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04-5226 (SFD),J P.O. Box 1504 a^ 78495 CALL^E TA-MF.IC-O LA Qu�`INT--A, CALIFORNIA 9,2253 'BUIL DING PERMIT Application Number Property Address';,, APN: Application description Property Zoning . . . Application valuation Owner ------------------------ SHEA LA QUINTA C/O JEFF MCQUEEN_ 8800 N GAINEY CENTER 350 SCOTTSDALE AZ 85258 BUILDING & SAFETY DEPARTMENT (760) .777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 -_04_-_0.000522.6--- - 81314 GOLDEN BARREL WY 764 -270 -999 -104' -300233 - DWELLING - SINGLE FAMILY MEDIUM HIGH DENSITY RES 210828 Contractor Date 6/29/04 DETACHED SHEA HOMES, INC. 81260 AVENUE 62 LA QUINTA CA 92253 (760) 777-6005 WCC: NTL UNION INS WC: 7165833 08-/01/04 CSLB: 672285 06/30/05 CCC: B -------------------------- Structure Information ------------------------- Construction Type . . . TYPE'V - NON RATED Occupancy Type . . . . DWELLG/LODGING/CONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC FIRE SPRINKLERS NO GARAGE SQ FTG 478.00 PATIO -SQ FTG 178.00 -NUMBER OF UNITS 1'.00 FIRST FLOOR SQ FTG ,2464.00 ---------------------------------------------------------------------------- Permit . . . . . .BUILDING PERMIT Additional desc Permit Fee . . 1028.00 Plan Check Fee 668.20 Issue Date Valuation . . . . 210828 Qty Unit Charge .Per Extension BASE FEE 639.50 111.00 3.5000 THOU BLDG 100,001-500,000 388.50 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL Additional desc . . Permit Fee . . . . 77.00 Plan Check Fee 19.25 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension P.O. Box 1504 • ����� VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: elll� Date: Architect wgir&, _ f� ArchitectorEngineer's Address: No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commeng with Section 7000) of Division 3 of the Business and Professionals Code, and my Li is in full force and effect. cense Clasrc'enseNo.�P O V Date • )IiFIAL�l --emfff c—tor 5 `y G [ r"'hw , OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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. . BA P.C. for this reason Date 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 r e an I maintain w ers' compensation insurance as required by Sectign 3700 of the Labor Code, for the performance of the work for which this permit is L sed fi of rs' co nsation in nce ca a 4V9l' b a er 1 olicy Number. - W _ I certify that, in the performance of the work for whi h 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 tha , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall Io�rtthhww, ith comply with those p ovisions. Date i ' 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 Lendees 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 on 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 gthea agree to comply with all city and county ordinances and state laws relating to building construction, an hereby authorize representatives of this couhtyr upone-mentioned property for inspection purposes. ate0� ignature (Applicant or Agent) Page 2 Application Number . . . . . 04-00005226 Date 6/29/04 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 3.00 6.5000 EA MECH VENT FAN 19.50 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 ---------------------------------------------------------------------------- Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc . . o Permit Fee 110.80 Plan Check Fee.. 27.70 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension. BASE FEE 15.00 2464.00 .0350. ELEC NEW RES - 1 OR 2 FAMILY 86.24 478.00 .0200' ELEC GARAGE OR NON-RESIDENTIAL 9.56 =---------7----------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc Permit Fee . . . . 165.00 Plan Check Fee ,. 41.25 Issue Date . . . . Valuation . . . . 0 Qty' Unit Charge Per .,.Extension BASE FEE 15.00 16.00' 6.0000 EA PLB FIXTURE 96.