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9808-096 (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 Exp. Date +1i>+11 Bei 11 10"31 ! Date/�� Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury 4iA am exempt from the' ontractor'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. (N) 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. CLAW."NDOI+1IMS, II IKR_;W02-913 (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' compensate q provisions of Section 3700 of the Labor Code I shal Rforthwith comply with th s rove o -. �DateJ� Applicants�� /IV I I� 1 Warning: Failure to secure Workers Compensation coverage is unlawful and shall subject an employer to criminal penalties and ' it fines up to $100,000, in addition to the cost of compens��tio`y�, 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/e iter upon the above-mentioned property for inspection purposes. /� / ­41Sig"nature (Owner/Agent) Da r► _ !C/ t ,BUILDING PERMIT PERMIT# DATE 12115/198 VALUATION '$837,249." LOT 26,27 TRACT 27715 JOB SITE APN ADDRESS IM -00 1 TOM. FAM i,�tINE SOU 1H 761••x.12-4104 OWNER CONTRACTOR/DESIGNER/ENGINEER AILDA CO12.P SPACE, AUTLOEAS 4774 GOLF COURSE. Sl° 45350 VIA. CORONA. THOUSAND C)AKS CA 913Q INDIAN WELLS t:,'A 92210 (W,17764.500 C' 0JI 5446 USE OF PERMIT SF&GLE FAMILY DWELLINGS 1 SFD - Plal iT 1?CPHF ,.t NOT INCLUDiE 131.t:x.X WAI.i OR P0, _L DEC 1 5 1998 CU";1P TOM ;ir;d,, r xt. .'iO;v 1ii,1 Sig VO1Z.i:1WA110 1, 7064.00 Sly tilSftM,s.tk%C:;r'�I41'(Jkt'1' $,'.'.�►lf,t�iJ;.+#' j " �+ •'l a� !1 pit, �1 `r l� +�y ►f,«�rt IN INIX1 l�1M MST ;�, F �.�.Di v.�i��li i.i�.,q 3-Qile y fit 37,2'49.00 tr'UNNSTftUi:'t K N F,h , 101-LM-418-I)Citi a:9.U53.St� 131. AN ("t t 1 r*Jt I -T -R, 1 g X9.4 if+.7'7 I`" : 0 " O's t•f 10! 000 439 319 N&;,CilteN(CAL F17C i01•wJ421-0009i122.(),U0 #U,I-_C1'RJCAI., IFI- , lot -OW -420-M) $O-'�3.37 u!,T)T�1FifivCr F'I:i? Tfl!-(i6)iT-ai(1_(}(►fT $,^�5 �(1 v:voot TNnnnt-4 mr. - P%tzin 101..0M. -241-OM $83.72 CI11.IWINQ F. M- i{71 {)Ut} •3 :+-t`1(JCd $20.0ti INFRATilkil l'ORE F+"l.: 225-of)i/-443-.141 %,t)U o() ART !N P1 rrtT.lr xri,r>" # , : _ I�E4ti; '1011 ••tifX)-2;15.I11i[1 ' t,l� x.12 SUR -71-9,A1, ff)N -',0f TJ(,"S`!ON ANI.-) PLAN (_NI -,(.1.` $111,:51ig LESS PRt'1ltDE _Vi oo '1101'AI., 1'MM IT F KV -'S 1)I IE;NtJW $11,051.18 RECEIPT DATE BYN" DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs S_e Q u Underground Ducts Forms & Footings Ducts Slab Grade Q moo..- 2.22- g -I,- Return Air Steel Combustion Air Roof Deck C Exhaust Fans O.K to Wrap F.A.U. Framing u -3pCompressor Insulation - -~ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath (j Drywall - Int. LathJ-Oa _ I Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 1 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�J 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 Utllity Notice (Perm) Com/ COMMENTS: Siwe .- ! -t 3-`3 � s� 4 �d�-•f/Jv1-per' �c.i e ra 1 - I - 9'--7 S. ,Q e l a S 0 4 c ej peau 1,0- �� %� S 1- i5 • F �' Si ���� pt(,,- h 1-/3-7S SS Twit 0 f�lcv I t -�0 /�/� P.O. BOX 1504 /�J ��'' ` [' 78-495 CALLE TAMPICO APPLICATION ONLY Addrress L L �.� 7 i LA (�UINTA, CALIFORNIA 92253 lings A-04GL1�"r G+ • re City, �A I I zip t i l.