04-5682 (BLCK)V,
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION. REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . .
Property.Address . . . .
APN:
Application description .
Property Zoning . . . . .
Application valuation'. . . .
04=00-00:5:6.82 =� Date
78485 VIA PALOMINO
604-032-999-117 -305.212-
WALL/FENCE
LOW DENSITY RESIDENTIAL
4600
7/26/04
Owner Contractor
LENNAR HOMES OF CALIFORNIA LENNAR HOMES OF CALIFORNIA INC
78401 HIGHWAY 111, STE C 78401 HIGHWAY 111, SUITE C
.LA QUINTA., CA LA QUINTA CA 92253
LA QUINTA CA 92253
WCC: OLD REPUBLIC IN•
WC: MWC10877600 11/01/04
CSLB: 728102 09/30/04
CCC: B
-----------------------------=-----=-------'----------------------------------
Permit . . . . WALL/FENCE PERMIT ^�
Additional de,sc
Permit Fee . . . . 72.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 4600
Qty Unit Charge Per. Extension
BASE FEE 45.00
3.00 9.0000 THOU BLDG 2,001-25,000 27.00
----------------------------------------------------------------------------
Special Notes and Comments
85 L.F.�6' GARDEN WALL, 99 L.F. COMBO
WALL, 2' RETAINING, 6' GARDEN, BOTH ORCO
SYSTEM.
Fee summary Charged PaidCredited Due
Permit Fee Total 72.00 .00 .00 72.00
.Plan Check Total .00 .00 .0.0 .00
Grand Total 72.00 .00 00 72.00
(1TV SIF ° f?a f1 d�"�y9llk a
P.O. BOX 1504• '�C���
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Q —.5& 8 2 Date: L/
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S 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 Licens is in full force and effect. �/
�Cicense Class icense No. /at�t C).?-
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit,to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she 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).):
U 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , B.& P.C. for this reason
Date u Owner
WORKERS' 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
i sue �lrs' compensationjpsarance came and p�)jc�qupi���v
arrier olicy Number /(/( (if/L U6
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, 1 shall
forthwith comply with those provisions.
Date cant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth ori this 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, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Date 97 `&-U q �gnature (Applicant or Agent):
X
x
A
X
Pei,— % r Of- S-6 92
SSS QED -
.Bin# City of La Quinta =X:
Building BE Safety Division
Permit #P•O. Box 1504, 78-495 Calle Tampico
,C_ La Quinta, CA 92253 - (760) 777-7012
C��[ Building Permit Application and Tracking Sheet
Project Address: r7 g c// jc— Vi ca 0%%-ner's Name:
e�r e S
A. P. Number:
Address: �—
Legal Description:
Contractor:FTelephonc:
City. ST, Zip: S ,
3aZ i - ='-�"�
a _�_x
Address:
XProject Description:
City, ST, Zip: S ,
Telephone: .3,25' 4/.2
70 GF Sf�Z7' G E
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
':�: <,r_, . _ -
cam.•.-Ya�`;�'`'•':i%.� �::..:.:,i:.: ::
1
Construction Type: Occupancy:'
Project type (circle one): New Add'n Alter Repair Demo
q. Ft.: # Stories: # Units:
Telephone # of Contact Person: 2 ��' 1D
kstimatcdValue of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
4
Item
Amount
Structural Cala.
1 Reviewed, ready for correction i� e
Pla heck Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.f•L1.
H.O.A. Approval
Plans resubmitted
J
Grading
IN HOUSE:-
'"' Review, readv for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
7v V C/4—AAcct_- I a/!o
12/30/2004 THU 10:36 FAX 760 777 7112 Bldg & Saftey X008/010
�I�NGINC�RING, INC• PROJECT: S' RET. W%6' SCREEN WALL
�ICICR
,!•a - LA QUINTA DEL ORO, TRACT NO. 30521
`R✓ ? CIVIL ENGINEERING - LAND SURVEYING PLANNING LA QUINTA, CALIFORNIA.
