HomeMy WebLinkAbout1925 DOVE LN; ; CB141752; Permit08-27-2014
Job Address:
Permit Type:
Parcel No:
Valuation:
Oeeupancy Group:
# Dwelling Units:
Bedrooms:
Project Title:
City of Carlsbad
1635 Faraday Av Carlsbad.CA 92008
Residential Permit Permit No: CB141752
Building Inspection Request Line (760) 602-2725
1925 DOVE LN CBAD
RESDNTL Sub Type: RAD Status: ISSUED
2131120700 Lot#: 0 Applied: 07/22/2014
$0.00 Constuetion Type: 5B Entered By: SKS
Plan Approved: 08/27/2014
Issued: 08/27/2014
Inspect Area:
Plan Cheek #:
1
0
Reference #:
Structure Type:
0 Bathrooms:
Orig PC #:
LA COSTA GREENS(PALOMA) APTS:
BLDG 8 REPAIRS FOR WATER DAMAGE // REPLACE DOORS &
THRESHOLDS // REPAIR ONLY THRESHOLDS AS NEEDED // REPAIR
STUCCO WEEP SCREEDS // REPAIR STAIR NOSINGS // REFURBISH
EXTERIOR LIGHT POLES, LIKE FOR LIKE
Applicant:
BUCKLES & ASSOCIATES INC
Owner:
DOVE FAMILY HOUSING ASSCS
27381 VIA INDUSTRIA
TEMECULA CA 92590-3699
951-506-4815
1820 S ESCONDIDO BLVD #101
ESCONDIDO CA 92025
Building Permit $0.00 Meter Size
Add'l Building Permit Fee $233.50 Add'l Reel. Water Con. Fee $0.00
Plan Check $0.00 Meter Fee $0.00
Add'l Plan Check Fee $0.00 SDCWA Fee $0.00
Plan Check Discount $0.00 CFD Payoff Fee $0.00
Strong Motion Fee $1.00 PFF (3105540) $0.00
Park in Lieu Fee $0.00 PFF (4305540) $0.00
Park Fee $0.00 License Tax (3104193) $0.00
LFM Fee $0.00 License Tax (4304193) $0.00
Bridge Fee $0.00 Traffic Impact Fee (3105541) $0.00
Other Bridge Fee $0.00 Traffic Impact Fee (4305541) $0.00
BTD #2 Fee $0.00 Sidewalk Fee $0.00
BTD #3 Fee $0.00 PLUMBING TOTAL $0.00
Renewal Fee $0.00 ELECTRICAL TOTAL $0.00
Add'l Renewal Fee $0.00 MECHANICAL TOTAL $0.00
Other Building Fee $0.00 Housing Impaet Fee $0.00
HMP Fee $0.00 Housing InLieu Fee $0.00
Pot. Water Con. Fee $0.00 Housing Credit Fee $0.00
Meter Size Master Drainage Fee $0.00
Add'l Pot. Water Con. Fee $0.00 Sewer Fee $0.00
Reel. Water Con. Fee $0.00 Additional Fees $0.00
Green BIdg Stands (SB1473) Fee $1.00 Fire Sprinkler Fees $0.00
Green BIdg Stands Plan Chk Fee $0.00 Green BIdg Stands Plan Chk Fee
TOTAL PERMIT FEES $235.50
Total Fees: $235.50 Total Payments to Date: $235.50 Balance Due: $0.00
Inspector:
FINALAPPROVAL
Date: Ir^ t^/t4 Clearance:
NOTICE: Please take NOTICE that approval of your project Includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively
refen-ed to as "fees/exactions." You have 90 days from the date this pemnit was Issued to protest Imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth In Govemment Code Section 66020(a), and file the protest and any other required information with the City Manager for
processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their Imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exadions DOES NOT APPLY to water and sewer connection fees and capacity
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any
fees/exactions of which vou have previouslv been given a NOTICE similar to this, or as to which the statute of limitations has previouslv othenwise expired.
Inspection List
Permit*: CB141752 Type: RESDNTL RAD
Date Inspection Item
12/17/2014 18 Exterior Lath/Drywall
12/17/2014 19 FinalStructural
Inspector Act
MC AP
MC Fl
LA COSTA GREENS(PALOMA) APTS:
BLDG 8 REPAIRS FOR WATER DAMAGE /
Comments
RECEIVED DEPUTY REPORTS DATED,
11/18-11/21 2014, 12/02/2014,12/04/2014,
12/09-12/11 2014.