� Z IL Contractor Address State Lic. City & Classif. j I Lic. N Arch., Engr Designer 6" 1 ")15Lp 1 I Lic. TYPE'CONST OCC. GRP. A.P. Number ✓�1 '' / - ` -rL? Legal Description's Project Description.• Uu 1tsCi. i'LZ-, e 'ice LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 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 (5500). I.; I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and 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 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contract6r(s) licensed pursuant to the Contractor's License Law.) I'] 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 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. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i1 the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work -for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 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 relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip WHITE = FINANCE Sq. Ft. I O (q 2 No. No. Dw. Size / I Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL �( - 4svo C. ff t.L- . A AMOUNT 5700.00 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 Issued by: Date Permit Validated by: (� Validation: C,/ 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 12/15/98 APN # 761-531-004 No. 18124 Jurisdiction La Quinta .Owner NameBilda Corp No. 79-001 Street Tom Fazio Lane South Permit # Log # City La Quinta zip 92253 Study Area Tract # 27728 Lot # 26, 27 Square Footage 10,122 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 1.93 X 10,122 or $ 19,535.46 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now die issued Fees Paid B CC/CAL FED/Space ace Builders' 4 , By p Telephone ,776-4506 u�' r✓t Name on the check - u By Dr. Doris Wilson t<. Superintendent Fee collected /exempted by. Juanita Green Payment Received $19,535.46 Check No. 4023957428 Signature NOTICE: Pursuant of Assbly 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 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 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 JCM Inspections 39725 Gararid Lane Suite G Palm Desert, CA 92211 Phone: 760-345-5554 • Fax: 760-772-3895 Project Name: Project No: Date: sarr- o, - Af, qq- 11, Project Address: }-� UBC =— —Titre 24 Other: Client: Sub -Contra or: Weather: worm - General Contractor: Architect: Structure Engineer: , L O.%v., M_ 4 �s Loca ion of Samples: �ob�tns t^xO� �i �s 3 4 1E J 5 -'.Welding Process/ Electrodes + Slump (inches): Supplier: LA_o_QCc- (t41r SJ 3 Time Sampled: n Mix Design: Time in Mixer: 4%; n u!J'" Specified Strength: IO 00 0 : Welders: Water Added @ Jobsite: If) Admixture: -Z Concrete Temperature: FO #: L4 "' f Dl J� Ambient Air Temperature: �! '� Field I.D. Marking: If LA -Description of Work Inspected: Z A G; . r ' ne �_"O"' Q�1�7b �S a 6 RAC"' A l Pe Pin n e 4n r A: a10 1 i !1 C• "� K Q+� V nn el ai n7 waMM ttl�l u fCn n 10, 1 cu". A e�Av c ! caCke _ i zB A r -c Q Me n Cep ti PCacn c e\;r Pc I t34 S A r reL. Ti s e ucx eet C (PAl S C� t 1 T w f T i n�� S.\:"jv'&VSeC 1 f o .,1r VAC S. -11 i'ca fi ok GwIAtAk Co)n rCe7C2 ► Te' C-4--1,41, 0\aCaeP 'P 38 . 