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BPAT2015-001178-495 CALLE TAMPICO T4t!t 4 4 Q"Rrcu LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT 1,4O . CLUI S .`'1) W "Q*444r BUILDING PERMIT Application Number: BPAT2015-0011/�,�,,� � � Property Address: .5636&PEBBLE BEACH UNIT A �� ��► ! Application Description: PGA PATIO COV Property Zoning: Application Valuation: $11,520.00 Applicant: PGA RESIDENTIA ION FF 5420 SOUTHERN HILSW 710,60. LA QUINTA, CA 92253 OCITYF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT 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 Professions Code, and my License is in full force and effect. Licee a Clas : License No.: � ". Dafe: �� Coritractor:� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).: (_) 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 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.). (_) 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 contractors) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.C. for this reason Date Owner: 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: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/26/2015 Owner: PGA RESIDENTIA ASSOCIATION 54320 SOUTHERN HILLSW LA QUINTA, CA 92253 Contractor: PGA RESIDENTIA ASSOCIATION 54320 SOUTHERN HILLSW LA QUINTA, CA 92253 (760)771-1234 Llc. No.: 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. 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 and policy number are: Carrier: _ Policy Number: 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, I shall forthwith comply with ihose provisions. Date: / (.,) 7 AS APPI'cAt 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. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official 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, indemnify 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 city to enter upon the above- mentioned proppe/ty7for inspection purposes. Date: 3/,` / / ignature (Applicant oent): —' FINANCIAL •r -DESCRIPTION ;`> -ACCOUN AMOUNT;,' . ;:PAID . ' PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 . PAID BY ' ' ' '"METHOD u ,RECEIPT:# - CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 '�' DESCRIPTION ' �S'ACCOUNT ' ' r . QTY' •., hAMOUNT ".rv" PAID: a PAID. DATE PATIO COVER, STD, OPEN 101-0000-42404 0 $97.17 $0.00 t "3 PAID BY , :.: r, METHOD dr 4, :RECEIPT;# &. _:.. CHECK# "' CLTD BY . i, DESCRIPTION -, ... _• .° � . .• �. �. ACCOUNT "� , 'QTY AMOUNT,. _' .. w -PAID •. RAID DATE PATIO COVER, STD, OPEN PC 101-0000-42600 0 $95.72 $0.00 PAID BY , METHOD ,�: y`; RECEIPT # ' CHECK #x} ' 6:. 'CLTD BY Total Paid for PATIO COVER / COVERED PORCH / LATTICE $192.89 $0.00 ACCOUNT. QTY -AMOUNT- ' PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $1.50 $0.00 -•x ? PAID BY f ;} METHOD RECEIPT# L:', ' 'CHECK # CLTD BY Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $1.50 $0.00 TOTALS:00 Description: PGA WEST PATIO COVER Type: PATIO COVER Subtype: Status: APPROVED Applied: 2/26/201-5 PJU Approved: 3/26/2015 JJO Parcel No: 775131095 Site Address: 56300 PEBBLE BEACH UNIT A LA QUINTA,CA 92253 Subdivision: TR 20717-213 CM 060/60-69 CM 060/51- Block:. Lot: 2 Issued: 59 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $11,520.