Wednesday, December 17, 2014 Page 1 of 1
SOUTHERN CALIFORNIA
SOIL&TESTING,INC.
. A California Certified Small Business Enterprise (SBE)
LEA #047
6280 Riverdale Street
SANDIEGO, CA92120
Phone (619) 280-4321 Fax (619) 280-4717
83-740 Citrus Avenue, Suite G
INDIO, CA 92201
Phone (760) 775-5983 Fax (760) 775-8362
PL NC FIX
514 N. Califomia Avenue, Suite 5 9549 East Slauson Avenue
BEAUMONT, CA 92223 PICO RIVERA, CA 90660
Phone (877) 215-4321 Phone (877) 215-4321
yXoS'2./AJ
PAGE OF /
SCS&T FILE NO.
RO. NO.
FIELD INSPECTION REPORT FOR: d I-EINFORCED CONCRETE CH REINFORCED MASONRY d WELDING • FIREPROOFING • Q, C. CONCRETE • ROOFING / WATERPROOFING
n RT CONCRETE / STRESS • EPOXY ANCHORS • H.S. BOLTING •
PROJECT TITLE:
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PHASE.*: DSA/OSHPD FILENO,: DSA APP NO,:
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LOCATION OF WORK INSPECTED: SJ yy^yy^ y^ y^X y 3'
MATERIAL CLASSIFICATION:
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xTxi/'- A^Ucy.^, xS-CBC/ICC 1 hs reby certify that I have inspected the above reported woric. Unless noted
othetwise tt^e wotk inspected is to the best of my knowledge in compliance with the
approved plans, specifications and applicable sections of the governing building laws.
Inspector Initials
DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance
with the requir(}ments of DSA/OSHPD approved documents. Sampling dnd testing were*
conducted in accordance with the requirements of the DS/VOSHPD approved documefl^
The work inspected complies with the DS/VOSHPD approved documents.
Yes: No Inspector Initials: .*
•m^ , - ^
'signature authorizes the abS/e worti
• SeS&r 205 REV 7-20111
I.: -y
SOUTHERN CALIFORNIA
SOIL&TESTINGJNC.
A California Certified Small Business Enterprise (SBE)
LEA # 047
6280 Riverdale Street
SANDIEGO, CA92120
Phone (619) 280-4321 Fax (619) 280-4717
83-740 Citrus Avenue, Suite G
INDIO, CA 92201
Phone (760) 775-5983 Fax (760) 775-8362
SMN. Califomia Avenue, Suite 5
BEAUMONT, CA 92223
Phone (877)215-43il
9549 East Slauson Avenue
PICO RIVERA, CA 90660
Phone(877) 215-4321
PL NC FIX
SCS&T FILE NO.:
RO. NO.:
y/7xo> X'j^y/j
PAGE
FIELD INSPECTION REPORT FOR: • REINFORCED CONCRETE • REINFORCED MASONRY • WELDING • FIREPROOFING • Q. C. CONCRETE • ROOFING / WATERPROOFING^
• PT-CONCRETE/STRESS • EPOXY ANCHORS • H.S. BOLTING •
PROJECT TITLE.
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DSA/OSHPD FILENO,:
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DSA APP NO.:
PROJECT ADDRESS Xx=>\) r
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PLAN FILE NO.:
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GENERAL CONTRACTOR: SUB CONTRACTOR
LOCATION OF WORK INSPECTED:
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DESCRIPTION OF WORK INSPECTED: TIMEARRiyEp: ~/ -f//^ TIME DEPARTED:
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, , PRINT NAME
CBC/ICC I hereby certify that I have inspected the dbove reported work. Unless noted
otherwise the work inspected is to the best of my knowledge in compliance with fhe
approved plons, specifications and applicabie sections of the governing building Idws.
Inspector Initials
DSA/OSHPD I hereby certify that I hove inspected the above reported work in accordance
with the requirements of DS/VOSHPD approved documents. Sampling and testing were
conducted in accordance with the requirements of the DSA/OSHPD approved documents.
The work inspected complies with the DS/VOSHPD approved documents, t
Yes: No: Inspector Initials: , . _
ycy
•AUTITORIZING SIGNATURE
Signature authorizes the above wo*
SCS&T 205 BEV 7-2814
SOUTHERN CALIFORNIA
SOIL&TESTING,INC.