68487 Highway 111, Suite 43 SHEET: 1 OF: 1 _
i Cathedral City, CA 92234
Phone: (760) 202-1800 Fax: (760) 202-8267 CALC'D: M.D.H. CHK'D: D.H.
engineer@hackerengi
0 01 DATE: 11/16/04
NOTES: DESIGNED FOR 80 MPH EXP, C WIND. BUILDING & SAFRY DEPT.
fm=1500psi wlNO SPECIAL INSPECTION
CONCRETE BLOCK SHALL CONFORM TOUBC APPROVED
STD.21�.
USE "TYPE S" MORTAR PER UBC STD. 21-25. _
USE ASTM A615 GRADE 40 STEEL. MIN. GRADE FOR CONSTRUCTION
60 FOR #t5 BARS AND UP.
GROUT STRENGTH TO BE 2000psi MIN. PER UBC
STD. 21.19.
FOOTING CONCRETE: 2500psi MIN. @ 28 DAYS DA oy
USE TYPE V CEMENT.
PROVIDE W MIN. CONCRETE REBAR COVER FOR
ANY FOOTING CAST AGAINST NATURALQ l -r / (�'• �O
SOIL.
USE SELECT BACKFILL SOIL PER SOILS ENGR.
PROVIDE A ASTM C-33 V GRAVEL SUBDRAIN AS
SHOWN. 94 HORIZ. CONT. @ 24" O.C.
WATERPROOF BACKFILL SIDE OF WALL. '
PROVIDE PROPER SHORING DURING
CONSTRUCTION. -
6" C.M.U. W/ #4 @ 32" O.C. °
@ CENTER, PARTIAL GROUT o
s - '
EMBED. 24" MIN.
#4 HORIZ. CONT. @ 24" O.C. H1 I � i �—E 1 I
8" C.M.U. W1 #4 @ 16" O.C. o
@ EDGE, SOLID GROUT i�1
EMBED. 24" MIN. • o
,
(2) #4 HORIZ. CONT. @ 24" O.C.
12" C.M.U. W/ #4 @ 16" O.C.
@ EDGE, SOLID GROUT
Zit ,
ii—iii—Tris • .
#4 CONT. @ 12" O.C. — — — _�}1i5;'l` 1
3`-3u aP2 :�
CYC •T•3;.�S12B�!" �F1'f.' �.. ,+ _ 3
F RETAINING W/ 69
(UNDER SEPERATE WALL FSR.
NO SCALE
. t _ '� �• j\tri'
mem —
\� 'Wok
12/30/2004 THU 10:36 FAX 760 777 7112 Bldg & Saftey 0009/010
.L HACKER ENGINEERING, INC. Title Tract 30521 .lob #020701
68487 E. Palm Canyon, Suite 43 Dsgnr: Michael D. Hacker Date: 4:18PM, 16 NOV 04
Cathedral City, CA 92234 Description : La Quinta del Oro
760-202-1800 Fax: 760-202-8267 Scope: Retaining Wall.Design
engineer@hackerengineering.com Code Ref:' ACI 318-02, 1997 UBC, 2003 IBC, 2003 NFPA 5000
Rev: 580007 - -- "-
user: KW -0602789, Ver s-8.0,1•Dec•2003 Cantilevered Retaining Wali Design Page 1
(01983-2003 ENERCALC Engineering Software 020701.ECW:Calculations
Description 11'-0" Wall, 5-0" Retaining
Criteria Soil DataFooting Strengths & Dimenslons
Retained Height = 5.00 ft Allow Soil Bearing = 1,950.0 psf fc = 2,500 psi Fy = 40,000 psi
Wall height above soil = 6.00 ft Equivalent Fluid Pressure Method in. As % _ 0.0018
e Heel Active Pressure 35.0 psf/ft Toe Width = 2.25 ft
Slope Behind Wall = 0.00:1 Toe Active Pressure = 35.0 psf! _
Height of Soil over Toe = 0 psf/ Heel Width 1Yn
00
9.00 in Passive Pressure = 275.
