15248 (BLCK)Td.*Iwol
" /47-0,70 47-790 Via Nice
47-815,845t935,,995 P.O. BOX 1504 No. 15248.
78-495 CALLE TAMPICO
Builr�ing�lEi 9-6��3�.8'�'' r"'@1E'12e -•
Addresses LA QUINTA, CALIFORNIA 92253
M16
Owner Century Homes Com>unities
Mailing BUILDING: TYPE CONST. OCC: GRP. U� x
Address ` 153S South 'D" St=la A.P. Number
City Zip Tel. 17
San n6rnardint�, CA 92408 (909)381-6001, Legal Description 3Xs'3C'+C 26153
ContractorProject Description 75O ' l • f' of .6 f high garden
Same privacy tea.Zl
Address .
State Lic.
City
& Classif.. .B 3144?3
Lic. # 2120
Arch.; , Frank Gonzales & Associates
- Designerer ,.
1�cwfess
3115 East mhapman Ave.
Tel..
ti 314$ 532-6878
City
Zip
State
_' - Orange, _ �" �i
. 42£06
Lic. #
under provisid oCof Cha pt�9(commencing with Section
and Professions de„and my license is in full force and
OWNEkIlWILDER DECLARATION '
I hereby affirm that I am;ezemp 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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 penaftyof not more than five hundred dollars ($500).
❑ 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 improvementsrare not Intended or offered for sale. If, however, the building
or improvement is sold wfthtplone year of completion, the owner -builder will have the burden
of proving that he did not build or. Improve for the purpose or sale.)
❑ I, as owner of the -p or perty, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and .Professions Code: The Contractor's License Law
does not apply ton owner of property who builds or improves thereon, and who contracts for
such projects with acontractor(s) pcensed pursuant to the Contractor's License Law.)
❑ 1 am exer9p +ut nder Sec B. & P.C. for this reason
Date l Owner
+ WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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 -1" Company
VApy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need -not be completed ff the permit is for one hundred dollars ($100) valuation'
or less.) \
I certify that in the performance of thg work for whichthis permit is issued, I shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT. N, 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.
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
$18,1750.00
Rear Setback from Rear Prop: Line
I'
PERMIT
AMOUNT
Plan Chk. Dep.
-
-
from PFOperty
Plan Chk. Bal.
Side Setback LIRB�
a
Const'.
FINAL DATE
198.00
Mech.
�/
.Permit
Electrical
Issued by:
Dae
Plumbing
Validated by:
1190—
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances: ..
Front Setback from Center Line
r
Rear Setback from Rear Prop: Line
I'
WARNING:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback, r
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,
-
-
from PFOperty
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE: INTEREST, AND
ATTORNEY'S FEES.
Side Setback LIRB�
a
FINAL DATE
O�
I° NSPECC/1
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have this
�/
.Permit
read application and state that the above information is correct.
agree
Issued by:
Dae
I 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.
Validated by:
1190—
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
4 7 —� 7l1 & 4 ,r-•7 11 Via: N,1 4 Y
:]i
'kyA
4 7 � �Z.
r 6,1. 5 ., ir: 4 5 3 5 ,r::' y � P.O. BOX 1504
:dd,e'ss
g1' =Ki V a in nze 78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
Owner
Century r{Q. eo— C:tP_21 a1:I1i'►.1�'
Mailing
Address 1e.35 South hDR
CityZip Tel.
San F-:;,imardinoCA 92408 (909)381-600`4'
Contractor
SSE
Zip
State Lic. City
& Classif. R 314473 Lic. q 212 0
Arch., Engr.,
Designer-�'ri�nk Gc:rrais &. I�ssoCiat�
��East asy. 4:h praaa Ave. T (714) 532-6II 78
City (Zip (State
Ora ng£�,Cs:; 52565 Lic.fi
LICENSED CONTRACTOR'S DECLARATION
herebyy affirm that 1 am licensed under provisions of Chapter.8 (commencing with Section
XXI
of Dlvislon 3 of the Business and Professions Code,anb my license is in full force and
' tett
31IGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirin !hat I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Permit to construct, after, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter g (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).