A California Certified Small Business Enterprise (SBE)
LEA # 047
6280 Riverdale Street
SANDIEGO, CA92120
Phone (619) 280-4321 Fax (619) 280-4717
83-740 Citrus Avenue, Suite G
INDIO, CA 92201
Phone (760) 775-5983 Fax (760) 775-8362
c PL NC FIX
514 N. Califomia Avenue, Suite 5
BEAUMONT, CA 92223
Phone(877)215-4321
X^7Ay
9549 East Slauson Avenue
PICO RIVERA, CA 90660
Phone (877)215-4321
SCS&T FILE NO.
RO. NO. PAGE / OF/ /
PROJECTTITLE: ?5»60#:
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DSA/OSHPD FILE NO.:
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DSA APR NO.: /
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PERMITNO.: /\y /
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PIAN FILE NO,^-'
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ARCHITECT FNRINFFR'
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GENERAL CONTRACTOR:
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SUB CONTRACTQE; y y , /
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FIELD INSPECTtON REPORT FOR: D REINFORCED CONCRETE • REINFORCED MASONRY • WELDING • FIREPROOFING d S. C. CONCRETE UNROOFING / WATERPROOFING
D RT CONCRETE / STRESS • EPOXY ANCHORS • H.S. BOLTING •
LOCATION OF WORK INSPECTED: <C0i cy/cx^ yy -7^ / 9 XX'
MATERIAL CLASSIFICATION:
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NAME
CBC/ICC I hereby certify that I have inspected the above reported work. Unless noted
othetwise the wotk inspected is to the best of my knowledge in compliance with the
approved plans, specifications and applicable sections of the governing building lows.
Inspector Initials
DSA/OSHPD I hereby certify that I have inspected the above reported wotl< in accordance
with fhe requirements of DS/VOSHPD approved documents. Sampling and testing were
conducted in accordance with the requirements of the DS/VOSHPD approved documents.
The work inspected complies with the DS/VOSHPD approved documents.
Yes: No: Inspector Initials:
•/jOryOftlZING SIGNATURE
*signature aufhonzes fhe above work
SCS&T 205 REV 7-2014
SOUTHERN CALIFORNIA
SOIL&TESTINGJNC.
A California Certified Small Business Enterprise (SBE)
6280 Riverdale Street 83-740 Citms Avenue, Suite G
LEA #047
SANDIEGO, CA92120
Phone (619) 280-4321 Fax (619) 280-4717
INDIO, CA 92201
Phone (760) 775-5983 Fax (760) 775-8362
c PL NC FIX
514 N. Califomia Avenue, Suite 5
BEAUMONT, CA 92223
Phone (877) 215-4321
SCS&T FILE NO.:
RO. NO.:
9549 East Slauson Avenue
PICO RIVERA, CA 90660
Phone (877) 215-4321
PAGE [_ OF
PROJECTTITLE: PHASE*:
LX\ OOSTT^ XXyorr>C\ //V
DSA/OSHPD FILE NO: DSA APP NO.: ,
i } ! ^ PROJECT ADDRESS PERMITNO.: /V/ / Xi PLAN FILE NO,: (/'•^ 1 iCA
ARCHITECT:
l^)CyCL.c^X A SC>CXLJ r\T-c-, S
ENGINEER:
GEN§EAL CONTRACTOR: SUB CONTRACTOR:
FIELD INSPECTION REPORT FOR: D REINFORCED CONCRETE • REINFORCED MASONRY D WELDING • FIREPROOFING • Q. C, CONCRETE D ROOFING / WATERPROOFING
• RT CONCRETE / STRESS D EPOXY ANCHORS • H.S, BOLTING •
J OF WORK INSPECTED:
WERIALCLASSIFICATION: ' '
7 6^UG?^. 3-r-UC-C.o /O^TT-</\JC.7 . <^ »MR^STS„(2^ ^^Q^
DATE DESCRIPTION OF WORK INSPECTED: TIMEARRIVED: TIME DEPARTEDt
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RE. REVIEW:
CBC/ICC I hereby certify that I have inspected the above reported work. Unless noted
otherwise the work inspected is to the best of my knowiedge in compliance with the
approved plans, specifications and dpplicable sections of the governing building lows.