Water height over heel = 0:0 ft Total Footing Width =Soil Density = 110.00 pcf 9 Footing Thickness12
FootingIlSoil Friction = 0.400
Wind on Stem = 13.8 psf Soil height to ignore Key Width = 0.00 in
for passive pressure = 0.00 in Key Depth = 0.00 in
Key Distance from Toe 0.00 ft
Cover @ Top = 2.00 in @ Btm.= 3.00 in
Design Summary }s " Stem Construction Top Stem 2nd 3rd
Stem OK Stem OK Stem OK
Total Bearing Load = 1,693 lbs Design height ft= 5.00 2.00 0.00
...resultant ecc. = 6.36 in Wall Material Above "Ht" = Masonry Masonry Masonry,
Soil Pressure @ Toe = 1,031 psf OK Thickness = 6.00. 8.00 12.00
Soil Pressure @ Heel = 11 psf OK Rebar Size - # 4 # 4 / # 4
Allowable = 1,950 psf Rebar Spacing = 32 1
6.00d 16.001 16.00/
Soil Pressure Less Than Allowable Rebar Placed at = Cen Edge Edge
ACI Factored @ Toe 1,199 psf Design Data - -
ACI Factored @ Heel = 13 psf/FB + fa/Fa - 0.763 0.723 0.670
Total Force @ Section lbs = 82.8 240.3 510.5
Footing Shear@ Toe 10.2 psi OK Moment.... Actual ft-#= 248.4 654.3 1,389.1
Footing Shear @Heel = 0.0 psi OI� Moment..... Allowable ft-#= 325.5 905.4 2,074.4
Allowable = 85.0 psi `! Shear..... Actual psi = 3.7 4.2 5.1
Wall Stability Ratios Shear..... Allowable
Overturning = 1.94 OK Psi = 25.8 19.4 19.4
Sliding = 1.54 OK Bar Develop ABOVE Ht. in= 20.00 20.00 20.00
Sliding Cates (Vertical Component Used) Bar Lap/Hook BELOW Ht. in = 20.00 20,00 6.00
Lateral Sliding Force = 659.2 Ibs Wall Weight psf = 42.0 78.0 124.0
less 100% Passive Force= 421.1 lbs Rebar Depth 'd' in= 2.75 5.25 9.00
less 100% Friction Force= - 677.1 lbs Masonry Data
Added Force Req'd = 0.0 lbsD fm psi= 1,500 1,500 1,500
Fs psi= 20,000 20,000 20,000
....for 1.5: 1 Stability = 0.0 lbs_ O Solid Grouting = No Yes Yes
Footing Design Results Special Inspection = . No No No
Modular Ratio'n' = 25.78 25.78 25.78
Toe Heel Short Term Factor = 1.333 1.000 1.000
Factored Pressure = 1,199 13 psf Equiv. Solid Thick. in 3.90 7.60 11.62
Mu': Upward 2,797 0 ft-# Masonry Block Type= Medium Weight
Mu': Downward 1,017 0 ft-# Concrete Data
Mu: Design = 1,780 0 ft-# fc psi =
Actual 1 -Way Shear = 1.0.22 0.00 psi Fy psi =
Allow 1 -Way Shear = .85.00 0.00 psi other Acceptable sizes & Spacings
Toe Reinforcing = None Spedd Toe: Not.req'd, Mu < S' Fr
Heel Reinforcing = None Spedd Heel:•Not req'd, Mu < S ' Fr
Key Reinforcing = None Spedd Key: No key defined
t jNA
:-Q,!
12/30/2004 MU 10:37 FAX 76,0 777 7112 Bldg & Saftey
0010/010
i HACKER ENGINEERING, INC.
Title Tract 30521
Job # 020701
fl 68487 E. Palm Canyon, Suite 43
Dsgnr: Michael D: Hacker
'Date: 4:18PM, 16 NOV 04
Cathedral CityCA 92234
Description : La Quinta del Oro
j 760-202-1800 Fax: 760-202-8267
Scope: Retaining Wall Design'
-�- 1 engineer@hackerengineering.com
Code Ref: ACI 318-02, 1997 UBC, 2003113C, 2003 NFPA 5000
Rev: 580007•
User: KW06027S9,Ver 5.8.0,1-Dec-2003Cantilevered Retaining Wall Design
iG1983.2003 ENERCALC
--
Page 2
I Engineering Software
=..020701.ECW:Calculations
Description 11'-0" Wall, 5-0" Retaining
Summary of Overturning & Resisting Forces & Moments
.....OVERTURNING.....
