0108-154 (SFD)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 f '' Exp. Date
o9/30%C
Datej 2�- - � � �"( Signature of Contractor
� w•
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 tAe 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 Sianature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) 1 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.
P,�') 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 STATEFUND Policy No. 1640366-01
(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,
hose,proviisions.
fl ! 1
'at.• :--• 2-11 '0 t Annnnnt ? /. ,.I, /
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, dam' ages 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
the above-mentioned property for inspectionfpu�poses.
Signature (Owner/Agent) , /t Date[
r
• Ji
• BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
fJOB SITE
ADDRESS 7849() C.()�'r,��T 4��31'dY()�1 Ev() APN 7,70-240-013
OWNER CONTRACTOR/DESIGNER/EN INFER
RT
NYM JACK MIME, OL'.Em
PO BOX 8963 V0 BOX 1802
RAN M. I SAN A.�'. CA 92067 ;IJAJ.a.1fi.DXq.F.. �',a. CA 92260
A))8:36-919' CM114 5123
USE OF PERMIT
8 1C?1 1< F ItAffl, Y DvXS'wwo.
S.i+') - PERMIT DOES 'NOT ;tNC:1,1'r,SU)tifSW£:1�.VA7.ih.1 ,..r511:?R TV LI`iA!AY
APPROACK COMP111AIVNC`C7. W TH AIJ., VED & I&'W1'1i;1tiANW4 r14CL
k, -H ANC 1FX, ZD SPM, FS ACT OF IM IF APPLICATiL fi IS P.1C Q';D
CUSTOM CONSTI UC' TION 4T"51001111
F'ORC HIP,A'!"I:O l,ti.woo sir
CIARA0EICARPORT 1,113100 SIF
rIkR41:�s03) COST'OF CnNSY.RTYC"�l'YN
415.7 .10
�+y. y�''y7,qq //��^^d gfq� �.v ,yv�I�'r'��//q�,,.AI, �p•A q3�q��9
C(IINVrRUC TION FEE
101-000-1,18.000
si:14515ff
PLAN C'RE01C FEE
1011_000k439_318 1
$1,45113N
FF.E0EPOISIT
301-000.439-318
-$1,000.00
MF.C".HA.NICA1LVP7,
101.000-421-000
$1 &CO
:LEC:'! RIC.;AJ , M7,
101-000-420,-000
$2001-4
PLUMBING PEF,
101-0010-419-000
$316.85
STRONO MO7110N I%W - DOSIS
101-000-2 41-000
141
OFtADIND FE -F,
101--000-423-000
$70.130
VEs'V&OPQ IMPACT RE
11,9T1,00
:A42'! IN k UB1:1C; Pl.Al: PS -•ttf7��31I :730r0OO-443-000
DEC 2 8 20111
___...-_ ----
t z
w
t
RECEIPT DATE
Y,� f' I BY 16� FIN4QED'C�� INSPECy
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs/L
AUnderground
Ducts
Forms & Footings
(
Ducts
Slab Grade
-- G�
Return Air
Steel
Cn bustion Air
Roof Deck
• O
Exhaust Fans
O.K. to Wrap
•O
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
2,
_
Final 2
BLOCKWALL APPROVALS
Final Z
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
Water Piping
/ /— L/ .
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ _
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) r��
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 6
Final 2 O
Utility Notice (Perm)
COMMENTS:
-11
Building
Address
764°10 6dq 6M � J
�-f
Ownerp)
Q�7
MJ
• >r MYS •
j4C� M A
Mailing
d •
g )
Address
City
Wto
q
sIc TAS£1'ji
20 G'7
Contractor , `a 6F_` e -r_ y� N �7 !
Aaares /` I
ty
State Lic.
& Classif.
\ / Arch., Engr.,
(X. Designer
Address
ty�
AA f lt„
BUILDING: TYPE -CONST OCC. GRP.r7 P, -'s
A.P. Number r -1- / 7Q'')_gLD_ 0I/
Legal Description L•-oT- 7� 1 ;Zbg7f0''
Project DescriptionLF_.