Inspector Initiais
DSA/OSHPD I hereby certify that I hove inspected the above reported work in accordance
with the requirements of DS/VOSHPD approved Oocuments. Sampling and testing were
conducted in accordance with the requirements of fhe DS/VOSHPD approved documents.
The work inspected complies with fhe DSA/OSHPD approved documents.
Yes: No: Inspector Initials:
REGISTRATION NO.
/' /j2> llH
ZING SIGN/WJRE
'signature auttiorizes the above worl< SCSS<T205 REV 7-2014
SOUTHERN CALIFORNIA
SOIL&TESTINGJNC.
A California Certified Small Business Enterprise (SBE)
83-740 Citrus Avenue, Suite G
INDIO, CA 92201
Phone (760) 775-5983 Fax (760) 775-8362
6280 Riverdale Street
SANDIEGO, CA92120
Phone (619) 280-4321 Fax (619) 280-4717
PL NC FIX
514 N. Califomia Avenue, Suite 5
BEAUMONT, CA 92223
Phone (877) 215-4321
SCS&T FILE NO.:
RO. NO.:
LEA #047
9549 East Slauson Avenue
PICO RIVERA, CA 90660
Phone (877) 215-4321
PAGE / Oy_
FIELD INSPECTION REPORT FOR: d REINFORCED CONCRETE • REINFORCED MASONRY • WELDING • FIREPROOFING IZl Q. C. CONCRETE • ROOFING / WATERPROOFING
• RT CONCRETE / STRESS • EPOXY ANCHORS • H.S BOLTING •
PROJECTTITLE: . ^ AJ
Cr/s Xy^Cyy*^jy
fm*'-i^ DSA/OSHPD FILENO.:
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DSA APR NO:
y PROJECTADDRESS PIAN FILE
AL. ARCHITECT
Xl y 5
GENERAL CONTRACTOR:
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SUB CONTRACTOR:
LOCATION OF WORK INSPECTED:
XJ<y''<Cy^y^^ 2^ / 9 2 -T
MATEI^IAL CLASSIFICATION:
DATE/ / DESCRIPTION OF WORK INSPECTED: TIME ARRIVED: \KKivtu: .y TIME DEPARTED: ,
/^yi/y^f, Xy^ <-r y<c^^^y/t3
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PRINT NAME
C/yy(7y^
CBC/ICC I hereby certify that I have inspected the atx3ve reported work. Unless noted
otherwise the work inspected is to the best of my knowledge in compliance with the
approved plans, specifications and applicable sections of the governing building Idws.
Inspector Initials
DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance
with the requirements of DS/VOSHPD opproved documents. Sompling and testing were
conducted in occordance with the requirements of the DSA/OSHPD approved documents.
The work inspected complies with the DS/VOSHPD approved documents.
Yes: No: Inspector Initials:
*^JjSeI5lZING SIGNATURE
'Signature authorizes the atxwe wori<
REGISTRATION NO.
/a/?// 7
DATE 7 J
SCS&T206REV7-2014
SOUTHERN CALIFORNIA
SOIL&TESTING,INC.
ACalifornia Certified Small Business Enterprise (SBE)
LEA # 047
6280 Riverdale Street
SANDIEGO, CA92120
Phone (619) 280-4321 ,Fax (619) 280-4717
83-740 Citras Avenue, Suite G
INDIO, CA 92201
Phone (760) 775-5983 Fax (760) 775-8362
c PL NC FIX
514 N. Califomia Avenue, Suite 5
BEAUMONT, CA 92223
Phone (877)215-4321
SCS&T FILE NO.:
RO. NO.:
9549 East Slauson Avenue
PICO RIVERA, CA 90660
Phone (877) 215-4321
PAGE XU
PROJECTTITLE: •BUIl'it f* DSA/OSHPD FILE NO.: 1
' f ^ 'iA.
DSA APR NO.: •
A } / y} PggjECT ADDRESS PERMITNO: / ^ / PLAN FILE NO.: / \J [ y}
AKMECT ENGINEER:
GEWEfiAL CONTRACTQE: SUB pDlilTRACTOR:
FIELD INSPECTION REPORT FOR: Q REINFORCED CONCRETE • REINFORCED MASONRY d WELDING • FIREPROOFING d Q. C. CONCRETE • ROOFING / WATERPROOFING
• RT CONCRETE / STRESS • EPOXY ANCHORS • H.S, BOLTING •
ION OF WORKJNSPECTED:
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DATE I DESCRIPTION OF WORK INSPECTED: TIME ARRIVED: TIME DEPARTED: £> yi ,y, u/?i C'TT.1 ^ TIME DEPARTED: j2j^l/'^[XX^A
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CBC/ICC I hereby certify that I have inspected the above reported work. Unless noted
otherwise the work inspected is to the best of my knowiedge in compliance with the
approved plans, specifications and applicable sections of the governing building laws.
