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RC (0402-283)78065 Main St 0402-283 LICENSED CONTRACTOR 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 License is in full force and effect. License # Lic. Class Exp. Date 77188 Signature of Contractor l y- OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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 & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner 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 & policy no. are: Carrier STATEFUND Policy No. 1440125-02 (This section need not be completed if the permit valuation is for $100.00 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, and agree that if I sFPould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith,comply with those provisions.. `Date:'? % ,, //'pplicant -E" ..- /' r 4 Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 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 State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for insgeetion gurpos s. f Signature (Owner/Agent )Y rr/ r y Date h %+ y r BUILDING PERMIT PERMIT# 104 02-283 DATE ) VALUATION LOT TRACT _ t f I / JOB SITE APN ADDRESS 7,S_045 b4UN S'Iay% 770-521-003 OWNER CONTRACTOR / DESIGNER / EN (NEER OLT) TOWN LA QUINTA LLC MA VIN TIOMF49 79-080 CW EES'TADO MU 201 78.080 CA7.J,'X1?UUAD0 MT; 201 LA Q 1)NTA CA 92253 `L,% IQl)lw `A. CA 9225.3 (700)771-2567 CSLA 5407 USE OF PERMIT COMM -T -Al CiAll REVISION TO 5H91,L CORRIDOR DOORS & WINDOW.) AT 1i0Q38R1 a fH (PLD0 tri SUITE 200. M OCC., T"YPEV-1 HRUOI t"ODES, St3i'1'L TO PFR:AHT 01.11194 ETnWeM COST OF CONS MITC-M-0N 0.00 PMUMT YEE STAChURY PI„AH CHECK VEL 101-000-439-318 $52.50 V 0 31004 L CIT11 OF LA QUINTA FINANCE DEPT. BUB -TOTAL CORS'MUCTION AND MA9 CTT'ECY $52.50 LTOS PRE-P.AWT-EFS O,i10 TMAL PFRWf 1+'I ' 4 D>i1R1: O W RECEIPT DATE _ BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) AUG -17-04 TUE 3:08 -PM RIV. CO, FIRE P&E INDIO FAX YO, 1 760.863 7072 P. 1 RIVERSIDE COUNTY FIRE DEPARTMF;NT In cooperation with the I California Department of Foresrry and Fire Protection 210 Westan Jacinto Avenue* Perris, California ornia ( ) ax Torn Tisda!e Fire Chief Proudly serving the UnincotrwAtod Areas of Riverside Count\, and the Cities of Banning Beaumont w Calimesa Canyon lake Coachella Desert Hot Springs Indian Wells c• Indio lake Elsinore. La Quinta Moreno Vtd ley ti Palrn Desert Peffis Rancho R2irage c• San Jacinto Temecula Board of Supervisors Bob Busier, District I John Tavaglionc, District 2 Jim Venable, Dis!rict 3 Roy Witson, Uistrict 4 Marion -Ashley, Nstrict S August 13, 2004 k City Of La Quinta Building Department I Re: `-.OIdJown Hogs Breath --- / nd=Shell=building-0-ccupanc - The Riverside County Fire Department is granting a fire and -life safety clearance for the Following address located at 78085 Main St- La Ouinta, Please call if you should have any questions, FRANK KAWASAKI Chief Fire Department Planner BY Terrya oucy Fire Systems Inspector EMERGENCY SERVICES DIVISION . PLANNING SECTION . INDIO OFFICE 82-67S Highway 111, 2n0 FI., Indio, CA 92201. (760) 863-8886. Fax (760) 863-7072 78=065 Main. St 2001 Allowable Area Calculations Type V-1HR, 2 -Story, Mixed Uses (A-3, B, M) [Fire -Resistive Substitution per Section 508] Actual Areas: 1St Floor 11,745 SF, 2nd Floor 12,920 SF, Total 24,665 SF A-3: 10,500, 2 -Stories —Actual 1St 3,650 SF and 2"a 7,383 SF M/B: 14,000, 3 -Stories —Actual: 1St 9,112SF and 2nd 5,537 SF Area Increase for Separation on three sides per Section 505.1.2 52'-20' =32' x2.5%=80%or 1.8 Story increase for buildings over one story per Section 504.2 Twice that permitted by Table 5-13 A-3: 10,500 x 2 x 1.8 = 37,800 SF M/B: 14,000 x 2 x 1.8 = 50,400 SF Aactual (A-3)/Aallowable (A-3) + Aactual (B/M)/Aallowable (B/M) 3,650/10,500 + 9,112/14,000 .347 + .650 =.997 < 1 First Story OK Aactual (A-3)/Aallowable (A-3), + Aactual (B/M)/Aallowable (B/M) 11,033/37,800 + 14,649/50,400 .291 + .290 .580 < 1 Building OK A1— May 7, 2014 [79-065 Main St Shell — Permanent Building File] Albi Manufacturing Phone: 949-720-0997 602 Larkspur Ave., Villa #1 Corona del Mar, CA 92625 0111012004 (UL263) Fire Tests of Building Construction and Materials as specified in the Uniform Building Code, Division 7. According to the General Information in the 2003 UL Fire Resistance Directory the same hourly rating applies when a steel section with an equal or greater W/D (weight/perimeter) is substituted for the specified column size. Empirical evidence demonstrates that greater W/D has greater inherent fire resistance; A/P (cross sectional area/perimeter) is generally used for hollow shapes. According to ULI and the SFPE Handbook of Fire Protection Engineering, both are comparable. Hence less fireproofing is required to achieve the same fire resistance rating as the W/D increases. The converse would also be true. The following table reflects these W/D and A/P calculations: Beam Member W18X60 W21 X73 W24X62 W/D A/P 1.02 1.11 0.92 ULI Listing N-607 N-607 N-607 Dry Film Thickness 77 mils 73 mils 82 mils W24X76 1.03 N-607 76 mils Column Member W8X 18 x 0.49 X-625 116 mils 4X4X5/16" 0.27 X-628 170 mils 5X5X3 8" x i 0.33 X-628 139 mils 5X5X 112 - 0.42 X-628 109 mils Summary for Beams: Albi is suggesting that the beams be sprayed with overlaps of at least one -inch be "encapsulated" with intumescent fireproofing on either side of the top flange. It needs to be noted that the beams and/or columns will be unexposed and enclosed in both the Floor/Ceiling UL one-hour rated Assembly and the one-hour rated Stud Walls. Summary for Tube Steel Columns: The tube steel columns are unexposed in a rated one-hour wall. For these members Albi Clad TF should be applied to all steel surfaces. Where wooder or metal nailers are used then the Albi Clad TF should be applied to those milers thereby "encapsulating" the tube steel member. Testimonial Underwriters' Laboratories: Since its first development of fireproofing products in the 1940's, Albi Manufacturing has carried out fire tests in its own furnaces and has subjected AN products to rigorous testing by independent laboratories throughout the world. One such laboratory is Underwriters' Laboratories, Inc. (UL) - an independent, not -for-profit organization testing for public safety. UL provides a classification service for the evaluation of products with respect to fire resistance. These products