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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
-Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
% MRS *zE _7£11_111148
pate �� t `)L Signature of Contractor' -
OWNER -BUILDER DE LARATION
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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those, provisions.
,Pate: •", 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.
t
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
.the above-mentioned property for
inspection purposes.
iiig ture (Owner/Agent) /' "".*ra - , � ""' " Date •� f- `9�
BUILDING PERMIT PERMIT#
DATE f VALUATION LOT 9807-12a TRACT
7
�l t + G'14 1, 1ft;:�4ti.1 U3 25429
JOB SITE
APN
ADDRESS 7-4-111'.501 COVOTE CRE .EX
769-5.504132
OWNER
CONTRACTOR/DESIGNER/ENGINEER
IMiNlSTRELLt-1y UN'' ED COVE,. INC,
MINIS i"l2ELLI-PA'1T7't20 COVE 'INC
-0445 .M,-)i.[WIA.tN S1-i.AI.)O hlS RD
50445 MOUNTAIN SMAC: AIS RD
[A QU1N't'A. CA, 9,1253
il+.•}AC.AHN'1tpA CA 92253
M1125
USE OF PERMIT
ai*'U - t' i- 4i f i.,)OL:S NO T iNCLUDDE FILCI0K
PUBLIC* PLACES GRI-.VIT 01- 5176.37 Pi -,'1i; AORRMIP4IEN!" WITH (X*,AN1U1Ni *Y
�
DVVf;Le. MfVft_-NT fXY; Alt'!°t14RNT.
2,80 ,00 ,,,IF
t1t RfV% YC:AR.t (dlVV 73t.00 .91.
COST OF COtd.4'-f'R t1t..°UMN
110,54100
iN- Fit 7 t El t -t}(1() %) ! K -()(3f) SlIN8011
t37,A d 11;1111 r"t: FEi? 1(111-0110-4314-3!9 $751M
101 .000-4-19-31-9, -3251).())
Altit;11�1N[t;Aj. i t;i, it)i-GP6_42t-11111X11 $.105.01+
tz!,}ae;".1Lti('111.Irl F: 101-t!()0-JI20-(K)0 S185.19
tot iIN1111N(1Vl.f•' !(111-{(fl11• 141-(tl1S! 11W 51)
,/,r`.,'�3 ' 0,N IIU 'R 1t? IW -0.00 1,210.000 $170540
11'1 rL JlA'1 'i l 1'�1 1.1:, � 1\ 1 •L
Ciitr\ lwl i i.L. 101-00-4234)00 km.W
t
dNi l4A. ,lf3t+>:`f'CtkT:,t3iFi 21:� 4)(Nt-H•i3-?cf2 $3,745.71
AtiT P4 11f .!(I PI,A07,'1yfj7('tl-f?(}()_25s._wn $17f 37
ta''70._11
1)1<:(,"C31' '(-;C0 ;�"7'l�+tYs ,"�'? N �tNf 1 PI, A'Id t;!'1 t;
fit1,()?S,rit
ES,. PRE41AID .i"l:ES
426.37
RECEIPT
DATE
BY r
DATE FINALED
INSPECTOR
'\
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS,
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
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
BLOCKWALL APPROVALS
POOLS - SPAS
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
Waste Lines
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
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
Utility Notice (Perm)
COMMENTS:
is L4 9g S
a
01Lb BEMauEob By 7rz3�9sz�
_ s TY OF LA QUINTA
�G & SAFETY DEPARTMENT
I. 777-7012
r� INSPECTION REQUEST LINE
777-7153
Owner , MTNICTRVT,111-PAINTED COVE, INC.
Contractor MINiSTR E i i i D A i1�TTii it !`n`JE, WC
Permit Number 9807-121
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-195 COYOTE CREEK
SFD - PERMIT DOES NOT INCLUDE BLOCK
WALLS OR POOL
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
rj
FOOTING STEEL
AIX
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF
/ i. AO,.
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
-
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL :Li• L Z y
PLUMBING
FINAL GAS TEST
H EATING - A/C
HOUSE NUMBERS
JOB COMPLETED -
TEMP POWER ci
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
• f�G1 �iti1C�/ q507 - 12 �
P.O. BOX 1504 APPLICATION ONLY
Building 19 / 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner
MailinRel cl s- u e- � a BUILDING: TYPE'CONST. OCC. GRP.
Address SD 11415 440v /771/* C y*Y49 W4j A.P. Number ` / 6 0.3,2
City Zip Tel.
OU%—I ,� 9Zz5�3 SG%��'!�� Legal Description �^ / 7 P _2SW`9
Contractor �/J Project Description
Address
State Lic. City
& Classif. X 93599 I Lic. # Ga
Designer �!
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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
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
thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
17 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, Buisness 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 properly, 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 contractors) licensed pursuant to the Contractor's License Law.)