Inspector Initials
DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance
with the requirements of DS/VOSHPD approved documents. Sampling and testing were
conducted in accordance with the requirements of the DSA/OSHPD approved documents.
The work inspected complies with the DS/VOSHPD opproved documents.
No:
ny
Yes: Inspector Initials:
REGISTRATION NO.
DATE
'signo^ure authorizes ihe atxjve worii
SCS&T 205 REV 7-2014
SOUTHERN CALIFORNIA
SOIL&TESTING,INC.
A California Certified Small Business Enterprise (SBE)
83-740 Citrus Avenue, Suite G
INDIO, CA 92201
Phone (760) 775-5983 Fax (760) 775-8362
6280 Riverdale Street
SANDIEGO, CA92120
Phone (619) 280-4321 Fax (619) 280-4717
PL NC FIX
514 N. Califomia Avenue, Suite 5
BEAUMONT, CA 92223
Phone (877) 215-4321
7s^ui SCS&T FILE NO.
P.O. NO.
9 O ,n
LEA # 047
9549 East Slauson Avenue
PICO RIVERA, CA 90660
Phone (877)215-4321
PAGE OF
FIELD INSPECTION REPORT FOR: • REINFORCED CONCRETE D REINFORCED MASONRY • WELDING • FIREPROOFING • Q, C. CONCRETE • ROOFING / WATERPROOFING
• Pl CONCRETE / STRESS / • EPOXY ANCHORS • H.S. BOLTING •
PROJECT mE: ' PHASE #: DSA/OSHPD FILE NO.:
7^
DSA APR NO:
ijeCT ADDRESS
C7\^-X3FX^T>
PLAN FILE NO.
'<JC1CL£.5 ASSoCyAX<^^
ENGINEER:
tOSATION OF WORK INSPECTED: , ^ y", ^ ^ ,
X\^xx'ux^ /A -^tCiOU\sr\c XX /- 'lXS^.itJ .6^AJC)6.£, Hf70. (X)7^JA7
DESCRIPTION OF WORK INSPECTED: TIME ARRIVED: TIME 0^?M(\&i/(^S/$TJ^/f^iO
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PRINp^ME
CBC/ICC I hereby certify that I hove inspected the above reported work. Unless noted
otherwise the work inspected is to the best of my knowledge in compliance with the
approved plans, specifications and applicable sections of the governing building iaws.
Inspector Initials
DSA/OSHPD I hereby certify that I hove inspected the above reported work in accordance
with the requirements of DS/VOSHPD approved documents. Sampling and testing were
conducted in accordance with the requirements of the DS/VOSHPD approved documents.
The work inspected complies with the DSA/OSHPD opproved documents.
Yes: No: Inspector Initiols:
yyyy'l^
fiORIZING Sl
'signature authorizes the obove wort;
SCS&T205 REV 7-2014
^ f.^ y^ (~- ^
SOUTHERN CALIFORNIA
SOIL&TESTING,INC.