❑ 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
orImprovement 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.)
❑ I, as owner of the o -ny, am exclusively contracting with licensed contractors to con-
struct the project. 7044, Business and .Professions Code: The Contractor's License Law
does not apply to owner of property who builds or improves thereon, and who contracts for
such projects w' a contractors) licensed pursuant to the Contractor's License Law.)
O 1 am a t ander Sec. B. & P.C. for this reason
1
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a ceitificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
,O
/Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 certify that in the performance of the work for which 4his 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, ff, after making this Certificate or 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.
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.
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 1 have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and slate 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
BUILDING: TYPE CONST
P. Number
No. 15248 r
L
OCC. GRP.
:gal Description '1 r -ac L 26152
oject Description 750 1.f.- of 6' high gars c: n
rivacy wall
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter G Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
%INSPECTOR
Issued by:
Date• Permit
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
4
Plan Chk. Bal
�v-
Const.
198.00
Mech.
Electrical
Plumbing
S.M.I.-
Grading
Driveway Enc.
Infrastructure
TOTAL
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:
\ ;'
4
�v-
"f
*o 4 14
+4 r —170 & 47--79' ) V`& i;t:r
�'-6 1. 5 ` -, ), s35 -9
ngP.O. BOX 1504 No.1524 8
BU,I . 7 r ri i+ �7 a 11l .''iii_'- 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253 °
Owner
`E.%!�t:Ury
Mailing
BUILDING: TYPE CONST. OCC. GRP.
Address1535 South "Dt° tL-o al_
City Zip Tel.
Sian Fs--�1:nardin05 CA 92408 (909) 3&1-6007
Contractor
SL.me.
Zip
State Lic. City
& Classif. R . 314473 Lic. # 2120
Designer
esig Engr.,
DesigeFrank' Gonzales & Associate-.0Associate-.0n�
IlYlTSr
East (7hapruan AVE?. T 010532-6878
City A Zip State
Csrartge ,,C7=k X2666 Lic.#
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed under provisions of Chapter.0 (commencing with Section
feet f Division 3 of the BBsiness and Professions Codg,enff my license is in full force and
r _ -• __
I-OGNATURE DATE
OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bushess and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the appticant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 8 (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).
❑ 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
butlds 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. tl, however, the building
orImprovement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or knprove for the purpose of sale.)
❑ 1, as owner of the operty, am exclusively contracting with licensed contractors to con-
struct the project. 7044, Business and Professions Code: The Contractor's License Law
does not apply to owner of property.who builds or improves thereon, and who contracts for
such projects with a contractor(s) ficensed pursuant to the Contractor's License Law.)
❑ 1 am exerppt under Sec B. 8 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.L Company
9,Z6py is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(rhis section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which Ithis permit is issued, I shall not
employ anyparson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE .TO APPLICANT. ff, alter 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 shell be deemed revoked.
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 ($100,000), IN ADDITION TO THE -COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number
Description
Trac'c. 261'$
Project Description ^50 l.f. of 6' high gardf_rt
privacy wall_
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation c 1ci 75U OU
PERMIT
AMOUNT
Plan Chk. Dep.
Distances:
Plan Chk. Bal.
Front Setback from Center Line
Const.
198.00
Mech.
Side Street Setback from Center Line
Electrical
Side Setback from Property Line
Plumbing
S.M.I.
FINAL DATE
Grading
Issued by:
Driveway Enc.
Infrastructure
Validated by:
Validation:
\
TOTAL
9 f? ,
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
INSPECTOR
FINAL DATE
Issued by:
Date• Permit
Validated by:
Validation:
\
QUA&
4 ! —:,70 v 4 ;--793 Vit: Nice
4 81.44
5 E.45 935r '9 ; P.O. BOX No. 15248
`•
Buil ng:t„-.l Wit;;) �7 78-495 CALLS TAMAMPICO r
Address LA QUINTA, CALIFORNIA 92253 ' 'y,,� e/7
---” Centum Co!1_aunitie-, I
mailing I
Address 1 35 South "DR Li>=rocet-
City Zip Tel.
