0106-088 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F CFi2ter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
/License # Lic. Class Exp. Date
ate ^ � � Signature of Contractor, ��`•' �
U
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) 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.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
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
supject to the workers' compensation provisions of Section 3700 of the Labor
Gode, I -shall forthwith comply with those prouisi6nO
„✓Date: P 142Z 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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon
thelldbove-mentioned property for inspectiort purposes.
tS gnature (Owner/Agent) ? • Date %
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS
APN
}". -'1:M Ct?�s' ,!AAL
'17€3-370-021
OWNER
CONTRACTOR/DESIGNER/EN (NEER
TRA M09 CLUB ASSO MMS
"D)T2EW YLEMCE MRA3,1qM
78.304 OLD VE'1RM S2
40.15 DrM (AXYO%7M)
LA QUINT A. C.`'roA. 92253
PALbADE+ t,i CA, 92261.
(760)346-3228 CSU# 03031
USE OF PERMIT i
+i'MIA FAMILY DWK .3HO
10PUAI T DOBE NOTINCLUDER BLOC `iV Ai.. JPO0Ltti31UVF.W iY
.APPRO'ACz"-COMPUANCE WITH ALLMMAL &-STNR,', LAM NNCL111 D40
THE Ln4D ti*,H0'ZRV,,0 SPECTE3 ACT OF 19'%f' 1li'.f• PPLICAi3LY,,r'IS Rc,9v.'4,CA
PORCMATIO 2.77.00 SF
CMACt1?,�C.;, RPOnT 843.00 3?
'F`WMA`7C1. COU OF C CDN91MUC'TION
247JX21.99
iV'1'r MIU1FEE Ww111 Ry
Cl'?AfFa"1'} UC:t'It`)N FRY, 101-000641.6-000 i1,1mo
Pa-" c.",13:M':9. FIV 101-000-439-318 100.40
#I2. M911 1011.000.439-318 - ,iS0
lt6Ai91•iAMCAL V N+' 101400-421 -000 $261sa
F•U P-TAiICAL FEE 101-000-.420-000 $194.41
$214.25
P'Z,.tCYtr4LA�TtEf6ft�h�+� ,
p e�Y ry St 101 -000-241
S'�rYwE�.M!'iY MOT 1101E b' li - RNSID 01 -1+00-241-WO X724. 19
CLRAOM YKEi w 101-000.4,23.000 PROD
AXT 1H NUBM 1'lACYS - fiiAM.EI: 701 -000 -255 -OW ",4D39.Eff
fl Art
13•'1 . C 9 tti1 1t�N T i�P CX
I � H l . A -TAM ITEM
:�;�1,i1 0.65
4750,00
AUG
'1'MAL + . 5(1 IND t t I.VQW,
$4,020.0
OFLaTW__ �
RECEIPT
DATE
BY
DATE FINALEDINSPECTOR
5 —.170 -oma
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
4
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
Underground Ducts
Ducts
��v-01
Slab Grade
Return Air
Steel
_
Combustion Air
Roof Deck
%/ Z, K
Exhaust Fans
O.K. to Wrap
—Q
_ //C-
F.A.U.
Framing
_�
Compressor
Insulation
r_G/L —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party -Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
_
Final
Final
�l
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
WaterlinesQ
_� Ol ��
!!
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
t
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility No
. J _ ,��_ ..... ,,.. , .. 5�. .. -• ''y�,'..r�-.-. .F•.:,�".•-, x -'iY .��,��:.»..:�",,�i(yr,.. ,.r.,t74' ;:+°sf..�-..r"r. �, n
eq
• ����I{�
'7$ -! 30 Cora( C -ane P.O. BOX 1504 APPLICATION ONLY
Building 78-495 CALLE TAMPICO
Address 'i12,A4T- is +✓OT 11 LA QUINTA, CALIFORNIA 92253
Owner
maning
Address 4.4 PZC7
City Zip
e. 0.
Contractor
Address
City Zip
BUILDING: TYPE'CONST. OCC. GRP.
4p4yolq A.P. Number -?7/()- 370,- OZl
Tel. 1
el.. � Z �g Legal Description 29A -en- �T i 1
Project Description -
Tel.
f zt 3 2.2
State Ljc.3 I City
C�f Z 0
8 Classif. v Lic. #
Arch., Engr.,
Designer
Address t Tel.
