining at time of sale. = --i•--__ _ »' .
Signature of Declarant orAgent determining tax—Firm Name
'Amp" ,
GRANT .DEED.
FOR A VALUABLE CONSIDERATION, receipt of which is hereby actino .ledged,
o
JAMES W. HINES, JR. and LOIS L.HINES, TRUSTEES UDTSEPTEMBER' 14, 19,87
hereby GRANT(S) to WILLIAM E. DORAN and VERNA H. DORAN., T S ES OF THE DORAN- FAMILY
TRUST dated 09/10/81 ,
the real property in the City of La Quints
County of Riverside State of California, described as -
Lots 4 and 5 of Block 7 of Santa Carmelita at Vale La Quinta , Unit No. 1 as shown
on a map thereof recorded in Book 18, Page 46 of Maps, in the Office of the
County Recorder of said County.
Dated October 22, 1993
STATE OF CALIFO }ss.
CO Y OF
U1. . l__ 4 "664
me,
I .-
personally appeared
personally known to me (or proved to me on the basis of satisfactory
evidence) to be the person(s) whose neme(s)is/are subscribed to the within
instrument and acknowledged to me that4WsWthey executed the same
in4ieler/their authorized capacity(ies), and that by his/her/their Signa-
ture(s) on the instrument the person(s) or the entity upon behalf of which
the person(s) acted, executed the instrument. j
WITNESS my band and official seal.4 f
IN
Ja s W. Hines, Trustee
Lois L. Hines, Trustee
OFFICIAL SEAL
_ CAROL FELLBAoO
UM
PRINCIPAL OFFICE IN
ORANGE COUNTY
My CommiWon Expires Nov. 18, 1995
� � n
Signature ! Ln-� ~ (This area for official notarial sea])
L. ' ^^•!•; R« .:yriya•gt•.,-�-n.Mr�•� �nta !•y'M'�t�n117f'��'!Sr�'V'fV9W�'�' :s1, r
COACHELLA VALLEY WATER DISTRICT
T CASH RECEIPT DETAIL
Received From: 1 \ d` W� ,JVY6` 1�
Account No. " LotsTL It S •C,
Tract
Service Address — a e 0. lJ G.A. Code
'EKeter(s) J L4"" $ Z? -S,(:) v J
j ❑ Service(s)
❑ BackflOW(S)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ -Meter Surcharge .�
tatiori Capacity Charge
❑ W.S.B.F.C. 1
❑ Temporary Construction Meter
• ❑ Turn on Charge "
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
- Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. - Bond - ; ,•
Assmt.
❑ Customer Deposit
❑ Other �' \
M1 TOTAL $ 17S. V v
' Remarks:' ..tJy\I � VV!_�t, l J�" �-�•,�
;1•..
❑Copy,to:'
Cash Water Service
Check
Money
Order Cashier
CVWD-438(11/89)
t
ELI
Earth Systems Consultants
Southern California
Building Permit No.:
'LILY REPORT OF INSPECTII
SB/R.S CO. GOV. U
OSA Apolication No.:
79-811B Country Club Drive
Bermuda Dunes, CA 92201
(619) 345-1588 • (800) 924-7015
OF STRU
TITLE 21/24 OTHER
Date of Inspection: - o
Project Name: �Qs:�Q•�c� i Job No.: C_- Shy -Pi
Project Address: S Y.S wo; e.2,. La u s Ac. Cc..
Architect: IZ-)OW,� Structural Engineer: �aJt ���•1
General Contractor: 9'A Sub Contractor: �� « 66C O VA
TYPE OF INSPECTION: Reinforcing Unit Placement((routS ace Cleanouts rout e
Description of Work Insp(ectend:'Q AorenQ cn. \�✓ kAnt)S. insoP.-J ogna S1 ', n `
t n Q, fir, r ., h _ _ .., 1n -- `a' `" n ^T n..:. � LI (_ / �r � ,•Cl
RE
Unresolved Items:
rI
Descriptive Location of Samples:
v--
Slump:.� •r�o 'i"4es Grout Temper �' Tune in Mixer: �� tin � upplier: '� Admixture: non �
n � C6 Ski
Water Added: o Air Temp: . &:Z Type Cement: Mix Design: �I.D. Mark:
C.M.U. Unit Sizes & Colors: i�'� C�'�- cn�r� b��•� Bond Pattern: ( Mortar Type: nnnQ,
I hereby certify that I have inspected all of the above reported work, finless otherwise noted, and to the best of my a ility I have found this work to comply with the approved
plans, specifications & applicable building laws. Final report issued at: project completion. r
Inspector's Name/No.-arc\, � , t1'1',� 1,� Inspector's Signature
Time in- O A n— Time out Lunch
Straight Time O.T.