I-1 r- Ir /A -r HI= n C U C, - b A./1 V4 A t,A F _
Lic. # Sq. Ft -.4674 • � No. I No. Dw. I
Size• • Stories Units
el.
�2 MIT -Am
Zip- State
077, jc.#
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
1 hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
permit to construct, atter, 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 Contraetor'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 for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
l'! 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.)
1 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
doesnot 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.)
1! 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 sell -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
1`7 Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need nor be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thQ work for which this permit is issued, I shall not
employ any Parson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT., H. 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. fSec. 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
ateMailing Address
City, State, Zip
New)( Add ❑ Alter ❑ Repair ❑ Demolition O
1 n
IEstimated Valuation *700000
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOU
ZONE: BY:
Minimym Svtback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
St de Street Setback from Center Line
1 2_0 Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 12/19/01
No. 22775
Owner Name1W & Mrs. Jack Smith
No. 78-490
City La Qunita
street Coyote Canyon
APN # 769-162-001
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Tract # Lot # Square Footage 4875
Type of Development Single Family Residence No. of Units 1
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
2.05 X 4,875 or $ 9,993.75 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/La Jolla Bank - Joe Portolesi Telephone _
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $9,993.75
_ Check No. 841901
Signature
NOTICE: Pursuant of AssaImbly 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 runfro the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) or to another public entity authorized to
collect them on the Disbj (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
Tradition
August 28, 2001
Mr: Narendra Patel, Architect
69-730 Highway 111, Suite 118
Rancho Mirage, CA 92270-2873
Re: 78-490 Coyote Canyon
Dear Mr. Patel,
The Tradition Architectural Committee has reviewed your submittal of construction
drawings for the Smith residence. The plans were approved as submitted. The landscape
plan is in process now of being reviewed. I will contact you with the landscape review
comments when I have them
Thank you for your submittal and patience in our review of the plans. Construction
cannot begin.until the $5,000 construction performance deposit is submitted. The check
should be made payable to: Tradition Community Association. Please call me at 346-
1161 if you have any questions on this information.
Sincerely,
M
Mindy Gutierrez, Property Manager
Tradition Community Association
cc: . Mr. and Mrs. Smith
PCM/DESERT RESORT PROPERTY MANAGEMENT COMPANY
POST OFFICE BOX 4772, PALM DESERT, CALIFORNIA 92261-4772 • 73-550 ALESSANDRO, SUITE 5, PALM DESERT, CALIFORNIA 92260
PHONE: (760) 346-1161 FAX: (760) 346-9918
KNAPP & TANG STRUCTURAL ENGINEERS, INC.
408 S STODDARD AVENUE SAN BERNARDINO, CA 92401
(909) 889-0115 Fax (909) 889-0455
July 18, 2002
To: City of La Quinta
Building & Safety Department
Re: The Smith Residence
Lot 55
Traditions C.C.
La-Quinta, CA= -
7Y►- ygo co `csi �e c �� �
On july 17, 2002 I performed a structural inspection on the subject residence. I found
the construction to be in substantial compliance with our structural plans, and of quality
craftsmanship. I therefore, am recommending that the contractor be allowed to install
the finishes.
Respectfully submitted,
�Q Q�ESSIO4j;-"!
C - k�
C 3(577 m
l/ c� No. zo
Exp- 3-31 04 �r
Leonard C. Knapp CMS-
Engineer of Record T'�TF OF CA`\COQ'
CITY OF LA QUANTAaK
SUB -LIST
4741 C PALM CANYON,
VALLEY POOL & SPA PALM SPRINGS
CONTRACTOR ADDRESS
OWNER SMITH JOB ADDRESS 78490 COYOTE
CANYON DR
This form shall be posted on the Job with the Building Inspection Card at all times in a conspicuous place.
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that
are on this list are the same persons performing the work. Any changes to this list must be approved the
City of La Quinta Department of Building & Safety prior to work being performed by a changed sub-
contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit.
LATHING
C-26
....:...::..
...::.......
DRYWALL
SUB -CONTRACTORS
TYPE:OF .::....
S: A'IE:'::>>RK
T..::..>:;:..::...;:;.:
E R..S:
U51NES& `
18 .