I q( Y-) iu1 x'T- �� + L 94
City Zip d State'
j '�ftzV itb}1F.�� -1 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7M),Of Division 3 of the Business and Professions Code, and my license is in full force and
effec
SIGNATURE 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
lot 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 live hundred dollars ($500).
I-_, 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, andthe structure is not intended or offered for sale. (Sec. 7044, Buisness and
1. Professions Code: The Contractor's License Law does not apply to an owner of property who
III 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.)
I1 I, 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
doesnot apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a conttactor(s) licensed pursuant to the Contractor's License Law.)
t - 1'3 1 am exempt under Sec. B. 8 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
n Copy is filed with the city. O 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 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.
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
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.)
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 relting to building
construction, and hereby authorize representatives sof this city to an the above.
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip +t
Sq. Ft. 2 No. No. Dw.
Size �1J() Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
imated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure WIr
TOTAL
REMARKS FiNt��I QEPT
AMOUNT^
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 INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/31/01
No. 22339
owner NameTradtion Club Associates
No. 78-130 Street Coral Lane
APN# 770-370-021
Jurisdiction La Quinta
Permit #
Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 2930
Type of Development Single Family Residence No. of Units 1
Comments
*Received a cashier's check in the amount of $34,921.75 for 5 single family dwellings.
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
2.05 X 2,930 or $ 6,006.50 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 CC/Palm Desert Nat'l Bk -Autumn, Andrew Pierce Telephone `
Name on the check =Y
By Dr. Doris Wilson 'G
Superintendent
Fee collected &,/exepted" by Annette Barlow
Signature
Payment Received 1 $6,006.50
Check No. 082400
OWE Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to nofify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
ollect them on the District('s)(s) behalf, whichever is earlier.
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
4
CITY OF LA QUINTA
PLAN CHECK CORRECTION LIST
July 3, 2001
Gouvis Engineering
4400 Campus Drive Suite A
Newport Beach, CA 92660
PLAN CHECK NO.: 0106-088 SECOND/FINAL CHECK
JOB ADDRESS: Tradition Village Lot 11 OCCUPANCY: R3/U1
Plan 1C
TYPE -OF -CONST.: V -N
AREA-S.F.- : 3773
The submitted plans and specifications have been reviewed by VANDORPE CHou ASSOCIATES. It is
our professional opinion that the plans are in substantial conformance with the building codes and
regulations adopted by the CITY OF LA QUINTAand the State of California Amendment.
APPROVAL FOR A BUILDING PERMIT IS HEREBY RECOMMENDED SUBJECT TO OBTAINING
APPROVALS/CLEARANCES FROM ALL APPLICABLE CITY DEPARTMENTS, AGENCIES, AND
ASSOCIATIONS.
Plans checked by: 4 �
Dorothy Gordon, P.E.
VANDORPE CHOU ASSOCIATES.
295 N Rampart Street, Suite A
Orange CA 92868
(714) 978-9780 VCA File No. LQ -13204.2
JUL-31-2001 14:08 TRADITION GOLF CLUB 760 564 2356 P.01i01
q-radiff"on
ARCHITECTURAL DESIGN, REVIEW
July 31, 2001
Ms. Nickie Gormley
Building and Safety
CITY OF LA QiUINTA
78-495 Calle Tampico
La Quinta, CA 92253
Re: Tradition
Old California Village, Swimming Pools
Dear Niclde,
Via Facsimile
760-777-7011
This letter will serve as ARRC approval to obtain a building permit for the swimming pools
at the Old California Village at Tradtion. If you have any questions, please do not hesitate
to call.
Thank you.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
Aid.
cc: Jody Jones, APC (via first class main
cvM Oahn�w.on,ad.wprsn�..vwy>wd,�a
78505 OLD Av&mm 52 — L+ QutNTA — CA 92253-1120 — PHONE 760/564.3355 — FAx 760/564-2356
TOTAL P:01
Certificate of. Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
78-130 CORAL LANE
Owner of Building: TRADITION CLUB ASSOCIATES
Building Official
vti
Bldg. Permit No.: 0106-088
Land Use Zone: RL
Address: 78-505 OLD AVENUE 52
City: LA QUINTA, CA 92253
By: RICHARD KIRKLAND
Date: 05-20-02
POST IN A CONSPICUOUS PLACE
REXCO
ELECTRICAL
CONTRACTOR
TRADITION VILLAGE
PLAN 1C
LA QUINTA, CA.