All inspections based on a minimum.of 4 hours; over 4 hours will be an 8 iour minimum.
In addition, any inspection extending past 12 pm will be an 8 hour minimum. /
Contractor's Representative '�-
Copy 1 ESC Lab Copy 2 Project Superintendent Copy 3 Governing Agency
I_` :..
C
(9—%, Earth Systems Consultants
'1�F Southern California
July 10, 1994
Building Department
City of La Quinta
78-495 Calle Tampico
La Quinta, California 92253
Project: 52-285 Avenida Juarez
La Quinta, California
Buam Engines Dli lolon
79-811 B Country Club Drive
Bermuda Dunes, CA 92201
(619)345-1588
(619) 328-9131
FAX (619) 345-7315
ST -5688-P9
This letter was prepared to formally notify City officials that our firm has been
retained by Mr. Bill Doran to perform inspection services during the grouting
operations on the above referenced single family residence. The inspection services
will be performed by a certified ICBO inspector in accordance with the project
specifications.
If there are any questions concerning this report, please contact the undersigned.
Respectfully submitted,
Earth Systems Consultants
Mark Houghton
Testing and Inspection Supervisor
Copies:
1- City of La Quinta; Building Department
1- Bill Doran
TABLE OF CONTENTS TOC
Project Title.......... Date........ 02/26/95
Pro'ect Addre
LA QUINTA
Documentation Author... ROBERT L. EVANS
'Company ................ REDE ENERGY CALCULATIONS
Telephone
.............. (909) 792-1429
=Compliance Method...... MICROPAS4 by Enercomp, Inc.
Climate Zone........... 15
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -TOC
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
TABLE OF CONTENTS
Report Page
FORM CF -1R ................ 1
FORM MF -1R ................ 4
FORM C -2R ................. 6
HVAC SIZING ............... 9
CERTIFICATE OF COMPLIANCE: RESIDENTIAL Page 1 CF -1R
Project Title.......... Date........ 02/26/95
Project Address.... ..
LA QUINTA
Documentation Author... ROBERT L. EVANS
Company ................ REDE ENERGY CALCULATIONS
Telephone .............. (909) 792-1429
,Compliance Method...... MICROPAS4 by Enercomp, Inc.
Climate Zone.... ...... 15
Building Permit
Plan Check Date
Field Check/ Date
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -FORM CF -1R
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
GENERAL INFORMATION
Conditioned Floor Area..... 2026 sf
Building Type .............. Single Family Detached
Construction Type ......... New
Building Front Orientation. Front Facing 90 deg (E)
Number of Dwelling Units... 1
Number of Stories.. ...... 1
Floor Construction Type.... Slab On Grade (Package D)
BUILDING SHELL INSULATION
Component Insulation Assembly
Type R -value U -Value Location/Comments
Wall R-40 0.024 TYPICAL
Roof R-38 0.029 ATTIC
Door R-0 0.330 ENTRY, GARAGE
SlabEdge R-0 0.900 TO OUTSIDE
SlabEdge R-0 0.720 TO OUTSIDE
FENESTRATION
# of Interior
Over -
Area U- Pan- Shading/ Exterior
hang/ Framing
Orientation (sf) Value es Description Shading
Fins Type
Window Front (E) 44.0 0.870 2 drapes None
None Metal
Window Back (W) 70.0 0.870 2 drapes None
None Metal
Window Left (S) 48.0 0.870 2 drapes None
None Metal
Window Right (N) 90.0 0.870 2 drapes None
None Metal
Door Front (E) 34.0 0.650 2 drapes None
None Wood
THERMAL MASS
Area Thickness
Type Exposed (sf) (in) Location/Comments
S1abOnGrade No 1196 3.5 CARPETED
S1abOnGrade Yes 830 3.5 L.R KIT FAM RM.