are listed in the UL Fire Resistance Directory and receive a classification marking from UL contingent upon the establishment of UL's follow-up Service Agreement Under the Follow-up Service, AN Manufacturing has agreed to maintain a production program that assures compliance of the classified products with UL's quality control requirements. On its part, UL carries out unannounced spot checks at the AN Old Town La Quinta ACTF 1 Hr WF TS Rationale 01 10 2004 2 Albi Manufacturing Phone: 949-720-0997 0111012004 602 Larkspur Ave., Villa #1 Corona del Mar, CA 92625 Attention: Mr. John Stanford, John Stanford Architects e-mail. slaarch@aol.com Fax: 760-776-8477 Phone: 760-776-8478 From: Ernest Detmers, Western Regional Manager e-mail: edetmers@adelphia.net Fax: 949-720-0993 Phone: 949-720-0997 .—, Reference: Old Town, La Quinta, CA lyw Subject. Rational for One (1) hour calculated thickn intumescent fireproofing CITY OF LA QUINTA BUILDING & SAFETY DEPT. pPR ED FOR CONS TION ATE to BY 1l TF interior Mr. Stanford, as per our meeting yesterday, it is the purpose of this correspondence to: Pass on Albi's response to our job site review and your faxed request with reference to the required Albi Clad TF water based intumescent fireproofing thickness for your projects steel sizes. Attachments: 1. RED TAB: 12 December 2003: Your fax request for the thickness required to achieve a one-hour interior intumescent fireproofing rating for your project's wide flange beams, columns and tube steel, Albi Clad TF Project specific Intumescent Fireproofing Specification; Albi Clad TF Underwriters Laboratories, Inc (UL) "Listing" for wide flange columns (X-625), wide flange beams (N-607) and tube steel members (X-638). 2. ORANGE TAB: Technical and material safety data sheets for Albi 490-W primer, 3. :: ; Technical and material safety data sheets for Albi Clad TF intumescent fireproofing 4. GREEN TAB: Technical and material safety data sheets for Albi 144 protective color top coat, 5. BLUE TAB: Technical and material safety data sheets for Albi's Field Procedure for Density and Dry Film Measurements; ASTM -E-605 `Standard Tests Methods for Thickness and Density of Sprayed Fire -Resistive Material Applied to Structural Members" (Wide Flange Steel); Uniform Building Code Standard 7-6 Thickness and Density Determination for Spray -Applied Fireproofing" (Wide Flange Steel); Testing Institute of Alaska, Inc. "Sprayed Intumescent Fire Resistant Material Thickness Measurement Procedure No. SFRM-101 "(Tube Steel) and Two examples of Dry Film Thickness Gages. Scope: You requested the rationale for determining the thickness to achieve a one (1) hour interior fire resistance rating on wide flange steel beams, columns and tube steel members that will unexposed inside of one hour rated ceiling/walls. Thickness: This correspondence outlines our analysis. Our approach is to base the calculated recommendation on the full-scale fire test N-607 for beams, X-625 for wide flange columns and X-638 for tube steel members according to ASTM -E-119 protocol, Old Town La Quinta ACTF I Hr WF TS Rationale 01 10 2004 R-.e.kirew..m. 11OA;" m 5 " MAY-12-04 09:25 FRIOM-AA-1 Services,Inc: 562 633 