Electrical Load Calculations
General load @ 3 watts per square foot (3167 X 3)
Small appliance circuits 0500 X 2)
Laundry Circuit
Ovens/Range
Dishwasher
Disposal
Washer
Dryer
Refrigerator
Microwave
PARTIAL LOAD
First 10 KVA @ 100%
Remainder @ 40%
Pool Equipment 100%
Air conditioning @ 100%
TOTAL LOAD
-n-136 Caea. 1..4
CITY OF L.A QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE �O! •2. BYI
_
10000.0
10360.0
9000.0
24000.0
53360.0
240 VOLTS / 53360 WATTS = 222 AMPS
USE 400 AMP MAIN SERVICE
Dfftc.e GCre1'
9501.0
3000,0
1500.0
9500.0
1800.0
1200.0
1200.0
5500.0
1200.0
1500.0
35901.0
Lic. #611016
78-900 Anchovy Rd., Bermuda Dunes, CA 92201,-(760) 345-8051
Enigneering
6782 Stanton Ave., Suite E, Buena Park, CA 90621 (562) 864-4121 (714) 523-0952 Fax (714) 523-1369
39-725 Garand Ln., Suite G, Palm Desert, CA 922.11 (760) 772-3893 Fax (760) 772-3895 '
March 30, 2001
Andrew Pierce Company
P. O. Box 3420
Palm Desert, California 92261
Attention: Mr. Jodie Jones
Project: The Village at Tradition
Tract No. 30056
Tradition Golf Club
La Quinta, California
Subject: Geotechnical Update
Ref: 1. Report of Observations and Testing During Rough Grading
Engineering dated July 30, 1997, Project No. 522-6138-G].
2. Geotechnical Update prepared by Sladden Engineering. dated
Project No. 444-6130.
Project No. 544-1092
01-04-152
prepared by Sladden
December 12, 1996,
As requested, we have reviewed the referenced geotechnical reports as they relate to the design
and construction of the proposed single family residences. The project site is located within the
south end of the Tradition Golf. Club. development in the City of La Quinta, California.. The
proposed development will include 13 lots for the construction of single family residences. It is
our understanding that the proposed residences will be a relatively lightweight wood frame
structure supported by conventional shallow spread footings and concrete slabs on grade. The
proposed development will require substantial regrading of the previous rough graded lots along
with the construction of various water features and the associated landscaping.
The subject lots were previously graded during the rough grading of the Tradition project site.
The rough grading included moisture conditioning and recompaction of the native surface soils
along with the placement of extensive engineered fill soils to construct the building pads. The
site grading is summarized in the referenced Report of Observations and Testing During Rough
Grading along with the associated compaction test results.
The referenced reports include recommendations pertaining to the construction of residential
building foundations. Based upon our review of the referenced reports, it is our opinion that the
structural values included in this referenced grading report remain applicable for the design and
construction of the proposed residential structure foundations. The structural values should also
be applicable for use in the design of the associated retaining walls and water features. The slope
stability calculations performed in conjunction with the preparation of the referenced reports also
remain applicable. The planned 2 to 1 slopes comply with previous recommendations and
applicable grading ordinances.
March 30, 2001 -2- Project No. 544-1092
01-04-152
Because the lots have been previously rough graded, the remedial grading required at this time for
should be minimal. The grading areas should be cleared of surface vegetation, scarified and
moisture conditioned prior to precise grading. The exposed surface should be compacted so that
a. minimum of 90 percent relative compaction is attained prior to fill placement. Fill material
Should be placed in .thin lifts at near optimum moisture content and compacted to at least 90
percent relative compaction. In areas that the grading encroaches upon the existing slopes, proper
benching should be performed during fill placement.
Allowable Bearing Pressures: The allowable bearing pressures recommended in the grading
report prepared by Sladden Engineering remain applicable. Conventional shallow spread footings
should be bottomed into properly compacted fill, material a minimum of 12 inches below lowest
adjacent grade. Continuous footings should be at least 12 inches wide and isolated pad footings
Should be at least 2 feet wide. Continuous footings and isolated pad footings should be designed
utilizing allowable bearing pressures of 1500 psf. An allowable increase of 200 psf for each
additional 6 inches of depth may be utilized if desired. The maximum allowable bearing pressure
Should be 3000 psf. The recommended allowable bearing pressures may be increased by one-
third for wind and seismic loading.