TRADE
:. NAME:; : ::....:....LICENSE::
8/7/02
HVAC
C-20
ELECTRICAL
lGenerall
GATTUSO POOL
C-10
6 7 2 8 5 0
816A
ROOFING
C-39
SHEET METAL.
C-43
FLOORING
C-15
GLASS/
GLAZING
C-17
INSULATION
C-2
SEWAGE DISP.
C-42
PAINTING/
DECORATING
C-33
TILE
C-54
CABINETS/
INSTALLATION
C-6
FENCING
C-13
LANDSCAPING.
C-27
POOLS
C-53
OTHER
J & L
472187
Qq
P'ti 11�_
12/9/2001 0_5:36 8369197
ORANGE COAST 7603406455
AJPORTOLESI PAGE 02
12/07 101 11:43 NO.417 02/U4
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....�o.�....,.�.--....,.�.�...,.,.�..�.� ,w..-.�..r.�--.w—�•� ..• .....-►..«,.fir. i..-.
tj taw .1
.. .. .... � -- - .. . ,. ,. ...��a•.. x'10 -:-y�o -,.o� �
R@Cbldirlq Requested BY
NO COR FILED 4659 6 y T
NIatMII■1a111� �qoa Comp�lb _
arra. zos�o3s-�� �c �
a NIL 19 1817
AAD
IN RSOOAMAML TO. PAID DECG
4 fI tr o . Sa t c h 000. TtEtsIM To �
0. Box 8941 r Z�
aeho Sant* re, CA ' 92067 �� � ,
POCt1MEKTARY TILUREM TAX $.
.�.. fix.. as a ainvidwadoft a WON erptopaq
ey OR
%Ma AS ABOVE w Me awWwadw er tduf bac Uns or
mteme�.v*oM aa�risbj to tlm cf elb
7 70 - zw 413 *�+ r<o..Iw>.� Ayntt ddtt nut.P$to Nami
►= o2aols a�IAlrre>e�
t A VALUAMI CCNi>1DJMAT K me* at mWeb In ben by .ergo«Wg4
LDrrMN CLUB ARROCIATU = a Dwk.ran Hmbtd IbWft aWnpwy
b`v)t0 Jack C. smith Jr. and Christina A, Smith. Trustees vt the
trh ra,t&Zy Tru#t UPOT dated Babruar•y 5, 1997
+•l ply bt dw MY of Ld Quin"
OW of Ithwai* fto stwhMik da "Red u
Lot -3-5 'Ram 2f*70.1 (ape IlXM* W- AMO&W HMto)
December 6. 1997
r of C LUANaw )
) o.
)
malty blew+ m me (Of peeved Is is op 4r a 0+itt6atory
neat) to bo dw pmoeolq wlpw rton(p Wwn mr>wter{"d to the
b+ f�toet as/ aAmevrlwipd b ore dW 6o/�tYey arsenbd the
t to bislWAI.k rahedpd eapaeity(LML am am by hk4w ek.
tUM+q) a do bAw !o patroa(0) w do wuq �rpon b bdir of
ih du Ponce scM4 tlowoted �r irsva+rm.
TitAO LLC
eK Aur / te�
Its,, Aaiun g N4/ aviagaor
DR
t
t .
(M MM fm GMW MMEW Mal)
Orders MC-0000o09MITA psscriptionr 1997.463956 Page 1 of 3 CoiQment.
t
12h9/2..001.05: 36
ORANGE COAST
8369197
• 7603406455
AJPORTOLESI PAGE 03
12/07 101 11:44 NO.417 03/04
.�..--.+r..�.-•'--•-•.r... �- � .r.�r-•--.�.....�, wr..� v �.-�.4�w,� r rte.
_ �....._� .�.V � ii vt._ . ...I. r..� .. ... ..� �... � .... �.N.�I. ... .. ... .....-. r• ...� �.---� �.�- ..' IIS ..�
0r
wool"juee�ad BY 465956 T ?
.. ..�....�.,�., rte COR MED•'_ .�
Un ss --of Traet 29470-1, a 9imm by map on IDe in b6ok 263 papa '76 through 90
of maps, neon of Riverside County. Cali fomla.