,,,;,RESISTING.....
Force Distance Moment
Force Distance Moment
Item lbs ft ft-#
lbs ft ft-#
Heel Active Pressure _ 630.0 2.00 1,260.0
Soil Over Heel =
_
3.25
Toe Active Pressure = -53.6 0.58 -31.3
Sloped Soil Over Heel =
- Surcharge Over Toe =
Surcharge Over Heel =
Adjacent Footing Load =
Adjacent Footing Load =
Added Lateral Load =
Axial Dead Load on Stem =
0.00
Load @ Stem Above Soil = 82.8 9.00, 745.2
Soil Over Toe -
185.6 1.13 208.8
SeismicLoad =
Surcharge Over Toe _
Total = 659.2 O.T.M. = 1,973.9
Stem Weight(s) =
Earth @ Stem Transitions=
734.0 2.61 1,916.5
110.0 3.08 339.2
Resisting/Overturning Ratio = 1.94
Footing Weight =
487.5 1.63 792.2
Vertical Loads used for Soil Pressure = 1,692.7 lbs
Key Weight =
Vert. Component =
175.6 3.25 570.6
Vertical component of active pressure used for soil pressure
Total =
1,692.7 lbs R.M.= 3,827.3
- JAN-03-2005 MON 02:19 PM HACKER ENGINEERING FAX N0,.7602028267 •P. 01
1 N C 0 R P '0 R A I f D
FAC81MILE- TRAN8M.1T'TAL
To: VCA From: Mike Hacker
Attn: Hue Luu ' Date: January 3, 2005 .�
Fax: 17143634747 1 Pages: 2 `
'Re: Tract 30521, Wall. Detail W.O.: 020701
❑ Urgent ❑ For Review Z For Your Use [Z As Requested ❑ Please Reply,
Transmitted: Excerpt from soils report re: allowable soil bearing
Notes:.. In determining the total allowable soil bearing 1 increased the initial value per ,
additional foot of footing width as prescribed in the soils report. Please call me ~
! if you have any questions. .`
ti
68-487 Highway 1 l 1, Suite 43 -Cathedral City, CA 92234 (760) 202-1800 Fox (760) 202-8267 _
anginaFr!alhnckaran PPring r nm
_ JAN -03-2005 MON 02:19 PM HACKER ENGINEERING FAX NO. 7602028267 P. 02
' Recelved: 8/22/02 12:50PM; 790 325 3791 -T HACKER ENGINEERING; Page 5
AUG -22-2002 THU 12:38 PM C( �_RSTONE DEVELOPERS FAX NO,.- ) 325 3791 P. 05/08
j Aug 22 02 11:53a sladden palm desert, 760 772 3895
P.
August 8, 2002 -3- Project No. 544-2128
02-08-455
The following recommendations present more detailed design criteria that have been developed on the
basis of our field and laboratory investigation.
Foundation Design: The results of our investigation indicate that either conventional shallow
continuous footings or isolated pad footings, which ane supported upon properly compacted soils,
may be expected to provide satisfactory support for the proposed structures. , Remedial
compaction should be performed as described in the -Site Grading Section of this report.
Footings should extend at least 12 inches beneath lowest'adjacent grade. Isolated square or
rectangular footings at least 2 -feet square may be designed using an allowable bearing value of
1800 pounds per square foot. Continuous footings at least 12 inches wide may be designed using
an allowable bearing value of 1500 pounds per square foot. Increase in allowable bearing
pressure may be realized with increased footing size. Allowable increase of 200 psf for each
additional I foot of width and 250 psf for each additional 6 inches of depth may be utilized if
desired. The maxumni allowable bearing prcasure should be 2500 psf. Tile allowable bearing
pressures are for dead and frequently applied live loads and may be increased by' Ila to resist
wind, seismic or other transient loading..