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 FACTION DATE$COMPLETION DATE,NOTES Details: (2) PATIO COVERS ALUMINUM & STEEL (1) 12'X42'& (1) 12'X 20' TOTAL OF 268 SQW FT. 2013CBC. THIS PERMIT DOES NOT INCLUDE HELIOCOL SOLAR PANELS. 28 : J Applied to Approved + Printed: Thursday, March 26, 2015 5:57:51 PM 1 of 3 SYSTEMS ADDITIONAL CHRONOLOGY x; CHRONOLOGY TYPE" " STAFF NAME ..: FACTION DATE$COMPLETION DATE,NOTES NOTE PHILIP JUAREZ 3/13/2015 PLANS WERE RETURNED TO PHILIP TO BUILD PERMIT GET PLANNING DEPT APPROVAL AND CONTACT APPLICANT PLAN CHECK SUBMITTAL RECEIVED PHILIP JUAREZ 2/25/2015 2/25/2015 PUBLIC COUNTER VISIT PHILIP JUAREZ 3/11/2015 3/11/2015 TELEPHONE CALL PHILIP JUAREZ 3/2/2015 3/2/2015 CALLED APPLICANT CORRECTIONS NEEDED. CONDITIONS CONTACTS •;.}NAME•TYPE y : - ••NAMEADDRESSl 'CITY STATE , k'< ZIP PHONE'.a FAX' 3. EMAIL ,x.r - APPLICANT PGA RESIDENTIA ASSOCIATION 54320 SOUTHERN LA QUINTA HILLSW CA 92253 (760)771-1234 + Printed: Thursday, March 26, 2015 5:57:51 PM 1 of 3 SYSTEMS i INSPECTIONS .SEQID ,INSPECTIONTYPE INSPECTOR SCHEDULEDCOMPLETED iRESULT. • REMARKS . + NOTES x.. DATE r DATE FINANCIAL INFORMATION DESCRIPTION .' y. ACCOUNT, "` -QTY r AMOUNT... "�' PAID f. C PAID. DATE ";RECEIPT # CHECK #'. METHOD, : PAID BY ' LTD - CONTACTS ,BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 NAME TYPE _ . s NAME - ADDRESSI' "CITY r STATE ZIPr TPHONE• FAX+ CONTRACTOR PGA RESIDENTIA ASSOCIATION 54320 SOUTHERN HILLSW LA QUINTA CA 92253 (760)771-1234 OPEN ,OWNER PGA RESIDENTIA ASSOCIATION 54320 SOUTHERN HILLSW LA QUINTA CA 92253 (760)771-1234 INSPECTIONS .SEQID ,INSPECTIONTYPE INSPECTOR SCHEDULEDCOMPLETED iRESULT. • REMARKS . + NOTES x.. DATE r DATE FINANCIAL INFORMATION DESCRIPTION .' y. ACCOUNT, "` -QTY r AMOUNT... "�' PAID f. C PAID. DATE ";RECEIPT # CHECK #'. METHOD, : PAID BY ' LTD - . ,BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: PATIO COVER, STD, 101-000042404 0 $97.17 $0.00 OPEN PATIO COVER, STD, 101-0000-42600 0 $95.72 $0.00 OPEN PC a, Total Paid for PATIO COVER / COVERED PORCH / LATTICE $192.89 $0.00 SMI - RESIDENTIAL 101-0000-20308 0 $1.50 $0.00 Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $1.50 $0.00 TOTALS:0• INSPECTIONS .SEQID ,INSPECTIONTYPE INSPECTOR SCHEDULEDCOMPLETED iRESULT. • REMARKS . + NOTES x.. DATE r DATE FINAL" PARENT PROJECTS REVIEWS `REVIEW TYPE '� REVIEWER SENT DATE' DUE DATE - RDA EED STATUS REMARKS NOTES Printed: Thursday, March 26, 2015 5:57:51 PM 2of3 cffrSYSTEMS NON-STRUCTURAL JIM JOHNSON 2/25/2015 3/4/2015 3/13/2015 APPROVED APPROVED NON-STRUCTURAL JIM JOHNSON 3/11/2015 3/18/2015 3/13/2015 APPROVED APPROVED PLANNING WALLY NESBIT 3/11/2015 3/18/2015 3/25/2015 APPROVED ASSIGNED 3/24 BOND INFORMATION ATTACHMENTS Printed: Thursday, March 26, 2015 5:57:51 PM 3 of 3 CB?SYSTEMS Bin #City � Permit # /�,� �✓ Of La Quin to . Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: ' p Owner's Name: I NL A. P. Number: . 0 Address: 511R12O o 4 Legal Description: Tatv.4-e I City, ST, Zip: i v �j 2Sj nt r Coact or. I I L Teleh nc: P 0 1 Z 3 Address: Pro'ect Description: City, ST, Zip: 253 pp! te b — U Telephone: p 12 ..... r � • State Lic. # : City Lie. #: 2 Arch, Engr., Designer: Addiess: /1 City., ST, Zip:- Telephon;rir<.><:;><<:::> .. , Construction Type: Occupancy: State Lie. #: Project type (circle one): Ne Addf n Alter Repair Demo .Name of Contact Person: Sq. Ft.:70 # Stories: # Units: Telephone #,of Contact Person: Z) 7� Estimated Value of Project: 1522 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES. Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Vis. Plans resubmitted Mechanical Grading plan 2qd Review,.ready for correclis/issue Electrical Subcontactor List Called Contact Person -31f ] 45 Plumbing Grant Deed Plans picked up S.M.I. I-I.O.A. Approval Plans resubmitted Grading IN IIOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue Se11061 Fees Total Permit Fees Permit Number: BPAT2015-0011 Applied: 2/26/2015. Approved: Issued: Finaled: Status: UNDER REVIEW Parent Permit: Parent Project: Description: PGA WEST PATIO COVER Site Address: 56300 PEBBLE BEACH UNIT A City, State Zip Code: LA QUINTA, CA 92253 Applicant: PGA RESIDENTIA ASSOCIATION Owner: PGA RESIDENTIA ASSOCIATION Contractor: PGA RESIDENTIA ASSOCIATION Details: (2) PATIO COVERS ALUMINUM & STEEL (1) 12'X42' & (1) 12'X 20' TOTAL OF 268 SQW FT. 2013CBC Printed: Thursday, 12 March, 2015 1 of 1 CRWSr5TEM5 LIST OF t �CONTACT4} STATUS" ` SENT DATE;` ,,RETURNED} SENT DUE'DATE TYPE t REMARKS - .,';DATE Review Group: BLDG IST (1WK) 2/25/2015 3/4/2015 NON-STRUCTURAL JIM JOHNSON r r +� r + .., ■ C: ,... t , t i i 'S.•.�x�z Review Group: BLDG 2ND (1WK) 3/11/2015 3/18/2015 NON-STRUCTURAL JIM JOHNSON rc NOtes -. ;�a' ,r -r�,� ,;fir ' �,;� i�, F � U ;�, G `•': F(+'+ ' (aA. � r��' k r� ,.i �z Y r �i F * ' s Y � �. i'' -r ♦N � t t ' r,, , u ' �5 « ,r *"'• t 5' + " F s i n. " . :. $.., . J ,; i)' •Tru _ _ ^7 ; . 3/11/2015 ?�2� / j 3/18/2015 PLANNING PLANNING BUCKET No(tes 15) J, I,y- . f" ny..i., >j `► � fa•i.B � ^fL r ,f, i ra< � 11 .,� f,., e "4Mr$ w. ..�A, t .r: fa . 1 �. h. Printed: Thursday, 12 March, 2015 1 of 1 CRWSr5TEM5 r k Pool 8B X56- ebble Beach F �,Qvo�PA CO pE 1T`( SAFETY FPBuILo'NSOVED ST gY I DATE dl: go 4 CITY OF LA QUIN Q�UIN�A SAFETY DEP UINTA BUILDING & OFLA Q -%I A MjaWriw6L PU'l.;:MN FOR CONSTRUCTION C01,4S FRUCTION DATEBy 0n3 10 0 V� Lvvoro Tg� 10 cc -2 Caf POST SPACING DETERMINED BY 1 TABLE ON SHEET 23 of 49 25lbs./sq.ft. - 110mph wind load —10 I � RAIN GUTTER--,I - 3"X8° DOUBLf � \ HEADERs I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I PANEL SPAN 9'-6" (25lbs. LIVE LOAD REQUIRES .020 MIN GAUGE PER iG� I��IGI HIIIIII1111 111111 o N ENGINEERING Pg. 3 of 49) ; • �- I I I I (1i'k'f4A�! ISR IA�LI Pad i�)I I I I I I I I I I I I I I I I I "' _. _� - ' � � IIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIII II 2`X6° SIDE FASCI 3"X8` DOUBL • - HEADERS " NORTH RAFTER TAILS ®24° O.C. " WIDE X 12' LONG s - INTERLOCKING PANS ' . POST SPACING DETERMINED BY TABLE ON SHEET 23 of 49 '' T 25lbs,/sq.ft. - 110mph wind load .42P 4 1'-6° 13' 13' 13' 1'-6- RAIN -6°RAIN GUTTER _ - Y• - `� t h. 1'r ! 