A California Certified Small Business Enterprise (SBE)
6280 Riverdale Street
SANDIEGO, CA92120
Phone (619) 280-4321 Fax (619) 280-4717
83-740 Citms Avenue, Suite G
INDIO, CA 92201
Phone (760) 775-5983 Fax (760) 775-8362
514 N. Califomia Avenue, Suite 5
BEAUMONT, CA 92223
Phone(877)215-4321
PL NC FIX
SCS&T FILE N0.:_
RO. NO.:
LEA #047
9549 East Slauson Avenue
PICO RIVERA, CA 90660
Phone (877)215-4321
PAGE OF /
PROJECT TITLE: ^ PiJ^
y7-^ CC^y^Cr^ 7X^ -XXy X
DSA/OSHPD FILE NO.:
/
DSA APR NO:
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PROJECT ADDRESS PERMITNO,: y\y /
y-f
PLANB|/NS2I.: ^
Xr
ARCHITECT
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ENGINEER;
GENERAL CONTRACTOR:
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SUBCONTRACTOR: yi y
7^0y / Syy/?y€r 73r^r
LOCATION OF WORK INSPECTED: j ^ '
y.XXyyyXyyy X C^X^3 5
FIELD INSPECTION REPORT FOR: • REINFORCED CONCRETE • REINFORCED MASONRY • WELDING •FIREPROOFING • Q, C. CONCRETE • ROOFING / WATERPROOFING
• RT CONCRETE / STRESS • EPOXY ANCHORS • H.S. BOLTING d
yp-7..yyrdX yXryr Cy fy^'yyr SSo X/y Wyy/, X<^y^cyy'
DATE
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DESCRIPTION OF WORK INSPECTED: TIME ARRIVED:
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TIME DEPARTED:
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NAME /y
yjy
RE. REVIEW:
CBC/ICC I hereby certify that I have inspected the above reported work. Unless noted
otherwise the work inspected is to the best of my knowledge in compliance with the
approved pidns, specificdtions and applicable sections of the governing building laws.
Inspector Initials
DSA/OSHPD I hereby certify that I hove inspected the above reported work in occordance
with the requirements of DS/VOSHPD approved documents. Sampling and testing were
conducted in occorddhce with the requirements of the DS/VOSHPD opproved documents.
The work inspected complies with the DS/VOSHPD approved documents.
Yes: No: Inspector Initials:
/^_3^_
*AliBjfeffl2[NG SIGNAll
'Signature auttiorizes the abme work
SCS&l 205 REV 7-2014
SOUTHERN CALIFORNIA
SOIL&TESTING,INC. LEA #047
A Cal ifornia Certified Small Business Enterprise (SBE)
83-740 Citms Avenue, Suite G
INDIO, CA 92201
Phone (760) 775-5983 Fax (760) 775-8362
6280 Riverdale Street
SANDIEGO, CA92120
Phone (619) 280-4321 Fax (619) 280-4717
PL NC FIX
514 N. Califomia Avenue, Suite 5
BEAUMONT, CA 92223
Phone (877^ 215-4321
cyc^i^/x7
RO. NO.:
9549 East Slauson Avenue
PICO RIVERA, CA 90660
Phone (877) 215-4321
SCS&T FILE NO.:
PAGE I OF /
PROJECTTlfLE: ^ ^ ^^f^
yCy^C^O'^y cy^^,yyy/t /^yyy
DSA/OSHPD FILE NO:
/
DSA APR NO.:
/
PROJECT ADDRESS^
"^oyy ,c.yyycr
PERMITNO.: /\y /
X
PLAN^FJIipiO/
ARCHITECT:
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ENGINEER:
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GENERAL CONTRACTOR: ^ ^
-y-y^ y -'"y^^ry^.v X7y/yy?^'^s
SUB CONTRAOeR: / ^ ,
Lyy^y^y y^ ^ryX X^^ 7
FIELD INSPECTION REPORT FOR: • REINFORCED CONCRETE • REINFORCED MASONRY • WELDING D FIREPROOFING • Q. C, CONCRETE [^ROOFING / WATERPROOFING
• PT CONCRETE / STRESS • EPOXY ANCHORS • H.S. BOLTING •
LOCATION OF WORK INSPECTED:
MATERIAL CLASSIFICATION: xcyyj,:.
DATE /
izX i
/ /
DESCRIPTION OF WORK INSPECTED: TIME ARRIVED: TIME.BePARTED:
y7 I ^y..yu I y Xjyy S y^XXr^yXi ^ y<Xr^Xf d'y,^,
X7y^ y y y^ S X'V cyor fry 4P
r:^_yXyy^<^^ ry^,^ X
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y-. yyf^y y <o/-" jyy .ycr / yU
, ^r^4y /Jyjr - x ^y
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'RINT NAjjt^
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<yyyy .^Cyr'^Cyy
CBC/ICC I hereby certify thot I hove inspected the above reported work. Unless noted
otherwise the work inspected is to the best of my knowledge in compliance with the
approved plans, specifications and applicable sections of the governing building Idws.
Inspector Initials
DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance
with the requirements of DS/VOSHPD approved documents. Sampling and testing were
conducted in accordance with the requirements of the DS/VOSHPD approved documents.
The work inspected complies with the DS/VOSHPD approved documents.
Yes: No: Inspector Initiols: SCS&T 205 REV 7-201^