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 6.00 .7500 EA PLB'GAS PIPE >=5 4.50 1.00 15.0000 EA PLB GAS METER 15..00 ---------------------------------------------------------------------7------ Permit . . . GRADING PERMIT Additional desc Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation .. . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 104, PLAN 5515A, 290 SF GUEST Fee summary Charged Permit Fee Total 1395.80 Plan Check Total 756.40 Other Fee Total 2519.97 Grand Total 4672.17 Paid Credited Due .00 .00 1395.80 .00 .00 756.40 .00 .00 2519.97 .00 .00 4672.17 Page 3 Application Number 04-00005226 Date 6/29/04 --------------- ------------------------------------------------------------ Special Notes and Comments .SUITE, BOX BAY @ MBR -26 SF & NOOK -26 SF. PEkMIT DOES NOT INCLUDE BLOCK;WALLS, POOL, SPA OR DRIVE WAY APPROACH ---------------------------------------------------------------------------- Other Fees . . . . . . . . ART IN PUBLIC PLACES -RES 27.07 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 66.82 DIF FIRE PROTECTION -RES 97.00 GRADING PLAN CHECK FEE .00 DIF LIBRARIES - RES 225.00 DIF PARK.MAINT FAC - RES 5.00 DIF PARKS/REC - RES 502.00 STRONG MOTION ('SMI) - RES 21.08 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Permit Fee Total 1395.80 Plan Check Total 756.40 Other Fee Total 2519.97 Grand Total 4672.17 Paid Credited Due .00 .00 1395.80 .00 .00 756.40 .00 .00 2519.97 .00 .00 4672.17 01/18/2065 08:35 17603401819 PAGE 03/37 C �.y : .,/+-•n✓^nn✓h�r.r•r:-nrn: tura:vaa•z•n•r:•ra^i•ri^rr%.vri.m••✓v,•v�i✓rr,/rn a�•.•n^:..,.... �.�•r..t.r: rr�^ri �l�na%./•i•r>•r.•r••.,.•c•r^r•/-•: i.:.^�•/i%/..•:. •/ = INSULATION CERTIFICATE s This r.i to certify that insulation has been installed in conformance With the current energy regule ion, California Administrative Code, Title 24, State of California, in the building at 81-3'14 GOLDEN BARREL WAY, LOT 3104, PHASE 7113, LA QUI NTA CA CEILII,IGS: TYPE BLOW MANUFACTURER: Certainteed THICKNESS: R-38 WAL1: ;3: TYPE BLOW MANUFACTURER: Certainteed THICKNESS: R-13 GENE::ZAL CONTRACTOR: SHEA HOMES LICENSE # BY: TITLE: PARA:30N SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 TITLE: ACCOUNT REPRESENTIVI: DATE: ----d� %n.•..�r-ir:%ni.-.i.:•eiir. i�ir/n:i�.,•..•.-r�r..•.•rir..rri.i rri,:..,�rn rririiiiuri/i iv v>iz.;ii•,rrrinwii >ieri.,.rr./r...r>/rirr.�./i•.r.rr>�r�•r,:.n••r.•r>•rrr-c"rri!ri •r..:.rr.:�•r r•i,r,•.•�/r.. ... x....rv.•.Hc.s<nw�>••or.•>n:v.wr..:.....,.:>-.�...v:...y:vvvri:v:zi.�:vri.s-.:v.v.<.;,.:,-:.ri•..:vi••r•:/.�.�:vt.•i.•v:�•r/:r•rr"::.•.:">.. rrr,•-•�r.:r>✓w.v.vr,,..r i INSULATIONCERTIFICATE r, This is •:) certify that insulation has been installed in conformance with the current energy ; regulali ;)n; California Administrative Code, Title 24, State of California, in the., building located ' CEILINI;3S: TYPE: :ILOW MAUNFACTURER: Certainteed THICKNESS: R-38 WALL,: TYPE: BATTS MAUNFACTURER: Certainteed THICKNESS: R-13 GENET .AL CONTRACTOR: LICENSE # BY: TITLE: PARA ;;ON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 BY: TITLE: ACCOUNT REPRESENTIVE DATE: �r r r:r/ .. r .. :^n• ..ri•n/i:. !..r.. ,r:r.r .r:r rr h///rrr:vJ7Y/rJn'/.'>:/n'N .ir%.✓ rr + ` Installation Certificate: Residential CF -6R Site Address 81-31.4 Golden Barrel_Way1 1. BUILDER INFORMATION Shea Homes - Trilogy - LaQuinta 81260 Ave. 62 La Quinta, CA 92253 INSTALLING CONTRACTOR: 2. PROJECT INFORMATION DISTRIBUTION TYPF Flexible Ductwork in Attic and Between Floors DUCT OR PIPING R - VALUE Flexible Ductwork Will have a R -Value of 4.2 or. Better PERMIT # SUBDIVISION: Trilogy (a), La Quinta CI'T'Y: La Quinta COUNTY: Riverside WEST AIR CO"J-TIOMG I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment installed and that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In addition, Ihave verified that the equipment is equivalent to or more efficient than the equipment specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for residential buildings. 