4903 T-069 P.002/002 F-642 Alb! Manufacturing 502 Larkspur Ave-, Villa *1 • Phone: 949-720-0997 Corona del Mar, CA 92625-2318 12 04 A IN Clad 800 Compatible Primers Date Reviewed Manufacturer Product Comnatlble 18 March 1997 Tnemec 90.97. Yes 18 March 1997 Tnemec Series 10 No 19 January 1998 Ameron Amercoat 385 Yes 28 January 1998 Ameron Amercoat 400 05 March 1998 ICI Devoe Devguard 4120 06 March 1998 10 Ultra-Hide Durus No 06 March 1998 ICI Devoe Devflex— 4020 No ' 12 March 1998 Carboline 858 Yes 26 May 1998 Plasite Semcrete 954 03 August 1998 Tnemec FD88 No 14 October 1998 ICI Devoe Devthane 379 . 29 October 1998 Carboline Carbo Zinc I 1 HS 30 April .1999 Carboline 890 26 April 1999 ICI Devoe Devran® 224HS Yes 30 April. 1999 ICI Devoe ear-Rust 235°" Yes 24 August 1999 Miller Paint Co. Cray Quick Dry Primer X358 30 November 1999 Tnemec Series 66 Yes* 07 August 2000 PPC Pitt Guard 97-946 Yes 23 January 2002 ICI Devoe - Devron 224HS Yes* 10 March 2004 Frazee LO VOC Q/D Primer No Alb! Clad TF Compatible Primers Date Reviewed Manufacturer Product Compatible 19 December 1996 Carboline Carboline 858 Yes 01 April 1997 Plasite Plasire 794 Yes . 03 April 1997 Gelggs Ratmoore Ratmoore OC740 ; Yes 03 July 1997 ICI Unizrip-w8 Yes 11 July 1997 Tnemec Series 18 Yes 6 November 1997 Valley Paint, Mfg. V-001 Yes 19 January 1998 Ameron Amercoat 385 Yes 28 January 1998 Ameron Amercoat 400 16 February 1998 Tnemec FD88 Yes 18 February 1998 Carboline 890 Yes 04 March 1998 Maclac Mactek 42 Series Yes 06 March 1998 !CI Devoe Devflex x 4020.. Yes 14 October 1998 ICI Devoe Devthane 379 29 October 1998 Carboline Carbo Zinc l 1 HS 24 August 1999 Miller Paint Co. Gray Quick Dry Primer x•`358 ' } 01 December 1998 Valspar Chromox Primer i 01 June 1999 Plasite Semcrete 954 Yes 10 January 2000 Tnemec 3911.78 Gray Phenolic Alkyd Yes. 13 June 2000 Precision Technical Coatings, Corp, 161-R-20 Yes 23 January 2002 ICI Devoe Devron 224HS Yes= _ { 23 January 2002 Simpson Coating " 340VOC Mod/ lied Alkyd Yes r,+ 22 April 2003 Valley Paint Mfg. V-007 r,' ° : • ' IO March 2004 razee LO VOC Q/D Primer 'High Closs, should be scuffed for better adhesion <, ' Primer Compatibility List 2004 1 j TANDY'S INSPECTION INC. Pb BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OFINSPECTION PERFORMED SAMPLE INFORMATION DATE tL G!'sN 6 ''ii .RC1 -6y PHYSICAL ADDRESS PERMIT NUMBER 1 o VY- (";'8 JOB NAME TYPE OF STRUCTURE Qcb ARCHITECT ENGINEER 5t 1►. do D =c) A t k'OtL3 GENVRAL CONTRACTOR SUBCONTRACTOR DESCRIPTIOROF WORK INSPECTED fe O\:,' \ t-\kt1 X l vu u E. I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. CC: /INSPECTORS SIGNATURE INS TORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER TIME SAMPLED AIR TEMP SAMMPLLE SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. CC: /INSPECTORS SIGNATURE INS TORS CERTIFICATION AGENCY AND NUMBER SPECIAL INSPECTION DAILY REPORT TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED Q USED 212EPi2o0 S SAMPLE INFORMATION SUPPLIER DATE PHYSICAL ADDRESS PERMIT NUMBER - o c. s O (A - 3-a •OB NAME Out -Tow TYPE OF STRUCTURE _ IJ lei 6 • L' 6 L. i3U_l- C Edo l ARCHITECT ENGINEER WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER GENERAL