BATHS
J
0
CERTIFICATE OF COMPLIANCE: RESIDENTIAL Page 2 CF -1R
Project Title.......... Date........ 02/26/95
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -FORM CF -1R
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
Equipment Type
Gas
AirCond
HVAC SYSTEMS
Minimum Duct Duct Thermostat
Efficiency Location R -value Type
0.780 AFUE Attic R-4 Setback
10.00 SEER Attic R-4 Setback
WATER HEATING SYSTEMS
Number Tank External
in Energy Size Insulation
Tank Type Heater Type Distribution Type System Factor (gal) R -value
Water Heater to meet minimum CEC Standards
SPECIAL FEATURES/REMARKS
CERTIFICATE OF COMPLIANCE: RESIDENTIAL Page 3 CF -IR
Project Title.......... Date........ 02/26/95
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -FORM CF -1R
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance
specifications needed to comply with Title -24, Parts 1 and 6 of the
California Code of Regulations, and the administrative regulations to
implement them.. This certificate has been signed by the individual with
overall design responsibility. When this certificate of compliance is
submitted for a single building plan to be built in multiple orientations,
any shading feature that is varied is indicated in the Special Features/
Remarks section.
DESIGNER or OWNER
Name.... DAVE ADRIAN
Company. DRAFTECH
Address. 235 N. MURRAY STE A
BANNING, CA 92220
Phone... (9 849-122
License.
Signed.. ` "Z -2a -R5_
a e
ENFORCEMENT AGENCY
Name....
Title...
Agency..
Phone...
Signed..
(date)
DOCUMENTATION AUTHOR
Name.... ROBERT L. EVANS
Company. REDE ENERGY CALCULATIONS
Address. 630 ORCHARD DR.
REDLANDS „ CA 92374
Phone... (909) 792-1429
Signed..
FILk � �J tyy,�, C;�J95Jdatfl
MANDATORY MEASURES CHECKLIST: RESIDENTIAL Page 4 MF -1R
Project Title.......... Date........ 02/26/95
Project Address........
LA QUINTA
Documentation Author... ROBERT L. EVANS
-Company ................ REDE ENERGY CALCULATIONS
Telephone .............. (909) 792-1429
-Compliance Method...... MICROPAS4 by Enercomp, Inc.
Climate Zone........... 15
Building Permit
Plan Check Date
Field Check/ Date
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -FORM MF -1R
User#-MP0978 User -REDS ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
Lowrise residential buildingssubject to the Standards must contain these
measures regardless of the compliance approach used. Items marked with an
asterisk (*) may be superseded by more stringent compliance requirements listed
on the Certificate of Compliance. When this checklist is incorporated into the
permit documents, the features noted shall be considered by all parties as
binding minimum component performance specifications for the mandatory measures
whether they are shown elsewhere in the documents or on this checklist only.
BUILDING ENVELOPE MEASURES
Design? Enforce-
er ment
*150(a): Minimum R-19 ceiling insulation.
150(b): Loose fill insulation manufacturers labeled R -Value.
*150(c): Minimum R-13 wall insulation in framed walls i
(does not apply to exterior mass walls).
*150(d): Minimum R-13 raised floor insulation in framed floors;
minimum R-8 in concrete raised floors.
150(i): Slab edge insulation - water absorption rate no greater
than 0.3%, water vapor transmission rate no greater than 2.0
perm/inch.
118: Insulation specified or installed meets CEC quality
standards. Indicate type and form.
116-17: Fenestration Products, Exterior Doors and Infiltration/
exfiltration controls
a. Doors and windows between conditioned and unconditioned
spaces designed to limit air leakage.
b. Manufactured fenestration products have label with
certified U -value, and infiltration certification.
c. Exterior doors and windows weatherstripped; all joints
and penetrations caulked and sealed.
150(g): Vapor barriers mandatory in Climate Zones 14 and 16
only.
150(f): Special infiltration barrier installed to comply with
Sec. 151 meets CEC quality standards.