Lateral Design: Resistance to lateral loads may be provided by a combination of friction acting
at the base of the slabs or foundations and passive earth pressure along the sides of the
foundations. A coefficient of friction of 0.48 between soil and concrete may be used with dead
load forces only. A passive earth pressure of 300 pounds per square foot, per foot of depth, may
be used for the sides of footings, which are poured against properly compacted native soils.
Passive earth pressure should be ignored within the upper 1 foot except where confined (such as
beneath a floor slab). When used in combination, either the passive resistance or the coefficient
of friction should be reduced by one-third.
Retaining Walls: Retaining walls may be required to accomplish the proposed construction.
Cantilever retaining walls may be designed using "active' pressures. Active pressures may be
estimated using an equivalent fluid weight of 35 pcf for native backfill soils with level free -
draining backfill conditions. The recommended active pressure is based upon level free -draining
native backfill soils.
For sloping backfill conditions, the active pressure must be increased. The active pressure should
be increased to 55 pcf EFP when considering backfill sloping at a 2 to 1 (horizontal to vertical)
slope angle
For walls that are restrained, "at rest" pressures should be utilized in design. At rest pressures
may be estimated using an equivalent fluid weight of 55 pcf for native backfill soils with level
free -draining backfill conditions.
The bearing soils are non -expansive and fall within the "very low" expansion category in
accordance with Uniform Building Code (UBC) classification criteria. Pertinent 1997 UBC
Seismic Design parameters are summarized on the attached data sheet.
March 30, 2001 -3- Project No. 544-1092
01.-04-152
If YOU have questions regarding this letter or the referenced reports, please contact the
undersigned.
Respectfully submitted,
SLADDEN ENGINEERING
Brett L. Anderson
Principal Engineer 2
P90. C '5389
SER/pc Exp. 9-30-2 2
Copies: 4/Andrew Pierce Corporation
2/The Keith Companies
March 30, 2001
SI
Project No. 544-1092
01-04-152
1997 UNIFORM BUILDING CODE INFORMATION
The International Conference of Building Officials 1997 Uniform Building Code contains
substantial revisions and additions to the earthquake engineering section in Chapter 16. Concepts
contained in the updated code that will likely be relevant to construction of the proposed
structures are summarized below.
Ground shaking is expected to be the primary hazard most likely to affect the site, based upon
proximity to significant faults capable of generating large earthquakes. Major fault zones
considered to be most likely to create strong ground shaking at the site are listed below.
Fault Zone
Approximate Distance
From Site
Fault Type
1997 UBC
San Andreas
13.5 km
A
San Jacinto
29 km
A
Based on our field observations and understanding of local geologic conditions, the soil profile
type judged applicable to this site is So, generally described.as stiff or dense soil. The site is
located within UBC Seismic Zone 4. The following table presents additional coefficients and
.factors relevant to seismic mitigation for new construction upon adoption of the 1997 code.
c
Near -Source
Near -Source
Seismic
Seismic
Seismic
Acceleration
Velocity
Coefficient
Coefficient
Source
Factor, Na
Factor, N,,
Ca
C,,
San Andreas
1.0
1.1
0.44 Na
0.64 N„
San Jacinto
1.0
1.0
0.44 Na
0.64 N,,
c
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT OTHER',5PDXIA
❑ REINFORCED MASONRY ❑ FIRE PROOFING ////�'''//
JOB LOCATION
C1_
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
JED L
PERMIT -ft.
("(o -
DATE
10 -z - 95 1
DAY OF WEEK
MATERIAL bESCRIPTION
ARMC pHI`TOECT [� l `
INSPECTOR
HRS. CHARGED
ENGINEER
C» s
ASSISTANTS
HRS. CHARGED
INSPECTION GENERALSUB
DATE CONTRACTOR 0 'n "e/caCap. CONTRACTOR
Naw- Mo'.w\(-jA
1
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br,-hSjcA
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Ori -or 4o a
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE D
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
1
A - Q(N-Aj
SIjMURE OF RE ISTERED INSPECTOR
Sz Z4
A -US- 3226 Gg-US' 3226 tog (2
DATE OF REPORT REGISTER NUMRFR
SPEC IAL INSPECTION SERVICE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
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❑ POST TENSIONED CONCRETE ❑ ASPHALT )k OTHEREPaXa
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