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Home My WebLink About2819 LOKER AVE E; ; CB993663; PermitCity of Carlsbad 10/05/1999 Miscellaneous Permit Permit No:CB993663 Building Inspection Request Line (760) 438-3101 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: 2819 LOKER AV EAST CBAD MISC ltoo Subtype: 209083~ Lot#: $0.00 ACUSHNET COMPANY OTHER 0 CONG. SLAB & I BEAMS FOR MECH. ENCLOSURE Applicant: BURGER CONSTRUCTION STE 110 437 S HWY 101 SOLANA BEACH CA 92075 858-755-1800 Total Fees: $60.00 Miscelaneous Fee #1 Miscelaneous Fee #2 TOTAL PERMIT FEES FINiAPPROVAL Date: "Z 9 · /Jl) Status: ISSUED Applied: 10/05/1999 Entered By: MOP Plan Approved: 10/05/1999 lssUEfd~4 :li:@/Ql:&f'f99900.t Inspect Area: PD EST LTD PARTNERSH 0 NC INC ,00 Clearance: .00 .00 $60.00 NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government 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/exactions DOES NOT APPLY to water and sewer connection fees and capactiy 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 ou have reviousl been iven a NOTICE similar to this or as to which the statute of limitations has reviousl otherwise ex ired. CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 1. PROJECT INFORMATION FOR OFFICE USE ONLY f:,'3 PLAN CHECK NO. r=r -3~ EST.VAL._~~~~~~~~~ Plan Ck. Deposit--------- Validated By __________ _ Date.~-------------- 2 ~ 11 f.&:, LO /:-!l1',-- Address (include Bldg/Suite II Business Name (1t this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use Cruse. S/Acl? .J-I· 8~ s 1:912.-/)vsr: Description of Work SQ. FT. #of Stories # of Bedrooms # of Bathrooms 2. ~ONTACT PERSON (If clff.,.... from IIPPlicentl · (2 • J I s. ~ C' 0 f'1 • ;C)UQ_~ Cow...,57!2:vCDs:;,-,..J JA<:J£..'t:>vR.bcr1L :i37 . ~Y /0/ ((0 .....bL/t7-llr~O'\::ltV't"" Name Address City State/Zip Telephone # Fax # 3. APPLICANT ·~contractor D Agent for Contnlctor O Owner O Agent for Owner f'S1f, S-S-1 ~O F-t-t rSSl)s.-s-2~ l Name Address City State/Zip Telephone# 4. PROPERTY OWNER Name Address City State/Zip Telephone# 6. CONTRACTOR -COMPANY NAME (Sec. 7031 .5 Business and Professions Code: Any City or County which requires I permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law !Chapter 9, commending 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 ($5001). Name State License #.J:5 d :f ? '?"7 Address License Class _rs....;;.._-_,,/ _____ _ City State/Zip Telephone # City Business License # / 26 J./OZ. 7 Designer Name Address City State/Zip Telephone State License # ---------- 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perJury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. [j)...--,have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's c pensation insurance carrier and policy number are: Policy No. lf C,_ 7 -~ 5' Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1,$1001 OR LESS) 0 CERTIFICATE OF EXEMPTION: 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' Compens'ation Laws of California. WARNING: Failure to secure worken' compensation coverage is unlawful, end shall subject en employer to crimlnel peneltles and civil fines up to one hundred thousand dollars ($100.0001. in 1ddltion to the coat of compenution, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE DATE _________ _ 7. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: D 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 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 or improvemen~ 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). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(sl licensed pursuant to the Contractor's License Law). 0 I am exempt under Section ------Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO 2. I (have I have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firml to provide the proposed construction (include name I address I phone number I contractors license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name I address I phone number I contractors license number):·------------------------------------------------- 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address I phone number I type of workl:. ____________________________________________________________ _ PROPERTY OWNER SIGNATURE----------------------- COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY DATE_~~~~~~~~~ Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site 7 0 YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 8. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(il Civil Code). LENDER'S NAME _____________ _ LENDER'S ADDRESS ----------------------------~ 9. APPLICANT CERTIFICATION I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citt of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. I under the provisions of this Code shall expire by limitation and become null and void if the building or te of such permit or if the building or work authorized by such permit is suspended days (Section 106.4.4 Uniform Building Code). DATE /() r ) -c; 7 Inspection List Permit#: CB993663 Type: MISC OTHER ACUSHNET COMPANY CONC. SLAB & I BEAMS FOR MECH. ENC Act Comments Date Inspection Item Inspector ____ ____,____ _____ ·---------······ 11/3/1999 84 Rough Combo 10/29/1999 17 Interior Lath/Drywall 10/26/1999 11 Ftg/Foundation/Piers 10/18/1999 66 Grout 10/14/1999 15 Roof/Re roof 10/13/1999 11 Ftg/Foundation/Piers 10/13/1999 15 Roof/Re roof 10/8/1999 11 Ftg/Foundation/Piers 10/7/1999 11 Ftg/Foundation/Piers 10/6/1999 11 Ftg/Foundation/Piers Wednesday, June 28, 2000 PD PA CEILING AT 117, & UPPER OFFICE PD AP PD AP MECH ENCLOSURE PD AP PD AP PD AP PREVIOUSLY PD NS PD AP PD NR PD PA SLAB Page 1 of 1 TESTING ENGINEERS SAN DIEGO (619)-715-5800 FAX (619) 715-5810 REPORT OF COMPRESSION TEST ATLANTIC CITY• RAHWAY ·ORLANDO• SAN DIEGO• FT. LAUDERDALE PROJECT 99-486 PROJECT ADDRESS 2819 EAST LOKER AVE., CARLSBAD, CA CONTRACTOR BURGER CONSTRUCTION ----------------------------~ ARCHITECT/ ENGINEER SMITH CONSUL TING ARCHITECTS/KL T ENGINEERS BLDG. PERMIT NO. CB993663, PLAN FILE NO. NIA ---------. -·- SAMPLE DATA REPORT OF [[I CONCRETE D MORTAR D GROUT D HS GROUT D PRISMS D OTHER PLACEMENT DATE 10/27/99 DATE RECEIVED IN LAB 10/28/99 SUPPLIER SUPERIOR MIX DESIGN PSI 3000 MIX NUMBER CC6 MIX DESCRIPTION 5.5 SK TYPE OF CEMENT II TICKET NO. 157070 ADMIXTURE NIA SPECIFIED SLUMP: 4" SLUMP (IN.): 4 1/2" MIXING TIME (MIN) 30 AIR CONTENT(%) N/A CONG TEMP (°F) 78 AIR TEMP.