17 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
r7 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 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 slate 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 aOpficant Date
Mailing Address
City, State, Zip
Sq. Ft. No. Stories
NO.
Size p� Stories Unitss
New O Add O Alter O Repair ❑ i
i f f''4AA1 /<" L i XE
,P/-,4 At /d
3timated Valuation
PERMIT AMOUNT
Plan Chk. Dep. �,�Q
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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
4
Issued by: Date` Permit
Validated by: F A I Z
6 �V 1�-
Validation:
-� - - JUN 091998_
WHITE = FINANCE �_. YELLOW = APPLICANT PINK = BUILDING DIVISION. r� t ,g 17 ► �' ;"?
` Notice:
Document Cannot Be Duplicated
Date 7/6/98
No. 17287
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Jurisdiction
Owner NameMinistrelli
No. 79-185 Street Coyote Creek
City La Quinta zip 92253
Tract #
Lot # 38
Type of Development Single Family Residence
Comments
n er grandtathered agreement, 2,802 sq. ft.
APN # 769-550-032
La Quinta
Permit #
Log #
Study Area
Square Footage 1
No. of Units 1
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:
Under Mitigation Agreement
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Mitigation Agreement irt,the amount of
628.00 X 1 or $ 628.00 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
y'",
'1
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $628.00
' Check No. 08304
Signature �Qjj�
NOTICE: Pursuant of Ass Mbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run fro;i�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
collect.them on the Dislrict('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
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: SFD
Occupancy Group: . R3
79-185 COYOTE CREEK
Type of Construction: VN
Bldg. Permit No.: 9807-121
Land Use Zone: RM
Owner of Building: MINISTRELLI PAINTED COVE INC Address: 74-785 HWY 111 SUITE 105
Building Offic
City: INDIAN WELLS CALIFORNIA 92210
By: KIRK KIRKLAND
Date: 3-31-99
POST IN A CONSPICUOUS PLACE
ESI/FME, Inc.
STRUCTURAL ENGINEERS & CONSULTANTS
July 20th, 1998
MINISTRELLI CONSTRUCTION CO.
50-445 Mountain Shadow
La Quinta, CA 92253
ATTN: Kevan Peters
r%9 / ?S 6y6 6E.-4
RE: Roof Truss Calculations and Layouts on "PAINTED COVE", Plan 10A" -Lot 38 to
be built.in La Quinta for MINISTRELLI CONSTRUCTION CO. (ESI/FME 997-8246 /
BBG 124-0612)
Dear Mr. Peters:
We have reviewed the calculations and layouts by SPATES FABRICATORS and they appear
to comply with the requirements of our calculations and plans.
The review of these drawings does not relieve the contractor from compliance with the
drawings and specifications. This check is only for review of general conformance with the
design concept of the project and general compliance with the information given in the contract
documents. The contractor is responsible for confirming and correlating all quantities and
dimensions, selecting fabrication process and techniques of construction, coordinating his
work with that of other trades, and performing his work in a safe and satisfactory manner.
In addition at your request, Our Office will provide field observation for the above mentioned
project.
Thank you for your attention to this matter. Please do not hesitate to contact us if we can be
of further assistance to you on this project.:
Sincerely,
ESI/FME, Inc.
1921 E. CARNEGIE AVE., UNIT 3-J, SANTA ANA, CA 92705 • Ph. (949) 261-f811 / FAX (949) 261-8506
W--..6-98 TUE 9:35
I
I
ESI FME INC
FAX N0. 7142618506
ESI/1=ME, Inc..
STRUCTURAL ENGINEERS & CONSULTANTS
FIELD REPORT
SITE VISIT NO.: O N E
PROJECT:
PAINTED COVE - PLAN 10A- LOT38
BUILDER :
MINISTRELLI CONSTRUCTION
LOCATION:
La Quinta, California
ARCI IITECT:
1380 ARCHITECTS
ATTENTION:
Jerry with Mlnlstrelli
5
6
DATE
Oct. 6.1 Ago
PROJFCT NO 991-8246
CLIENT NO:
BBG
FILE NO :
FR10LQ38
SHEET NO :
1 OF 3
PROJECT SUMMARY
6inglo Family hnuRe Is situated in a developed area.
Field Observation on Or:tobar 2nd, 199ti with Cliff
FIELD OBSERVATION
The following stiuctwel Items were ohserved and need to be addressed:
For locatlon and clariftcatiurl of items, refer to photo reduaon of framing
plan on following sheet Extenur walls and Celling were paper lath and Interior insulutod
at the lime of visit.
9ADAW
Provide 112" die ttuvaded rod witq Simpson Set Epoxy Tic emhndded 4 114" into
monnthle foundatlon fur rmiesing ailchlbr holis.
