04678 (SFD)Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
NOTICE: THIS DOCULfr:§c�H70aleA�,�xIrI,,i, FEES ff NID
BE DUPLICATED. 1011,
TO: City of La Quinta DATE: /0—/9-99 1�0
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that\4U4' A.-aj. &Lzjq=�� --(.JCCvn pvi-c
developer of 1104,44 0 a,*Ay- which
loca'ted at
/:I& , within
this District, has paid school facility fees imposed pursuant to the
authority rat y Government C9de.Sectioli 530;80 1,,the amount of
—'W J/)? /7 /15-7
117.'1y9zn '1i , 60 g, �9
$ qx--, '�F "" 1i I oct4ad
#,&quare fe'�t of
covering al' -0'! r4s(aential or
( ) industrial/commercial development and that bui;c(T)i\r�q) permits for
this footage in this development may now be issued by your jurisdiction.
UC17-11L 1 U ()"I !�h&z Dz- &W't-b
43Dox-750�—,�- for DESERT SAODS UNIFIED SCHOOL DISTRICT
IP
White - Building Department 0 Yellow - Facilities Planning 0 Pink - Accounting 0 Gold - Developer
(10)-37
e R'S DAILY REPORT
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I 108 NO. 99 0 11
P
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INECTION
PERFORMED MAR 22 I!IMREINFORCED
WINFORCED CONCRETE % TRUCT. STEEL ASSEMBLY 0
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REPORT SEQUENCE, NO.
TYPE OF STFlU*
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NO.
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DAY OF WEEK
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CONCRETE SUPPLIER
AIR TEMPERATURE
CONCRETE SPECIFICATIONS AS PLACED
SUPT. SIGNATURE
APPROXIMATE YARDAGE
PLACED THIS SHIFT
TOTAL TO DATE
PART OF STRUCTURE PLACED
-j
METHOD OF PLACING
REINFORCEMENT
CURING
TESTS PERFORMED
TIME
SLUMP IN INCHES
CYLINDER NUMBER ADDITIONAL REMARKS ON SAMPLES
INSPECTION LOCATIONS OF WORK INSPECTED, TES SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC.
SUMMARY INCLUDES INFORMATION ABOUT -AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED, NUMBER, TYPE& IDENT. NO -SOFTEST
SAMPLES TAKEN: STRUCT. CONNECTIONS (WELD MADE H.T. BOLTS TORQUED) CHECKED; ETC.
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COPY SENT TO C . LIEN 2�
CONTINUED ON NEXT PAGE 0
TPAGE 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.
103 - 5/86
Sidi,
,$4TURE OF REGISTERED INSfATOR
'9 0 - c -
DATE OF REPORT REGISTER NUMBER
'6,-QR'S DAILY REPORT
REG ISTEfilkfrfir�ik,
IJSOT E.
B NO.
TYPE OF 0 REINFORCED CONCRETE %d'cTRUCT. STEEL ASSEMBLY 0
INSPECTION MAR 22 1 89POST TENSIONED CONCRETE /'D ASPHALT PCOTHER HO 40
PERFORMED -� 0 REINFORCED MASONRY 0 FIRE PROOFING -TN-s j>(-zc-n a
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REPORT SEQUENCE NO.
TYPE OF STRUCY619t" " - -' -- *
-�S - F.
PERMIT NO.
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9,91
DAY OF WEEK
MATERIAL DESCRIPTION
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ARCHITECT F
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ASSISTANTS
HRS.CHARGEO
CONTRACTOR
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CLIENTS REPRESENTIVE
(f , L) - S TE-�
WEATHER
CONTRACTOR'S SUPT. OR FOREMAN
CONCRETE SUPPLIER
AIR TEMPERATURE
CONCRETE SPECIFICATIONS AS PLACED
SUPT. SIGNATURE
APPROXIMATE YARDAGE
PLACED THIS SHIFT
TOTAL TO DATE
PART OF STRUCTURE PLACED
METHOD OF PLACING
REINFORCEMENT
CURING
TESTS PERFORMED
TIME
SLUMP IN INCHES
CYLINDER NUMBER
ADDITIONAL REMARKS ON SAMPLES
INSPECTION LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC.
SUMMARY INCLUDES INFORMATION ABOUT -AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED, NUMBER, TYPE& IDENT. NO'SOFTEST
SAMPLES TAKEN: STRUCT. CONNECTIONS (WELD MADE H.T. BOLTS TORQUED) CHECKED; ETC.
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COPY SENT TO CLIENTX
CONTINUED ON NEXT PAGE 0
FPAGE 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.
103- 5/86
V SIGNATURE O�FREGISTR& INSPECTOR
3-8- 9- <--P-A 0- C.
DATE OF REPORT REGISTER NUMBER