3. HEATING INFORMATION HEATING MANUF-ACT HEATING UNIT ACTUAL EFF. ' HEATING EQUIP HEATING EQUIP. MAKE MODEL # AFUE CAPACITY LOAD Furnace Lennox 80UHG4/SX-100 80% 100000 4. COOLING INFORMATION COOLING MANUFACT COMPRESSOR ACTUAL EFF, COOLING EQUIP COOLING EQUIP. MAKE MODEL ## SEER CAPACITY LOAD A/C Lennox 13ACC-060 12 The building design heat loss and design heat gain rate have been determined using a method specified in Section 150(h) of the Energy Efficiency Standards, and are two of the criteria used for equipment sizing and selection. &THERMOSTATIC EXPANSION VALVE (TXV): Thermostatic Expansion Valve (or Commision approved cquivalent) is installed and access is provided .for inspection. Yes Fj No U N/A j.�j 6. SUBMITTED BX DATE: Signature Installing HVAC Contractor JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 —1E INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS COMPRESSION STRENGTH TEST RESULTS Client: Shea La Quinta, LLC Date: 11/14/04 Project: Trilogy @ La Quinta - Shea Homes Project No: 02-1109 81-260 Avenue 62 La Quinta, CA 92274 Set ID Structure Age of Test Compression Strength JCM ID Loeatlon Date Cast Cylinder ID (days) (psi) Set A Phase 7B - Lot # 3104 Slab on Grade 9-30-04 Concrete 273-363 Kitchen Required psi: 4000 �i G 7823 7 3510 3 1 q 6O L Pf / 940-6, L (/V iC} 7824 28 4940 7825 28 4880 CERTIFIED: Page 1 of 1 ;ZM Inspections supplies the service of compression strength test results only. Per ASTMC39 Copy 1 JC M Insp ion Copy 2 Project Superintendent Copy 3 Governing Agency Page of t A"i in"spections 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTION S PRESTRESSED CONCRETE INSPECTION REPORT Date: Project Name: Project No: Trilogy @ La Quinta - Shea Homes 02-1109 Project Address: City: �✓ IBC 81-260 Avenue 62 La Quinta, CA Title 24 Client: Sub -Contractor: Shea La Quinta, LLC Sun Coast Tensioning Other: General Contractor: Architect: Structural Engineer: Shea Homes Bassenian Lagoni Borm 8 Assoc, I nc/Suncoast Post Tension LP Weather: Size and Type of Tendons: 1/2" Diameter Seven Strand Stress -Relieved Tendons Is uY1rl Unresolved' Items: Jack Machine Calibration: Received Sheet from Sun Coast -Gage Pressure in psi to Machine Load in kips ©. None PP psi to 33.04 kips/33,000 lbs s See Below Calibration Date: Machine # � _r) T PhaseLot# 00 Plan r. �� �� r �1 � A f� ProductBI Description of Work Inspected: Specified Lot # Location Tendons Elongation (in) Actual Elongation (in) h i� It 0A . c. llAA (Z, � nn tt iL� '�► v' W U •-. , e 1TLl qAr 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. Millin ICC Certificat' o: 0842216-89 Contra or's Re se tive: 11 -KAI\ ) Copy 1 JC M Insp ion Copy 2 Project Superintendent Copy 3 Governing Agency Page of JCM Inspections 39725 Garand Lane Suite F Palin Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 1 N S P E C T I O N S REINFORCED CONCRETE INSPECTION REPORT. Date: Project Name: Project No: Trilogy @ La Quinta - Shea Homes , 02-1109 Project Address: '" City: 81-260 Avenue 62 La Quinta, CA F -] Title 24 AWS QUBC Other: File # E] D 1.1 App# E] D 1.4 r Other Client: Sub -Contractor: Shea La Quinta, LLC t DCCCC General Contractor: Architect: Structural Engineer: Shea Homes Bassenian Lagoni Borm & Assoc,lnc/Suncoast Post Tension LP i Slump (Inches): Supplier: Time Sampled: Mix Design: Time in Mixer (min.): Specified Strength (PSI): Water Added @ Jobsite (gals.): Addmixture: Concrete Temperature (F): Truck #: Ticket #: Ambient Air Temperature (F): Field ID Marking: Weather: .� Unresolved'rtems: ® None E] See Below Location of Sample: cn nc c)ta Ste, ,,,�� e J n.. -i.