150(e): Installation of Fireplaces, Decorative Gas Appliances
and gas logs
1. Masonry and factory -built fireplaces have:
a. Closeable metal or glass door
b. Outside air intake with damper and control
c. Flue damper and control
2. No continuous burning gas pilots allowed.
MANDATORY MEASURES CHECKLIST: RESIDENTIAL Page 5 MF -1R
Project Title.......... Date........ 02/26/95
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -FORM MF -1R
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
SPACE CONDITIONING, WATER HEATING AND PLUMBING SYSTEM MEASURES
Design- Enforce-
er ment
110-13: HVAC equipment, water heaters, showerheads and faucets
certified by the CEC.
150(i): Setback thermostat on all applicable heating systems.
150(j): Pipe and Tank insulation
1. Indirect hot water tanks (e.g., unfired storage tanks or
backup solar hot water tanks) have insulation blanket (R-12
or greater) or combined interior/exterior insulation (R-16
or greater).
2. First 5 feet of pipes closest to water heater tank, non -
recirculating systems, insulated (R-4 or greater).
3. All buried or exposed piping insulated in recirculating
sections of hot water system.
4. Cooling system piping below 55 degrees insulated.
5. Piping insulated between heating source and indirect
hot water tank.
*150(m): Ducts and Fans
1. Ducts constructed, installed and sealed to comply with UMC
sections 1002 and 1004; ducts insulated to a minimum
installed value of R-4.2 or ducts enclosed entirely within
conditioned space.
2. Exhaust fan systems have backdraft or automatic dampers.
3. Gravity ventilating systems serving conditioned space have
either automatic or readily accessible, manually
operated dampers.
114: Pool and Spa Heating Systems and Equipment
1. System is certified with 78% thermal efficiency, on-off
switch, weatherproof operating instructions, no electric
resistance heating and no pilot light.
2. System installed with:
a. At least 36 inches pipe between filter and heater for
future solar heating.
b. Cover for outdoor pools or outdoor spa.
3. Pool system has directional inlets and a circulation
pump time switch.
115: Gas-fired central furnace, pool heater, spa heater or
household cooking appliance have no continuously burning
pilot light (Exception: Non -electrical cooking appliance
with pilot < 150 Btu/hr.).
LIGHTING MEASURES
Design- Enforce-
er ment
150(k): 40 lumens/watt or greater for general lighting in
kitchens and rooms with water closets; and recessed ceiling
fixtures IC (insulation cover) approved.
COMPUTER METHOD SUMMARY Page 6 C -2R
Project Title.......... Date........ 02/26/95
Project Address........
LA QUINTA
Documentation Author... ROBERT L. EVANS
'Company ................ REDE ENERGY CALCULATIONS
Telephone .............. (909) 792-1429
-Compliance Method..'.... MICROPAS4 by Enercomp, Inc.
Climate Zone........... 15
Bui ing Permi
Plan Check Date'
Field Check/ Da e
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -FORM C -2R
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
MICROPAS4
ENERGY USE
SUMMARY
Energy Use
Standard
Proposed
Compliance
(kBtu/sf-yr)
Design
Design
Margin
Space Heating..........
2.59
2.20
0.39
Space Cooling..........
30.80
29.80
1.00
Water Heating..........
11.76
11.76
0.00
Total
45.15
43.76
1.39
*** Building complies
with Computer Performance ***
Zone Type
.HOUSE
Residence
GENERAL INFORMATION
Conditioned -Floor Area.....
Building Type ..............
Construction Type .........
Building Front Orientation.
Number of Dwelling Units...
Number of Building Stories.
Weather Data Type..........
Floor Construction Type....
Number of Building Zones...
Conditioned Volume.........
Footprint Area .............
Ground Floor Area..........
Slab -On -Grade Area.........
Glazing Percentage.........
Average Ceiling Height.....