3"X8° ,. DO�i HEADERSU' l PANEL 2iu, ,;VNNREQUIRES .020 MIN GAUGE PER51bs. LIVE LOAD" `, ` • r '`•`� ` u r 1 1 1 1 1 1 1 "I I I i l I'Id I I I I I I I I I I I I�ad�fi�la I I I I I I I I I �IPN��1;1 I I I I I I I I I I' I I ENGINEERING Pg. 3 of 49) STEW POST. INSIDE ALL • I I I I I I,{�i�I I I I'I'I 1 1 1 1 1 1 11 1 1 1 1 1 I I KT't►l;�hlu IFID IAuu E'�r�Dl 1 1 1 1 1 1 111 I I I 1111111111111 11 2"X $l E iiFASCIA---' ` - 3 UOUB HE RS Z . RAFTE AILS ® WIDE X 12' LONG 4 90 r ,PGA WEST SHADE COVER - POOL 8B INTERLOCKING PANS NORTH N� 56301 PEBBLE BEACH 4 ' ' (251bs live load, 110mph wind load) ' --•G"" C G m k✓ TYPE C„ FREESTANDING f� W1 CANTILEVER OPTION 1 . (Pg. 1 of 49) Drawings prepared in accordance with -. ZOuralum Products, Inc. Engineering' j, Z Packet. Drawings are prepared by. Ben'Honey ` • "` " DlYpotio _ 4 sales@diypotio.com _ (951) 265-3078 is- . - .. _ _ • r YXY STEEL POST IN 33" CUBED FOOTING rn 0 -n > 20 C 0 90 Cl) 4 0 )0 -n C:: e , rn 4 AFTER TAILS @ 2' O.C. 37UTTER COLUMN SECTION VIEW Of SELF TAPPING 3'x8' HEADER SHEET METAL SCRE 3'x3" STEEL POST TOP VIEW DRILL W ACCESS HOLE FOR SMS M ATTAC HEADER TO POST 3*x3' STEEL POST ROUND COLUMNS YXY STEEL POST INSERT 0.188' WALL THICKNESS Pg. 7 of 49 GRADE -j ktv -he� t 2) YXY STEEL POST INSERTED 16' MIN. INTO 33*x33' FOOTING 33 Pg. 10 of 49 (3) POST/FOOTING DETAIL ISS Oil Drawings prepared In accordance with Duralum Products, Inc. Engineering Packet. Drawings are prepared by. Den Haney DlYpatlo salesmlypotio.com (951) 265-3078 CORBEL CUT RAFTER TAILS ® 24" O.C. FRONT FASCIA RAIN GUTTER 2 FASTENERS PER FOOT MINIMUM (#14 SMS) PER TABLE #2 Pg. 4 of 49 2.5" TALL X 14' LONG X 6" WIDE INTERLOCKING PANS 3"x8" DOUBLE HEADERS 7DRILLW"ACCESS HOLETO ATTACH 3"x3" STEEL POST O POST 8" COLUMNS HEADER/GUTTER DETAIL 2 GUTTER PIECES COME QTOGETHER OVER SPLICE. COSMETIC ONLY — WILL NOT AFFECT STRUCTURE'S RIGIDITY OR INTEGRITY /17 2' — - e '.. r.. l SCREW AT UPPER RIDGE PREVENTS �- SLIDING AFTER INSTALL CAULKING BETWEEN GUTTER/ AND SPLICE WILL PREVENT ALUMINUM SPLICE PIECE LEAKS AT SPLICE LOCATION SLIDES INSIDE GUTTER TO #14 SM 6": FLAT PAN ROOF ' �-1 LAI -n 0)> 0- z�9° �0)> JOIN 2 PIECES TOGETHER GUTTER SPLICE DETAIL 2"X6" SIDE FASCIA 4 SMS FORM HANGER T SECTION VIEW AT SIDE FASCIA Drawings prepared in accordance with Duralum Z Products, Inc. Engineering Packet. Drawings are rn Z 'X) prepared by. -1 Ben Haney DlYpatio sales®diypotio.com (951) 265-3078 :' • ` Y :See attached information for the Heliocol solar pool heating panel' I've attached.intormation aired from He- ,D material specifications. If we look at-the HC50 panel (which is the panel we want to use) the dry - • - l •.