10 6SOr v�SJ 1%ee 14 OM vvn el . A& %jNnk6 ri ir I u c an S,a % t1 e-mrrr K/tQ, J 6E'S VP � Yr1 S N A Q.. f, M P.C-4n al le -_5i G e a�r�s PAaw, , e'. (te "%Cp 0 I 1 Page of Inspector— G ` ; p . �` R « Cont<ractor's Re resenfative` ) p � A Jtie _�---- f1Q VI; C y t XMInspections Copy 2 Proiects .perintendent Copy 3 Goveming Agency J I�j �V*: ^y .f a j : n "4'� q '• S`2 PYsi�?��t 7 '"t•iat! "4.E :t. �"+' JCM Inspections 39725 Gararid Lane Suite G, Palm Desert, CA 92211 Phone: 760-345-5554 • Fax: 760-772-3895 Project Name: Project No: Date: -111 1- � -9� Project Address: UBC r✓- Title 24 Other: nbn a f t i'. (i� . Client: Sub -Contractor: Weather: General Contractor: Architect: Structural Engineer: k'%aeU"& I !. nG l Location of Samples: (� �c.ou Welding Process / Electrode - V x$ c m -% nrz_ Ce c ase e W ca 1 Qw- _w Slump(inches): Supplier: �t JA �•��� Time Sampled: Mix Design: —r- n Time in Mixer: J a n uc Specified Strength:' Welders: Water Added @ Jobsite: Admixture: fl n n -s-- - Concrete Temperature: ?° Truck #: Ambient Air Temperature: Field I.D. Marking: p A,3e y" Description of Work Inspected: _o X (% G ut r W t p 1 o cQ. oP.to Urcw_ Q. O n c CEJ{ 2. S Ui G Qi nn 6 ems' cR p or , vJ 00 � a E nn nn a' S rijl2_ C amt Si ZR .0LqC_0_!n,-AA 't n P t n2� �. 11 U codon 4n gko n v eD Il 0k" .N AY Page of Inspector :O c;tt_� L,( av til\i, Contraar`s Representative: ^ Coy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency �_ 'f„l4y,.p` �"y.,,,,-vLy� "b.wl�,,.,,,,`�.. h"ti��. �s,. *tyy" t,►`�ij�;r 'y�rr,.,..1v.'�,•`..(ly.•.r..r.-."J:✓.,,�.��,J"►\1....-.!?r*'ln�i�4`` .n A`L JCM' Inspections 39725 Garaiid Lane Suite G Palm Desert, CA 92211 Phone: 760-345-5554 • Fax: 760-772-3895 Project Name: Project No: Date: C �; e — he c — 5-99 Project Address: UBC L- Title 24 Other: Client: Sub -Contractor: Weather: CL. W��c d k n 'J General Contractor: Architect: La ci, Structural -Engineer: Knr^',&ear � 4 Ass CA vi Locatio of Samples: 1 S o �o u< S Welding Process / Electrodes: Slump (inches): Supplier: s."04 -rice Time Sampled: A ' oo atm. Mix Design: U611 i 0 oar L Welders: Time in Mixer: 99) M, n jT- Specified Strength: ODo �S; Water Added @ Jobsite: c:2,5 1406,-% Admixture: Concrete Temperature: %,2 °:F Truck #: OF ------- Ambient Air Temperature: ?tn Field I.D. Marking: X Description of Work Inspected: a� b X to C YnU S a W\n2, �[ X' Y4 r �aISeJS O r JA X $ -416 emu �e � W �Caw WS& VI\X- t c.oursas ~�� e ti 6c rel s , 'SA J'&n S; z.e� An c -a- no, P . b� �vba%� CMLS -'amy- 14, ak Aanm'zwAs, ervA 0.1 a� V'-"- ,.A, Ibm nkftrp,�"'Ae ar WLQ coar wews no+J 40112-1 r S eo ' loss --Onmv.ae c, '7, r, 'a,r fts c CaT ® 4. �,J �', aa�_ ,rr . � r•, �. �1 G Ccx.�S "�"ar+ . c �c - J ! Page of / Inspector—a Zr- 16 0C ctor`s Representative: CCP1y 1 JCM Inspections `.V JCopy 2 Project Su intendant !f, :) vc Copy 3 Governing Agency �`lit+lr"�.��'T.:,,;t.�,v;.(�''SJ�'y-'�t�`�"'1'V<<� �N�y^'lv-^+�l,r�-'�.Kt��s,:.',}-LiF`''l+>7y8•.7�11r'�•:c�'k�:.�.rt'nd'Yr\.-Y�s�4j�Y r;fyr'i+ ,Iv�'rt�jr. {';�„�i+i>�n.;��,*"s.. ..R'q e:�u�jf."v:fia:=� �'�,,.,.�.x.:�-�ti�'; JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 • Fax: 760-772-3895 Project Name:Project ex V2 r 2- Q rf.'