2026 sf
Single Family Detached
New
Front Facing 90 deg (E)
1
1
ReducedYear
Slab On Grade
1
19247 cf
2026 sf
2026 sf
2026 sf
14.1 % of FA
9.5 ft
(Package D)
BUILDING ZONE INFORMATION
Floor # of Vent Special
Area Volume Dwell Cond- Thermostat Height Vent Area
(sf) (cf) Units itioned Type (ft) (sf)
2026 . 19247 1.00 Yes Setback 2.0 n/a
.COMPUTER METHOD SUMMARY Page 7 C -2R
Project Title.......... Date........ 02/26/95
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -FORM C -2R
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
OPAQUE SURFACES
Area U- Insul Act Solar Form 3
Surface (sf). value R-val Azm Tilt Gains Reference
HOUSE
Location/
Comments
1 Wall 302 0.024 R-40 90 90 Yes TYPICAL
2 Wall 310 0.024 R-40 270 90 Yes TYPICAL
3 Wall 617 0.024 R-40 180 90 Yes TYPICAL,
4 Wall 575 0.024 R-40 0 90 Yes TYPICAL
5 Roof 2026 0.029 R-38 0 0 Yes None ATTIC
6 Door 24 0.330-R-0 90 90 Yes None ENTRY
7 Door 18 0.330 R-0 180 90 No None GARAGE
PERIMETER LOSSES
Length F2 Insul Solar
Surface (ft) Factor R-val Gains Location/Comments
HOUSE
8 S1abEdge 127 0.900 R-0 No TO OUTSIDE
9 S1abEdge 85 0.720 R-0 No TO OUTSIDE
FENESTRATION SURFACES
# of Vent Sc Sc Interior
Area Pan- Frame Open U- Act Glass Int Shading/
Surface (sf) es Type Type value Azm Tlt Only Shade Description
HOUSE
1 Window 44.0 2 Metal Slider 0.870 90 90 0.77 0.66 drapes
2 Window 70.0 2 Metal Slider 0.870 270 90 0.77 0.66 drapes
3 Window 48.0 2 Metal Slider 0.870 180 90 0.77 0.66 drapes
4 Window 90.0 2 Metal Slider 0.870 0 90 0.77 0.66 drapes
5 Door 34.0 2 Wood Hinged 0.650 90 90 0.77 0.66 drapes
THERMAL MASS
Area Thick Heat Conduct- Surface
Mass Type (sf) (in) Cap ivity R -value Location/Comments
HOUSE
1 S1abOnGrade 1196 3.5 28.0 0.98 R-2.0 CARPETED
2 SlabOnGrade 830 3.5 28.0 0.98 R-0.0 L.R KIT FAM RM. BATHS
System Type
HOUSE
Gas
AirCond
HVAC SYSTEMS
Minimum Duct
Efficiency Location
0.780 AFUE Attic
10.00 SEER Attic
Duct Duct
R -value Efficiency
R-4 0.825
R-4 0.803
COMPUTER METHOD SUMMARY Page 8 C -2R
Project Title.. ....... Date........ 02/26/95
MICROPAS4 v4.02 File-DT2026A Wth=CTZ15S92 Program -FORM C -2R
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
WATER HEATING SYSTEMS
• Number Tank External
in Energy Size Insulation
Tank Type Heater Type Distribution Type System Factor (gal) R -value
Water Heater to meet minimum CEC Standards
SPECIAL FEATURES/REMARKS
HVAC SIZING Page 9 HVAC
Project Title .......Date........ 02/26/95
Project Address........
LA QUINTA-
Documentation Author... ROBERT L. EVANS
•Company ................ REDE ENERGY CALCULATIONS
Telephone .............. (909) 792-1429
.Compliance Method...... MICROPAS4 by Enercomp, Inc.
Climate Zone........... 15
Bui ing Permit
Plan Check Date
Field Check/ Da e
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -HVAC SIZING
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
GENERAL INFORMATION
Floor Area... ............ 2026 sf
Volume.. ........... 19247 cf
Front Orientation.......... Front Facing 90 deg (E)
Sizing Location............ LA QUINTA
Latitude... ........ 33.7 degrees
Winter Outside Design...... 29 F
Winter Inside Design....... 70 F
Summer Outside Design...... 112 F
Summer Inside Design....... 78 F
Summer Range...... ..... 30 F
Interior Shading Used...... No
Exterior Shading Used...... No
Overhang Shading Used...... No
Latent Load Fraction....... 0.20
HEATING AND COOLING LOAD SUMMARY
Sensible Load....... 36511 33965
Latent Load ...................... n/a 6793
Minimum Total Load 36511 40758
Note: The loads shown are only one of the criteria affecting the selection
of HVAC equipment. Other relevant design factors such as air flow
requirements, outdoor design temperatures, coil sizing, availability of
equipment, oversizing safety margin, etc., must also be considered. It is
the HVAC designer's responsibility to consider all factors when selecting
the HVAC equipment.