Care should be taken to see that bearing soils are not allowed to become saturated from the
ponding of rainwater or irrigation. Drainage from the building areas should be rapid and
complete.
The recommendations made in the preceding paragraphs are based on the assumption that all
footings will be supported upon properly compacted engineered fill soils. All grading shall be
performed under the testing and inspection of the Soils Engineer or his representative. Prior to
the placement of concrete, we recommend that the footing excavations be inspected in order to
verify that they extend into compacted soil and are free of loose and disturbed materials.
Settlements; Settlements may result from the anticipated foundation loads. These estimated
ultimate settlements are calculated to be a maximum of 1 -inch when using the recommended
bearing values. As a practical matter, differential settlements between footings can be assumed as
one-half of the total settlement.
Lateral Design: Resistance to lateral loads can be providedtby a combination of friction acting
at the base of the slabs or foundations and passive earth pressure along the sides of tite
foundations. A coefficient of friction of 0.40 between soil and concrete may be used with dead
load forces only. A passive earth pressure of 275 pounds per square foot, per foot of depth, may
be used for the sides of footings that 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, 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.
VadAan Faeiaaariaa
CITY OF LA QUINTA
r PLAN CHECK CORRECTION LIST
Hacker Engineering Inc. January 3, 2005
68487 Hwyl 11 Suite # 43
Cathedral City, CA 92234
PLAN CHECK NO. 04-5682 FINAL CHECK
ADDRESS 78-485 Via Palomino OCCUPANCY U
SCOPE OF WORK Retaining wall TYPE -OF -CONST. V -N
PLAN CHECK FEE. 2 Hours total
The submitted plans and specifications have been reviewed by the VCA CODE GROUP.- In our
professional opinion the plans are insubstantial 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, AND THE FOLLOWING CONDITIONS:
1. Applicant to pay an hourly fee of 2 hours for review of retaining wall plans.
Plans checked by: Hue C. Luu, PE
VCA CODE GROUP
2200 W Orangewood Ave,. Ste 155
Orange, CA 92868
(714) 363-4700 ext. #752 VCA File No. LQ -16992
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Southwest In, an, dTesting, Inc.
10826 South Norwalk Blvd., Santa Fie Springs, CA 90670
_ 2)94 ,;29 0 • (7°14) 526-8441 - fax 1562)'946-0026
REGISTER D INSPE S'S DAILY REPORT
SWITJob N9.
�? 'l A7
Date
-
TYPE OF
INSPECTION
REQUIRED
einforced Concrete
❑ Post Tensioned Concrete
Reinforced Masonry
❑ Structural Steel Assembly ❑ Quality Control
❑ Fire Proofing p Other
❑ Asphalt
Job Address /city)
)
Job Name
Permit No.
Issued By
Type of Structure
Architect
NOMaterial
Description (type. grade, s u ce) i j
L
Engineer
Contractor
Le—v7N�
Inspectors) Name
Subcontractor
TESTS PERFORMED
TYPE OF SAMPLE
SLUMP
QUANTITY IN SFT
REMARKS ON SAMPLES
(ADDITIONAL
.n r
INSPECTION SUMMARY — LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC.
INCLUDES INFORMATION ABOUT- AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED, NUMBER, TYPE & IDENT. NO'S OF
TEST SAMPLES TAKEN: STRUCT. CONNECTIONS (WELD MADE H.T. BOLTS TORQUED) CHECKED, ETC.
Ar
S °r
70�j&7't7 �
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el--e ) X 17,4 ;V& 1&r
Iva
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CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE OBSERVED 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,
SPECIFICATION , AND APPLICABLE S CTIONS OF THI GOVERNING BUILDING LAWS.
If
c- SIGNATURE OF REGISTERE SPECTOR
SPECIALTY NO. AGENCY
CONTINUED ON NEXT PAGE ❑ PAGE' OF
TIME IN TIME OUT REG. HOURS O.T. HOURS CYL!NDEFiS t
All inspections based on a minimum of 4 hours and over 4 hours' B hour
minimum. In ddition, any inspe, ion exte ding p st noon liou-. :dill be an 8
hour minimu
Approved by V r--.- - ---
Project Superintendent