T81S DEED 13 MADE AND AMPTII:D SUBJECT TO THE FOLLOWINCt
1) NozmMhtqutttq rod "ate UX -8 spassmanta.
2) AU nutters of record, including without limitstlon, that 611111 DMInatlon of
Covsrgants, Cotod Oona, ReWiction turd ReWvWon of East MIts !br tit Ty'o 6011
Community, recoMed ou )uly 25,1997 ss Insu unarm No. 262677 tlrtd re-recordcd August
13. 1997 u Irutim"an no. 292116 both of Official recank of Rlvmide County.
Calir*mK which Is Incorpototed by TIAN Once; berein a if 11g11y at forth at lettdth (1116
"Doolarstion'7. T%g Dsctat'elion includee, mnons other matters, certaln architectural gold
development guidelines and restrictions L vddvh will apply to the conrTtruatien or a
trrsidat+a on the above-described lot.
Ordarr MC-000000SMITH Description: 1997.4689$6 Page 2 of 3 t7orssmontl
,12AM/2001 05:36 8369197 AJPORTOLESI PAGE 04
ORANGE COAST 7603406455 12/07 '01 11:44 NO.417 04/04
• •w,lu.� .r,�• ,rr_.•��_....�n.ti e... .. �. r. xttnt.•1,.:�arr-:.n'N'•Irr�.T.�Y1'S'. vv:-'s--aerr.dr••• w::rse�r' .�-w-6t-� ., �:'Ir
Under the pro.►isiou of Government Code V361.71 1 cerftty under tate
penalty of perjury that the notxty teal on the doeuffWt to which this
stat Wra t is attsehed reads as follows:
Name of Notary 091,
Data Coma4slon Expb= ...►? Q-0 -- f
Place of Execution let `'rralIP L.,0>
Dom
Slestiat�rc � �Ar • L� - r ��
j
a
Orders MC-000000OUXTH DWscription: 1997.465956 Page 3 of 3 Comment:
VERIFICATION OF SQUARE FOOTAGE
STREET ADDRESS OF JOB: 78-490 COYOTE CANYON
APN: 769462-001
DESCRIPTION OF WORK: SFD
SQUARE FOOTAGE: 4875 SF
OWNER'S NAME: MR & MRS JACK SMITH
CITY OF LA OUINTA
BUILDING & SAFETY DEPT.
APPROVED
DATE
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA92253
760 7718515
SCHOOL FACILITY FEES COLLECTION HOURS
9.00 A.M. -11.30 A.M.
1.30 P.M. - 4.30 P.M.
PLEASE NOTE FEES MUST BE PAID IN CASH OR CASHIERS CHECK
Any questions regarding this letter, please call. Ed Randall,
Permit Technician,
Building & Safety Dept.,
760 777 7012
EGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY ❑ FIt,$(l A--**)
❑ POST TENSIONED CONCRETE O ASPHALT ER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LO TI (] /' CA� o
REPORT SEQUENCE NO.
TY O�SJTURE /'�
PERMIT N0.
DA
O AY OF WEEK
MATERFFff111�,/ALESC${PTjON -A-5-3
� ���
.
ARCHITECT
IN
MRS. CHARGED
�`� D �/ , ^ ��•
CJ
ENGINEER
N ii
^
(/-
ASSISTANTS MRS. CHARGED
INSPECTION RAL oArO e'& ( CONTSUB
DATE CONTRACTOR `
CONTRACTOR RACTOR
i -\
w J C
Al
16
r—
' ' s6LA
0-r, ICA
-een- 641 LA.) e-,-
8 AI;� e.c�S w o�e.s
EJ
Cow-,06/Ax
O
COPY SENT TO CLIENT ❑
CONTI
ON NEXT PAGE ❑
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
SI ATURE OF REGISTERED kPECTOR
DA Tq Of REPORT REGISTER NUMRFR
G
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
0 REINFORCED CONCRETE
0 POST TENSIONED CONCRETE
0 REINFORCED MASONRY
O STRUCT. STEEL ASSEMBLY 0
O ASPHALT 0 OTHER
0 FIRE PROOFING
JOB y�A1Q�N�
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