\ No: - Date:N�s Project Address: '1 ©o k m JUBC. Title 24 Other: Client: n3 QC k & iLfl Sub -Contractor: Mn .ao�n Q \`IQSo♦\ Weat e Coo . (7VPf� Contractor: General wc(tl1 cL ®"\ @C Architect: Structura. Engineer:: p So,&. �SS Locate n of Samples: at.d (r,o �o�t. - S �A. \\•J�r w►nar WAC JaiX%\i\b C-T-%wl Ot ne $*)(9 1111m (IST u Cowrs1s Welding Process / Electrodes: Slump (inches): R, So Supplier: Time Sampled: %"M 0 'r N Mix Design: 9b0 i le 40 SAc del Time in Mixer: (min.) 90 W\%P,n Son . - fi� Specified Strength: '0100,0 rz" l Water Added @ Jobsite: (gals.) Admixture: V072 - Concrete Temperature: (°F) n 14 Truck #: LA 6 t tckw -I $ a - Ambient Air Temperature: (T) Sq Field I.D. Marking: X .. Welders: Description of Work Inspected: ?t,r t g X ��o C 'C�U\ S ► .O u t SQ of Wad1 01 \ S P i n t c. BBQ Qi i 0. i t scl'elan Tin to L6 P Si Wv2 • k4r. 01V e r a k1oc-% r IZ Wr Lk c, CO. Ca V Gt r c> f f In. tial: 2 e i a a 1�\Qt2 1? o;nc, V1,2 Wi a cr- \JC'. t �Gon� u! t w. .,1 \iur U i tpAs Y r,u o(�I �Uin r7 F e ; u �t \ ce^ �� 1 l e.V1A t� >C Vi a t.10 to 'Con , A DG XOk, C O t! w �P 1 V� ccso�v non I hereby certify that I have inspected all of the above reported work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans, specifications & applicable building laws. Final report issued at project completion. Page of Inspect6r17.-O� C. , t V 'rX =Lg O #�1 /ct 5L Contractor's Representative: (/%� "- "1 'l/\-2 \,,, py 1 JCM Inspections Copy 2 Project Su/+i�er ntendent Copy 3 Governing Agency " cS �-.�_ ..+-+ y= , .. `. ti;C� v. rte• `' 1' JCM' Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 • Fax: 760-772-3895 Project Name: `` 11 �ac�1 e * Mt�T c IN A 1P "CP "'T111 t tk.0.c f %4 Project No: c1cl - Date: q Project Address: `1 0o - z; d �. So UBC t.-- Title 24 Other: Client: �aC Z a LLC- Sub -Contractor: IT k AWfACnn ( 6 Y) -+C, Weather: LuM General Contt�iractor: S act. L7l , e S Architect: �r, Structural Engineer: A ' ` '� OSJI 1�� �i I nrat on of Samples: /� n E - c o er c .L, 9 % - IN es� 144 1- Welding Process / Electrodes`: �. -----� Slump (inc es): 4, as Supplier: c r.- Time Sampled: 11 'o Sea v, - Mix Design: 3sa. A� Time in Mixer: (min.) Ja<� Specified Strength: 2,000 iah Water Added @ Jobsite: (gals.Admixture: R._2_L- Concrete Jemperature:(°F) �1 Truck Ambient irTemperature: (°F) 1 Field I.D. Marking: 5 Welders: Description of Work Inspected: ; COr,c r L -- � (� 61 +�_ J 11 aur - Q , o e aia o tM �' nct, OC\ P C `CCL2_ P Qsr- Gr*Ar Q�aQ Jel ! 1 e s A'as-r 1-Oc td v e,rage 1Pn —CIO, P . �(1��, p /� ns o G.XY O.,i >r r deo Ml(SS: a n A C QS O r I ((� S�o�il� lS� no IoJC 6O��t o a,r cu c� 6.n i ue�\o .aclit, �t R1enl:nnS r - �•C TJX' Ofrl �I^+Ip�1 X r, O� d Tip b- Qa rnS W f E_ �i 3 \ e� a.. a� acd rocl c'er.c f Qe 't*� r ct'"Ze give G r ga rr.x ne aJ�l c> �ove-, c►1f` U 1 3'r& Wn. U � _h) co n Sri (1�� C o n -�Jf e- - L 1 ) M &.a cOc, r'06- ;)%X c� sSinr, T�sl s Crolc �. c 1 S LIZ A,1.�1. ncesc, v �' snon._, I hereby certify that I have inspected all of the above reported work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans, specifications & applicable building laws. Final re ort issued at project completion. Page of Ins ector:'G\% Y\' Con acto s r se t 4i e: t t'Copy�t JCM Inspections Copy 2 Project$y((enntendent C_ OU' Copy 3 Governing Agency rr��sM�'++wa.