CONTRACTOR SUB CONTRACTOR DESCRIPTION OF WORK INSPECTED SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER TIME AIR TEMP SAMPLE SLUMP TIME IN MIXER SAMPLED TEMP 'K-ZSE. RLSO C4GQLCb ll i"ic c u -X-mao 643 'A E- r- A- g -t R L O c2oo; ti Cg o .! oLA3 1-Y c6 eJ S A 2E $►Quo+ wt+ - st><+`s. Ir; -r E LDVo / WELDING INFORMATION PROCESS I WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER 1 HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED. AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS 8 APPLICABLE BUILDING LAWS. /iceTORS SIGNATURE =.e.a.o. Ar.dc . i I-8 cc; INSPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER TIME AIR TEMP SAMPLE SLUMP TIME IN MIXER SAMPLED TEMP LOCATION WELDING INFORMATION PROCESS I WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER 1 HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED. AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS 8 APPLICABLE BUILDING LAWS. /iceTORS SIGNATURE =.e.a.o. Ar.dc . i I-8 cc; INSPECTORS CERTIFICATION AGENCY AND NUMBER SPECIAL INSPECTION DAILY REPORT TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 OFFICE/FAX 909.769.9717 PAGER 760.776.3339 1 HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: I CTORS SIGNATURE %-mac. -104sy-->,ak INSPECTORS CERTIFICATION AGENCY AND NUMBER DESCRIPTION OF WORK INSPECTED ( 'Q*— b a ►J s l F-'sE 1403 c>, \ doh A-n--ruVe,-S TYPE OF INSPECTION PERFORMED DATE S'P 12• A _ -TEo 1C 6 EtJ µam L `T ° 'Low1 L s-- 11 -lb PHYSICAL ADDRESS PERMIT NUMBER -- o -ta -s7%-. ul- L 3 d q- 3 3 JOB NAME TYPE OF STRUCTURE 6 L> Towo L k uanz-TA, ' C . C04-L4-m05- 04-kwn0s^ARCHITECT ARCHITECT ENGINEER ;; [ ` `TC70 cJ\AOTV> VLt \ GENERAL CONTRACTOR SUB CONTRACTOR v- 1 HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: I CTORS SIGNATURE %-mac. -104sy-->,ak INSPECTORS CERTIFICATION AGENCY AND NUMBER DESCRIPTION OF WORK INSPECTED ( 'Q*— b a ►J s l F-'sE 1403 c>, \ doh A-n--ruVe,-S iUISC ID ZZ -4%5/A V-16 AWlXC WTX 4 #k 6-5S is -TEo 1C 6 EtJ µam L `T ° 'Low1 L SAE= T V. uJ6 — 2 P, tco sca S $P ei iwacE Loki o G 11✓ wl E 'o\M _3 7 1cE'r. 6 ALSO D WELDING INFORMATION PROCESS b TS Co w aJ ZU SPIe -%E Woo"t 00.' r"eA% e- "Tu.wD sL S IIL S `mat -D 1 ot cT E SLK :Ff-gwl \v.2G . Q- wco W t fl-nxCFslct 1 HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: I CTORS SIGNATURE %-mac. -104sy-->,ak INSPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER TIME AIR TEMP SAMPLE SLUMP TIME IN MIXER SAMPLED TEMP LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER 1 HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: I CTORS SIGNATURE %-mac. -104sy-->,ak INSPECTORS CERTIFICATION AGENCY AND NUMBER SPECIAL INSPECTION DAILY REPORT TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 OFFICE/FAX 909.769.9717 PAGER 760.776.3339 DESCRIPTION OF WORK INSPECTED SAMPLE INFORMATION - SUPPLIER W E2c 'P ls oY L Ct-N TYPE OF INSPECTION PERFORMED DATE -rl .. Q.6 Vit k 1 2 % 4w 6 S c<A-k PHYSICAL ADDRESS Y ov'3+ i E, STALL 3 co "kl fKc -kv- PERMIT NUMBER S• L-k3a- JOB NAME TYPE OF STRUCTURE — b o L'k C iK t4 t_ ARCHITECT ENGINEER GENERAL CONTRACTOR SUBCONTRACTOR DESCRIPTION OF WORK INSPECTED SAMPLE INFORMATION - SUPPLIER W E2c 'P ls oY L Ct-N S74VA 'T" S E Ion= ►. 