- �a1« „ �', nr_ �tAt f a ytjWr OA No Samples Taken Description of Work Inspected. r_� �qpt co ��, n rl r 1 `c N � "c � C'TA C'(i ''1�-. �►f l Q ` �' .'.� YAC rl'Iti� G .�' �� �1 �^ rte h�'\Cv� �(\��1.., �a�, b „{ .�� S .n tn��� c1t.� AtS C),nG c C� ,a{nil.-, �ie` c ... n .. h'a LI S�`Sr 1�T1 �.:i) IS C_" n l�`�Q/ 4 i 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: Jac C. Millin nn ICC Certification No 0842216-80 Contractcfr's RMe rase ati Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency . Page of JCM Inspections " 39725 Garand Lane Suite F 1 Palm Desert, C4 92211 I IY 5 P E C T I 0 N S Phone�•760-345-5554 - Fax: 760-772-3895 INSPECTIONS' REINFORCED CONCRETE INSPECTION REPORT Date:�_Q Project Name: t , ' Project No: Trilogy @ La Quinta - Shea Homes 02-1109 Project Address: City: 81-260 Avenue 62 La Quinta, CA E] title 24 AWS ❑✓ UBC Other: File # ❑ D 1.1 App# ❑ D 1.4 ` ❑ Other Client: Sub -Contractor: Shea La Quinta, LLC DCCCC General Contractor: Architect: Structural Engineer: Shea Homes Bassenian Lagoni Borm & Assoc,lnc/Suncoast Post Tension LP Slump (Inches): Supplier: `t o �- Time Sampled: 3z cnirA Mix Design: T--tl %a Time In Mixer (min.): Q Specified Strength (PSI): Water Added @ Jobsite (gals.): Addmixture: � �-y Concrete Temperature (F): `�' Truck #: 3D Ticket #:�'1�1M Ambient Air Temperature (F): " z Field ID Marking: -z_ �, Weather: A Unresolved 1 ms: ® None ❑ See Below Location of Sample: o r, GC c'ea ❑ No Samples Taken Description of Work Inspected:.\IcksavQ t•p.(1��F?`G Or�+�1t}i^(',OQ' ��1 p 1�)C' �{Cr `�Ot,�.�.�r'►I'1� `47�ar^S�C�Cc ¢-,S�G1>onUcc,-Cc, 21fco"C ��ntn \SIR;/. PrSD fQc�r1 �OOK ,ti\ C.l_t•v K;. ,,rtriQ�', iL clScck' d If C, �^. c A -,.c CC) (N( A4Z., a �(e�o—���.bc�o:.;Sr�S'-1��•i�,�cr,^�. Wcc•eol�ca�G ��,,f,•C..)n�ncc>.c �,r<t��sl3t�l.t•\R Deny Q (�r,��•\n C�G l.y\�'t, eec �c,� (Circ �CC,CIIv10 , w a((�� `u: //^-c�rWc.�Te.,G kS , k J C,a.r�t C r C. C. \S. �t� W C ] / vb 1 Cl.J / �? 'Mn , _ eu1 t'nw+pcccSiori oS S (-tAt.S e, 1 1 f� Cal (L� t) I - Al r h 6 2 i., �I; ( Pc�S�s. , 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: Jac C. Milli n ICC Corti�t-at o:'0842216-80. Contrac ^r's RLOPFV91 I Copy 1 JCM Inspections Copy 2 project Superintendent • 61 u Copy 3 Governing Agency Page _J of JCM Inspections { 39725 Garand Lane Suite F Palm Desert, CA 92211 1 71F "n ;1N M"C O N S Phone: 760-345-5554 - Fax: 760-772-3895 INSPECT I O N S REINFORCED CONCRETE INSPECTION REPORT Date: q_on -C)IA Project Name: Project No: Trilogy @ La Quinta - Shea Homes 02-1109 Project Address: City: 81-260 Avenue 62 La Quinta, CA Title 24 AWS Q UBC Other: File # F_� D 1.1 App# D 1.4 E] Other Client: Sub -Contractor: Shea La Quinta, LLC DCCCC General Contractor: Architect: Structural Engineer: Shea Homes Bassenian Lagoni Borm & Assoc,lnc/Suncoast Post Tension LP Slump (inches): Supplier: Time Sampled: Mix Design: Time in Mixer (min.): Specified Strength (PSI): Water Added @ Jobsite (gals.): Addmixture: Concrete Temperature (F): Truck #: Ticket #: Ambient Air Temperature (F): Field ID Marking: Weather: Z'�>\-\,, r kA Unresolved -tams: None E] See Below Location of Sample: No Samples Taken Description of Work InspectedqN\ n zl�. L - 31 D q VC "A oZ 1 tQ VX Say-, i T Erre") ! Y � \ 1 n C' 4, 1 'r C n l c f c hof V- C. �C vi k n res k In G`.. r h 4. E P i t +A r r, ,-r n Pr- n n) � ^,'� t�•r.\ V r r .. r r r. n.� { r —, 1 t r �-_l� �K^ f /! .!1 (^ r i ♦ ,\ to � C, `8 ~��s Gt\���ca�tV c n' fJ\RCL+`rJ C< �'i+�PSn A\a��. y C1S C1� cS�� D r 3i1 i 1 d. \�\Ci cc oDY� 4 1r�`. v - c\ X mkc n,\ � C("'&&Cc " � 'inr t� 1J-.'Sc'2_C: taker t a MA -C 69r�f c.r ' Aic C% 4zr`)xr On r 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" Millin ICC CertifictiLnKo:0842216-80 rs Represen rive: ContractoZZ _ r � ff Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page T of