•,:Nw.rj:1*Y'9'^rr'r�tw;,„,r.sr��7�✓:Z.'i�FJ',i"„iri'(1Fci7'":�'{Gt"�ys1'r�1►ti'/�:i�v.!�fj",*�w��►°�``�'�+t�'�1+„sc''.td'J'�;�{!? xtv JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 • Fax: 760-772-3895 Project Name: Project No: -- Date: Project Address: [ " '1 ®l T 4 '0 �0.r1 oto Vl lAi C UBC Title 24 Other: Client: � 'z 1 � L c. Sub-Contr or: T� Can Weather: u General Contractor: f c Architect: Structural Engineer: IZICIAPva SS o Loca on of Samples: r a 3 Welding Process / Electro . Slump (inches): y rC3o Supplier: san.nc+�r Time Sampled: 10 Flo aV—, Mix Design: Time in Mixer: (min.) —10 Specified Strength: `�oo o sl Water Added @ Jobsite: (gals.) nolx-- Admixture: oz -s -- Concrete Temperature: (T) I -. Truck #: 44!LUic-U#4 Ambient Air Temperature: (°F) '1 y Field I.D. Marking: df A Welders: Description of Work Inspected: Ili r- u AA eJ42Cr � f ' on Ir,- 3 s . b �1 o a o •� 9 ill S o .0 //wrQ 01 J. e- ^1) r 1LA- A-Ja say,PP n 9 e r ,,C Ver \t n r t a Jt r to M, 1 S twee InL'eat q bOCf'%eV- O r \ Sa A 7J C e L�J C .� zQ 2t:a a C o v e f a Q,_ Lo �, \j dQS ?-,Q6c, e t' i Irja� G Pb Scln • \ e .. �,� t'i t• c S P + e.r f- — �. 0 lT r -'Q" 9"^ CoAl A tA ' 'PtOn& SNAdW 0. �P�L 1 Wefn k11s �a e44 4. Lu q erg tar <t "'Ur go �'r taM r ne, ` ,Qeg Q �.S- CE C M1 E 1 r� IGV��� 1 (/•l4M Cf^ \ 2e neo inPn el arpL1( e, +Wo O(A�� QQRI� o14X 01002-0GJ. nTeC r \-s FF c �\Rn��sX r c a WAS p �dC c C ASO ' ronc� //��� ah/e ' r �i b o ' hrC O t� $f , PSI P i �Q j -r �1 a I hereby certify that I have inspected all of the above reported work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans, specifications & applicable building laws. /159)report issued at project completion. Page I of Inspect � " , , Gtr-\ I (( eset x v � Co y 1 JCM Inspections +Y Copy 2 r ie t SJ perintendent Copy 3 Governing Agency r 0 XMInspections 39725 Garand Lane Suite F .-,Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS REINFORCED CONCRETE INSPECTION REPORT Date.—I Project Name: Project No: Dave Smith Residence- The Quarry 99-111 Project Address: 'City: Title 24 AWS XUBC Other: —^� em O LC r -'e, o Lo�'Lk Cl File # App# E] D 1.1 E]D 1.4 Client: Sub -Contractor: Jarida,LLC c/o Space Builders _ Other General Contractor: Architect: Structural Engineer: ►-ic, • S S Assoc w.; ' Slump (inches): Supplier: Weather: ff Uercmis� (t� Time Sampled: Mix Design: Time in Mixer (min.): Spec'fied-Strength (PSI): rT MMI Water Added @ Jobsite (gals.): Addmixture: Unresolved Items: Concrete Temperature (F): Truck #: Ticket #: Ambient Air Temperature (F): Field ID Marking: None E] See Below Location of Sample: N c ,, 'n ♦ i A S Work Inspected: tiIDA Description of AE LeS r7 s i A I g,,n Soo 301 .. p ea ax' tt 1 , C? c c S S. n C ' k ' ' 1 r w .' n P F'Al n IAA Cn Ci0 , r N S' r C o Sa w a A� �J\Gvw -es, It,, pl-411 C. C e o' S f SC �a o. .e X00 I _ W S-Va t.47n C 1+ t 4L W D Q114 I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans, specifications _applicable building laws. Final report issued at project completion. Inspector: Jack C. MillinBO Certification No: 0842216=80 Contrac Re taticr C. U M�J o,' Copy 1 JCM Inspections Copy 2 Project Superintendent U/ Copy 3 G(Jing Agency Page of