••r4 weght is 22 las with a capacity of -14 liters of water (30.64 lbs) for a total wet weight of 52.64 lbs- The HC50 is: tfifty square feet — see the simple math below. t • M 9 -32.64 //.ST-'1'0 f ; Morri Mohr �• Director of Field Operations' (951) 736-2000 ext. 105 office _• s morri@mohrpowe�.com r a No'virus found in this message. '• Checked by AVG - Version: 2015-0.5577 /,,Virus Database: 4257/8786'- Release'Date: 12/22/14 PSI �I LA CIV t CI OF AFEN pEpT. BUILpING &Ft0S \JFD-/23/2 14 FOR CAPIONSTRUG.. BY • Ij , 1' � '♦n "� - �),h .".�i ^1�a��'�"iTG�i' � + Y.E' S�Si ¢Y `�i��; . W TECHNICAL INF RMATIONMANDAtSPECtF,pI�%CAT1C�t>i'S. SOLAR POOL HEATING. ENGINEERED FOR L.tFE o The Hellocol Advantage,'...' I - 1 THE FEATURE THE ADVANTAGE Patented individual tube design Allows expansion and contraction, eliminating cracks and leaks. , Lets roof breathe, keeping it clean and dry. Patented mounting hardware Eliminates hoses, clamps and straps. No gaps between panels for smoother look; less than half the number.of ioof penetrations. One-piece overmolded constructi ' Eliminates welds and weld leaks. Hurricane resistant Can withstand hurricane -force winds; Heliocol panels are'approved by most property and casualty insurance carriers. , Low collector -head loss rate " Reduces pump requirements. Using the power of the sun to heat your pool A. Using your existing pool' pump, pool water is directed through a series of valves to your solar collectors. B. Pool water enters the solar collectors at the bottom and rises to the top through . the individual tubes of the collector. C. As the water rises through the collector it ' is heated by the sun's radiant energy D. The water is then returned to the pool to repeat the cycle until your pool has been wormed by'the sun. Certification Data, - • ISO 9601:2008 and ISO 14001:2004 •'Ortech Intemational.Laboratories CIVO ti g jfi€p go�C,prp ration (SRCC) • �Q r r is Laboratory SEAL) BUILA �N �; �Y DEPT. MftbN comm rcial use) • Florida Solar Energy Center (FSE ) DATE . #RR -4508 , • British National Water Council (for. potability) • German Federal Health Board • NSF 50 for Recreational Water Facilities "Enjoy Year -Round Leisure Living. SOLAR POOL HFA-nNG. ENGINEERED FOR LIFE. z HC -204 10/2011 WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY th@,t the following described commodity was weighed. measured, or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with section 12700) of Division 5 of the California Business and Professions Code. administered by the Division of Measurement Standards of the California Department of Food and Agriculture. CY = Cubic Yard PY = Per Cubic Yard Weighed at: -Y H<Y � SUPERIOR READY MIX CONCRETE, L.P. M1. J SERVING SOUTHERN CALIFORNIA SINCE 1958 WITH LOCATIONS TO SERVE YOU SHOWN ON REVERSE jhfwI DATE CUSTOMER NO. ORDER NO. CUSTOMER P.O. NO. PLANT NO. DELIVERY TICKET NO. CUSTOMER NAME CUSTOMER JOB NO. JOB ADDRESS MAP A PAGE SPECIAL INSTRUCTIONS WEIGHMASTER ac +s,: DESIGN NO. ° ' � SLUMPJTRUCK.NO: � �t';1 `"� `?'