Son Be;:nardinol, CA 92408 1 (909IM1-600:
SviSE3'
State Lic. City
& Classif. fi 314473 Lic. # 210 0
Arch.,Engr., ASsi;0�8tt.�
Frank Gonzales z&
Designer &
TV East Chapr•':en Ave. T %'
'�714) 532-6878
CityZip State
Orange, 92666 Lic.#
LICENSED CONTRACTOR'S DECLARATION
herebyy 8ffirm that 1 am licensed under provisions of Chapter,9 (commencing with Section
of Division 3 of the Business and Professions COdq.affr my license is in full force and
feet'
..
SIGNATURE - e DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License law for the following
reason: (Sec. 7031.5,8uskfess 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 rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 8 (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 rive hundred dollars ($500).
❑ 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. d, however, the building
or improvement is sold wfthk) one year of completion, the owner -builder will have the burden
of proving that he did not build or knprove for the purpose of sale.)
❑ 1, as owner of the operty, am exclusively contracting with. licensed contractors to con-
struct the project. c. 7044. Business and .Professions Code: The Contractor's License Law
does not apply to owner of property who builds or improves thereon, and who contracts for.
such projects with a c_ontractor(s) Peened pursuant to the Contractor's License Law.)
❑ I am axe
�t onder Sec. B. 8 P.C. for this reason
r
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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
p�opy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed lt the permit is for one hundred dollars ($100) valuation
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
Date Owner
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become
suAlect to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. .
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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when properly filled out; signed and validated, and is subject to
expiration it work thereunder is suspended for 160 days.
1 certify that I have read this application and stale that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above..
mentioned property for inspection purposes.
Signature of appl
Mailing Address -
City, State, Zip -
BUILDING: TYPE CONST. OCC. GRP.
P. Number
,gal Description TraCL 2615$
oject Description 1'_ • f • of 6' high gardfen
rivacy wall
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation ej r 1 tS0` 0
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. 198.00
Mech.
Electrical
Plumbing
S.M.I-
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
t
ZONE:
BY:
Minimum Setback Distances:
Front Setback frog Center Line
Rear Setback Iron Rear Prop. Line
Side Street Setba•* from Center Line
Side Setback from Property Line
FINAL DATE
•61,SPECTOR '
Issued by:
Date• Permit ! `
Validated by:
ii
Validation:
�\ ;
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE JPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
�%
Gam/ 4/ ...,� r
j
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
PROTO-IITM WALK SYSTEMS'.
SPECIAL DEPUTY INSPECTION FORM
DATE: �y
As an accredited and certified Deputy Inspector of 'roto -H Wall
,.
Systems, Uwe hereby witnessed and certified the torqueing of he post-
tension rods by
This , �" day of k ,19x1
A. Wall System Description (Block Product and Height):
►Ic4 L j.
~
.lr C. 4�.
B. Location and Builder:
L �C L
. �Q
C. Length of Wall and number of rods and spacings
Y
o
'
D. Torque Applied to each Rod:
1. S
,Deputy Inspector
Distrib tion: Department of Building and Safety
47
Proto-H Wall Systems
T
Builder/Developer
Yt "
Angelus Block Co.
Installer -
.r ,
TM WALL SYSTEMS
PROTO_� �
A TY INSPECTION FOS
SP
ECIA EU
'P7 I
DATE:
accredited and certified Deputy �spector of Proto-� Wall
Asan accred - �
Systems, I/we hereby
witnessed and certified the torqueing of the post
tension rods by
..:i
Thi
�- day of
,19`�S
T
1 System Description (Block Product and Height) f
A. Wal y
1l19
B. Location and Builder: C- P#
Len hof Wall and number of rods and spacin p� _O c__C ��5
Applied to each Rod:
D. Torque App `�-- `�. k5
1.
Inspector
.,Deputy p
Distribution: Department of Building and Safety
Proto-II Wall Systems
Builder/Developer
Angelus Block Co.
Installer