Gary(jg._dnd Service. nm:
Rear of Garage: I'lovide additinnal Simpson A35's per Detall D1/SD3 at 16" O.C.
MASTERBFI)- OM AND MA$TERBAIH
Shear wall at Right side of MBR: Missing anchor bolls under shoor wall, provided fox
per item Ni above.
Btwn Garage end Library: Provide Simpson TS22 fioln Mono Girder Truss over
Library to well el loll side of GarAgn per Deleil 6I/SD3.
Well in Front of Library. Provide Simpson A35's or 8impAon 1-11'1 per Detail G1/Sr)3.
Llhrary, Kitchen, Dining.Room, Envy and LI1/Iny R000i
ShAar wall btwn Entry and f uwder Rm: WAIng anchor bulls, provided fix per Item#1
above.
t17Y1 E. CARNCGiC AVE., UNIT 3.1, BANTA ANA, GA 92/0b - Ph. (549) 201.1811 / FAX (049) 9$1.8606
P. 02
" 0 6-98 TUE .9: 35 ES I FME I NO FAX N0. 7142618506
ESI/F-ME, Inc.
STRUCTURAL ENGINEERS & CONSULTANTS
FIELD OBSERVATION: "Pulnted Cove"- PLAN 10A, Lot 38 nate: Qq(, 2, 1990
MINISTRELLI CONSTRUCTION ESI/FMC J.N. 887-8249
B [QQm 112 angla Sheaf No.: 2
7 Wall of Right siclu of DRff3: ProviCle Simpson Ht's at 24" o.,c. or Slmp6on A3.5'v at
Q 24" o.r.. per Delaii GVS03.
DISCLAIMER: THIS WAS A WALK-THRU REVICW. WE DID NU r INSPECT THIS
BUILDING. OUR OB8LRVATIQN WAS ONLY POR OBVIOUS PLAN OMISSION. A
UETAII.FO AND CON1131 ETE REVIEW WAG NOT PEKFORMEO
ISSUED BY:
ESI / FMC, INC.
STRUCTURAL LNGINCERS
BY:
Danny Mutuumofo, C.E.
a
COPIES TO:
(3) MINSTRELLI CONSTRUCTION
(fax) Athl: Jerly
0) BEG ARCHITECTS
Attn: Anton Marinkovwh
1e21 E. CAF1NLUIE AVP., UNIT yJ, SANTA ANA, VA 92708 • Pn. (M) 281.1$11 / FAX (040) 7614-11%
P, 03
OCT- 6-98 TUE 9:35 ESI FME INC FAX NO. 7142618506 P,04
E S I F M E I
STRUCTURAL EMOINEERS Dam 3-4-98
JN. 007-8248.8
'PAINTED COVE"'I 'M'INISTRELLI
LaOulnis, Callforidu
PLAN 10
v.
0
. .• Coop fl &L 19 L4 98 D
OF LA QUINTA
Of, oG & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
:• 777-7153
Owner MTNTCTRFI,T,T-PAINTED COVE, INC.
Contractor rTT�rTc rn T i i D A=zt�T�iY-b011E, !NC
Permit Number 9801-171
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-1 RS CnV01E CREEK
SFD - PERMIT DOES NOT INCLUDE BLOCK
WALLS OR POOL
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
t) - 5 -:Z?
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
S. .. �. :.3-r .,.��t.c,. 3 , .s _ .. .- ry,..--�.»,,.a�.;Aci�id'I.7r w•>•�> ..�i:�R'S""r'.
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
O REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
JOB LOCATION
Q ("/�"'� n+., i Q� e
r
LA TX
REPORT SEQUENCE NO.
_j
T'�F�RI�CTURE
PERMIT NO.
DAO /�� ^
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPECTOR
MRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPESUB
DTE CTION
CONTRAGENECTOR /� -�
CONTRACTOR Q Lk
T7
`'
op)SE�Vt-�
X "
A lR��
l2i Lt \
&A 1-4 C-�
C) V C -y
0-^, -iP o 1c y
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
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.
C `
C�2J1/'
SIG � AT� � F R G1ISTERED INSPECTOR����
DATE OF REPORT REGISTER NUMBER
CT1
14 RECV Paiool Ave. Desert,, CA 92211
etAD ,. Office (760) 772-7192
INSPECTION'� SApe4ax (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
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
JOB LOCATION
-� �]� ) �j t� �O ` /'�
/
- --� j� .` � _
(71`
REPORT SEQUENCE N0.
TYPE QF R�TURE
PERMIT NO.
DATTE1/ U
10
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL v
CONTRACTOR
SUB
CONTRACTOR �^ (� PA -
10107
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,S (wYOS am,— o
41
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COPY SENT TO CLIENT O
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.
SIGN TURE OF R
DATE OF REPORT
VSTERED INSPECT013
REGISTER NUMBER