6 CoJ 8 lAZF0 ?1 vJea -rl .. Q.6 Vit k 1 2 % 4w 6 S c<A-k WELDING INFORMATION Y ov'3+ i E, STALL 3 co "kl fKc -kv- WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER 1 HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. CC: : 'Kcqaks SIGNATURE f3to L4 INSPE9TORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION - SUPPLIER TICKET NUMBER MIX NUMBER TIME AIR TEMP SAMPLE SLUMP TIME IN MIXER SAMPLED TEMP LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER 1 HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. CC: : 'Kcqaks SIGNATURE f3to L4 INSPE9TORS CERTIFICATION AGENCY AND NUMBER TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED SAMPLE INFORMATION ' - DATE TICKET NUMBER MIX NUMBER TIME SAMPLED AIR TEMP SAMMPLLE SLUMP TIME IN MIXER PHYSICAL ADDRESS PERMIT NUMBER © -: 0 108 NAME I TYPE OF STRUCTURE Lb --mw COlM1M _ ARCHITECT ENGINEER 7:1-0b41J --TOAO GENERAL CONTRACTOR SUB CONTRACTOR DESCRIPTION OF WORK I I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. lo-ro it CTORS SIGNATURE s.ca 6. /1- i6rA I t-,RA INWCTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION ' - SUPPUER TICKET NUMBER MIX NUMBER TIME SAMPLED AIR TEMP SAMMPLLE SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. lo-ro it CTORS SIGNATURE s.ca 6. /1- i6rA I t-,RA INWCTORS CERTIFICATION AGENCY AND NUMBER SPECIAL INSPECTION DAILY REPORT f TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 OFFICE/FAX 909.769.9717 PAGER 760.776.3339 DESCRIPTION OF WORK INSPECTED SAMPLE INFORMATION SUPPLIETIME R TICKET NUMBER MIX NUMBER AIR TEMP SAMPLE SAMPLED TEMP SLUMP TIME IN MIXER TYPE OF INSPECTION PERFORMED DATE : ►J moi''- `-O PHYSICAL ADDRESS WELDING INFORMATION PERMIT NUMBER WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER •OB NAME TYPE OF STRUCTURE OU6 I 3 fxrA ARCHITECT ENGINEER b F- " 1J f=qt. GENERAL CONTRACTOR SUBCONTRACTOR AA- DESCRIPTION OF WORK INSPECTED I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. 'IIiSPECTORS SIGNATURE :GAB -0• .C- 6 - INSPE ORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIETIME R TICKET NUMBER MIX NUMBER AIR TEMP SAMPLE SAMPLED TEMP SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. 'IIiSPECTORS SIGNATURE :GAB -0• .C- 6 - INSPE ORS CERTIFICATION AGENCY AND NUMBER SPECIAL INSPECTION DAILY REPORT TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 OFFICE/FAX 909.769.9717 PAGER 760.776.3339 DESCRIPTION OF WORK INSPECTED s - - h E 4t -,4Z ovJ ,-s — o-c-s s 'A4 * S SEI' • t• - x —I o .. YCr - 'ariz3 SAMPLE INFORMATION SUPPLIER TYPE OF INSPECTION PERFORMED DATE Pax LOCATION S 18-04 PHYSICAL ADDRESS PERMIT NUMBER -or.rJ 1 LA-' JOB NAME TYPE OF STRUCTURE 6 JbL34G. C n-O&0kA-- ARCHITECT ENGINEER . 3b%koo. s eRl —261SJ GENERAL CO'N TR-A`CTOR.} SUB CONTRACTOR DESCRIPTION OF WORK INSPECTED s - - h E 4t -,4Z ovJ ,-s — o-c-s s 'A4 * S SEI' • t• - x —I o .. YCr - 'ariz3 I HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. ///,- J, 4 4, z " I TORS SIGNATURE INS TORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER TIME SAMPLED AIR TEMP SAMMPLLE SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. ///,- J, 4 4, z " I TORS SIGNATURE INS TORS CERTIFICATION AGENCY AND NUMBER