� NAME `d' "c ORDERED BY QTY ORDERED ,' ..S . , JDRIVER 0?-� i ..1V a'f �: GI f : �? 1, •g „� LOAD QTY CUMULATIVE QTY UOM PRODUCT DESCRIPTION PRODUCT CODE UNIT PRICE TAX AMOUNT .. ±9i •;i, �: j%ji f`9 .Y .Sr t ! filen i �',�• ,rf•`?^l�'fE#�ic�". i'} {Y .QTY TO GO Excessive water is detrimental to concrete C.O.D. TICKET TIME ' ARRIVE performance. ❑ Cashlr: . ? 4 ' TOTAL FOR THIS TICKET Gallons to full load k" /Slump ❑ Check No. START FINISH Gallons to 3/4 load ' /Slump ❑ Credit ~ ` r t TOTAL FOR THIS ORDER Gallons to 1/2 load /Slump Driver CommeritS STAND-BY TIME FOR THIS TICKET Gallons to 1/4 load /Slump PREVIOUS STAND-BY Water added on job at customer's request. Authorized By: TOTAL "Customer acknowledges that the described material has been selected and ordered by Customer and that Superior has not reviewed any plans or specifications nor Given any of recommetadations or assurances regarding the fitness of the material for a specified purpose, unless Superior has provided such review, recommendations or assurances in a writing sign. by an authorized representative of Superior. Superior does not warrant that the materials Supplied comply with SB 800. Concrete is porous. Some cracking, pop -outs. surface blemish or color variations may occur for which Superior is not responsible. Water is added only at Customers request. Added water will increase water/cement ratios, decrease strength at may cause increased cracking and color variations. Superior is not responsible for the addition of water or any other material to the concrete by the customer. Customer agrees to defen indemni- y and hold Superior harmless. to the fullest extent of the law, from any liability or claims for damage relating to the ordered material being not suitable for its intended use or n suited for placement upon the ground soils or conditions where the materials are placed." y y. Received in good condition by: CUSTOMER Mix Design Report Superior Ready Mix Concrete, L.P. 1508 W Mission Rd Escondido, CA 92029 760-745-0556 Mix ID# D837P-- 4500 PSI 1" [0] This design is being submitted for approval. Conformance With specification should be reviewed. Contractor: PGA West Project: PGA West Compressive Strength : 4500 psi at 28 days Aggregate size: 1" -- 25 mm Air: 1.2±1.0% Water/Cement ratio : 0.45 slump: 4.00 ± 1.00 in Source of Concrete: SUPERIOR READY MIX CONCRETE Construction type : Placement: TRUCK PLACE / 4" PUMP Unit Weight: 147.89 pcf Design Date 01/14/2015 Constituents : Quantity Density Volume ASTM C150 TYPE II/V CEMENT 559 Ib 3.150 2.84 ASTM C618 CLASS "F" FLYASH 99 Ib 2.200 0.72 Water 296 lb 1.000 4.74 ASTM C33 #57 ROCK 1418 Ib 2.670 8.51 ASTM C33 #8 ROCK 350 Ib 2.640 2.13 ASTM C33 FINE AGG 1269 Ib 2.640 7.70 ASTM C494 TYPE A WATER REDUCER 26.32 floz (US)/yd' 1.000 0.03 Air 1.2%. 0.32 Total : 3993 ;< 27.00' Remarks Reported by Superior Ready Mix L.P. Approval by: Date : 01/01/2015 Date : / / Oltv II ------ ----- . ......... I 1-013 D -d,31 'b5YlA- DEPT. �i