Heating
Cooling
Description
(Btuh)
(Btuh)
Opaque Conduction and Solar......
11948
4926
Glazing Conduction .............
9895
8206
Glazing Solar .....................
n/a
8920
Infiltration .....................
11349
6726
Internal Gain ....................
n/a
2100
Ducts... .........................
3319
3088
Sensible Load....... 36511 33965
Latent Load ...................... n/a 6793
Minimum Total Load 36511 40758
Note: The loads shown are only one of the criteria affecting the selection
of HVAC equipment. Other relevant design factors such as air flow
requirements, outdoor design temperatures, coil sizing, availability of
equipment, oversizing safety margin, etc., must also be considered. It is
the HVAC designer's responsibility to consider all factors when selecting
the HVAC equipment.
HVAC SIZING Page 10 HVAC
Project Title.......... Date........ 02/26/95
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -HVAC SIZING
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
V
CONDUCTIVE TOTALS FOR GLAZING SURFACES 9895
INFILTRATION: (Type: Medium)
19247 cuft x 0.80 ac/hr x 0.018 Btu/cuft-F x 41.0 = 11349
SUBTOTAL 33192
DUCT HEAT LOSS: Duct Location: Attic 0.10 x 33192 = 3319
TOTAL HEATING LOAD: 36511
HEATING LOAD
CALCULATIONS
•DESIGN CONDITIONS FOR ZONE
'HOUSE':
WINTER DESIGN TEMPERATURES:
Inside Temperature ................................
70.0
F
Outside Temperature ...............................
29.0
F
DESIGN TEMPERATURE DIFFERENCES
Standard ..........................................
41.0
F
CONDUCTIVE HEAT LOSS:
U -value
Heat
Area
(Btu/hr-
TD
Loss
Description
Orientation
(sgft)
sqft-F)
(F)
(Btuh)
Wall
East
302
x 0.024
x
41.0
= 297
Wall
West
310
x 0.024
x
41.0
= 305
Wall
South
617
x 0.024
x
41.0
= 607
Wall
North
575
x 0.024
x
41.0
= 566
Roof
Horizontal
2026
x 0.029
x
41.0
= 2409
Door
East
24
x 0.330
x
41.0
= 325
Shaded Wall
n/a
18
x 0.330
x
41.0
= 244
S1abEdge
n/a
127
x 0.900
x
41.0
= 4686
SlabEdge
n/a
85
x 0.720
x
41.0
= 2509
CONDUCTIVE
TOTALS FOR OPAQUE
SURFACES
11948
Double Window
East
44
x 0.87
x
41.0
= 1569
Double Window
West
70
x 0.87
x
41.0
= 2497
Double Window
South
48
x 0.87
x
41.0
= 1712
Double Window
North
90
x 0.87
x
41.0
= 3210
Double Door
East
34
x 0.65
x
41.0
= 906
CONDUCTIVE TOTALS FOR GLAZING SURFACES 9895
INFILTRATION: (Type: Medium)
19247 cuft x 0.80 ac/hr x 0.018 Btu/cuft-F x 41.0 = 11349
SUBTOTAL 33192
DUCT HEAT LOSS: Duct Location: Attic 0.10 x 33192 = 3319
TOTAL HEATING LOAD: 36511
HVAC SIZING Page 11 HVAC
Project Title.......... Date........ 02/26/95
MICROPAS4 v4.02 File-DT2026A Wth-CTZ15S92 Program -HVAC SIZING
User#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
COOLING LOAD CALCULATIONS
,DESIGN CONDITIONS FOR ZONE 'HOUSE':
SUMMER DESIGN CONDITIONS:
Inside Temperature ................................ 78.0 F
Outside Temperature...............................112.0 F
Temperature Range ................................. 30.0 F
DESIGN EQUIVALENT TEMPERATURE DIFFERENCES
Standard...... ................................ 34.0 F
Frame Walls and -Doors.. 32.6 F
Ceiling Under Vented Attic ................... 53.0 F
FramePartitions .................................. 24.0 F
CONDUCTIVE
HEAT GAIN:
Shading
Gain
Orientation
U -value
x 0.67
Heat
East
44
x
Area
West
(Btu/hr-
TDeq
Gain
Description
Orientation
(sqft)
32
sqft-F)
(F)
(Btuh)
Wall
East
East
302
x
0.024
x 32.6 =
236
Wall
West
310
x
0.024
x 32.6 =
243
Wall
South
617
x
0.024
x 32.6 =
483
Wall
North
575
x
0.024
x 32.6 =
450
Roof
Horizontal
2026
x
0.029
x 53.0 =
3114
Door
East
24
x
0.330
x, 32.6 =
258
Shaded
Wall
n/a
18
x
0.330
x 24.0 =
143
CONDUCTIVE
TOTALS
FOR OPAQUE
SURFACES
4926
Double
Window
East
44
x
0.87
x 34.0 =
1302
Double
Window
West
70
x
0.87
x 34.0 =
2071
Double
Window
South
48
x
0.87
x 34.0 =
1420
Double
Window
North
90
x
0.87
x 34.0
2662
Double
Door.
East
34
x
0.65
x 34.0 =
751
SOLAR HEAT GAIN:
Description
Double Window
Double Window
Double Window
Double Window
Double Door
CONDUCTIVE TOTAL FOR GLAZING SURFACES 8206
EXTERIOR SOLAR TOTAL (Sext) 8920
INFILTRATION: (Type: Medium)
19247 cuft x 0.57 ac/hr x 0.018 Btu/cuft-F x 34.0 = 6726
Area
Shading
Gain
Orientation
(sgft)
x 0.67
SHGF
East
44
x
73
West
70
x
73
South
48
x
32
North
90
x
15
East
34
x
73
EXTERIOR SOLAR TOTAL (Sext) 8920
INFILTRATION: (Type: Medium)
19247 cuft x 0.57 ac/hr x 0.018 Btu/cuft-F x 34.0 = 6726
Heat
Shading
Gain
Coeff.
(Btuh)
x 0.67
= 2154
x 0.67
= 3426
x 0.67
= 1030
x 0.67
= 905
x 0.57
= 1405
EXTERIOR SOLAR TOTAL (Sext) 8920
INFILTRATION: (Type: Medium)
19247 cuft x 0.57 ac/hr x 0.018 Btu/cuft-F x 34.0 = 6726
HVAC SIZING Page 12 HVAC
Project Title........... Date........ 02/26/95
EUs
MICROPAS4 x4.02 File-DT2026A Wth-CTZ15S92 Program -HVAC SIZING
er#-MP0978 User-REDE ENERGY CALCULATIONS Run -SINGLE FAMILY RESIDENCE
INTERNAL GAIN: 4 Peoplex 225 Btu/person + 1200 Btu (appliance) = 2100
SUBTOTAL 30878
DUCT HEAT GAIN: Duct Location: Attic 0.10 x 30878 = 3088
LATENT LOAD:
ti
TOTAL HOURLY SENSIBLE HEAT GAIN 33965
0.20 x 33965 = 6793
TOTAL COOLING LOAD 40758
PUNCH LIST
� �- • lei List No.
Projectyv No. Sheet I of Sheets
Location V e "
Date
Inspection was conducted at above project by —f=L,4 at o'clock this date..
REPRESENTATION
CONTRACTOR -OWNER ENGINEER
Contractor: ' I 1, ,�n� � Project Mg/Eng.
Owner:?,)AResident Project Rep.
The following items are to be corrected or completed to comply with the contract documents:
DISTRIBUTION: 1. Project Manager
2. Contractor's Representative
`3. Resident Project Representative
4. File
Fisk Form 17-1
JP
cs /' %I/. NE
HER
M
�. _• � i . � 1 . ter.. �
___-
•Ai Ait vii T.ISI
DISTRIBUTION: 1. Project Manager
2. Contractor's Representative
`3. Resident Project Representative
4. File
Fisk Form 17-1