(°F) 78 DESIGN STRENGTH (f '0) PSI 3000 @ 28 DAYS SAMPLES MADE BY R.MOTSINGER LOCATION OF PLACEMENT ENCLOSURE B LABORATORY DATA AGE DIMENSIONS TEST AREA MAXIMUM LOAD COMPRESSIVE (days) LAB NO. DATE TESTED (inches) (sq. inches) (lbs) STRENGTH (psi) 7 29546 11/3/99 6X12 28.27 90,500 3200 28 29547 11/24/99 6X12 28.27 137,000 4850 28 29548 11/24/99 6X12 28.27 140,000 4950 56 28549 12/22/99 DISC ALL SAMPLING AND TESTING PERFORMED IN GENERAL ACCORDANCE WITH ASTM TEST METHODS. *ACTUAL MEASURED AREA. REMARKS: TWO (2) 28-DAY TESTS COMPLY WITH PROJECT SPECIFICATIONS /~ CHECKED BY: REVIEWED BY: R. DOUGLAS PROVINS, RCE 56018 p.Vf DATE:~-=~~~~ TESTING ENGINEERS SAN DIEGO (619)-715-5800 FAX (619) 715-5810 REPORT OF COMPRESSION TEST PROJECT ACUSHNET PROJECT ADDRESS 2819 EAST LOKER AVE., CARLSBAD, CA CONTRACTOR BURGER CONSTRUCTION ATLANTIC CITY• RAHWAY 'ORLANDO• SAN DIEGO• FT. LAUDERDALE ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ARCHITECT/ ENGINEER SMITH CONSUL TING ARCHITECTS/KL T ENGINEERS BLDG. PERMIT NO. CB993663, CB993377 Tl PLAN FILE NO. N/A SAMPLE DATA REPORT OF [8J CONCRETE D MORTAR D GROUT D HS GROUT D PRISMS D OTHER PLACEMENT DATE 10/25/99 DATE RECEIVED IN LAB 10/26/99 ~~~~~~~~~~ SUPPLIER ESCONDIDO READY MIX MIX DESIGN PSI 3000 ~~~~~~~~~~~~~~ -~~~~~~~~~~~~~~ MIX NUMBER CC6 MIX DESCRIPTION 5.56 SK TYPE OF CEMENT II TICKET NO. 330804 ADMIXTURE N/A SPECIFIED SLUMP: 4" SLUMP (IN.): ~~~~~~~~~~~~~~- 4 1/2" MIXING TIME (MIN) 45 AIR CONTENT(%) N/A ·~~~~~~~~~~~~~~- CONG TEMP (°F) 78 AIR TEMP.(°F) 86 DESIGN STRENGTH (f '0) PSI 3000@ 28 DAYS SAMPLES MADE BY R.MOTSINGER ~~~~~~~~~~~~~- LOCATION OF PLACEMENT FOOTING NORTH @ EXISTING BUILDING LABO RA TORY DATA AGE DIMENSIONS TEST AREA MAXIMUM LOAD COMPRESSIVE (days) LAB NO. DATE TESTED (inches) (sq. inches) (lbs) STRENGTH (psi) 7 30250 11 /1 /99 6X12 28.27 115,500 4090 28 30251 11/22/99 6X12 28.27 133,000 4700 28 30252 11/22/99 6X12 28.27 133,500 4720 56 30253 12/20/99 DISC ALL SAMPLING AND TESTING PERFORMED IN GENERAL ACCORDANCE WITH ASTM TEST METHODS. *ACTUAL MEASURED AREA. REMARKS: TWO (2) 28-DAY TESTS COMPLY WITH PROJECT SPECIFICATIONS CHECKED BY: DATE: ______ , REVIEWED BY: R. DOUGLAS PROVINS, RCE 56018 ~ DATE: \ S-z;z.,--\OQI . \ SM&WtJSE-il#HM\&ffefbt? AifiSSZ&GS l"t14-Rifu&Ri~"'.ff:M£ i$,¥/tt¥?(k § !i!&AAMM#Sftt&# . ~ iifW4&i¥WCi M Testing Engineers-San Diego, Inc. Established 1946 FIELD INSPECTION AND TEST REPORTS Date: Job No: Job Name: Address: Report No: 12/2/99 99-486 ACUSHNET 2819 East Locker Avenue Carlsbad, California Plan Number: Permit Number: 2572 Field Supervisor: GREGORY SMITH, PE NIA CB993663/CB993377 TI Enclosed are field inspection and/or test reports, for the above referenced project, _for work performed on 11/20/99. These reports cover the locations of work inspected and/or tested following recognized standards and do not constitute engineering opinion or project control. These reports do not relieve the contractor of his responsibility to build per the plans, specifications and all applicable codes. Should you have any questions regarding these reports, please contact our office at (858) 715- 5800. Reports enclosed (1) Testing Engineers -San Diego, Inc .. 7895 Convoy Court, Suite 18 San Diego. CA. 92111 (858) 715-5800 Fax (858) 715-581 O nn Testing Engineers -San Diego, Inc. 7895 Convoy Ct., Suite 18 San Diego, CA 92111 INSPECTION REPORT Page_1_of +- ,\)/'\ r ~ ,J -• _J_ (9 ~ ltQI Project Name -~~-'-=-~"-"""~fll,l,~}J_ie><r ______________ TESD Project# -9-+-~......_-_<-v_~CJ\O.~----=-=,--e--- Address __,J"""-$......._._19-A---..:::J!:.:C..:..:i.-'--'h,-'-=-fldl_--'--='-=--.,cw=-><----'CA&="-""'/$ ....... ~"-"'Jlh~----'C' ........ A=-------------~'--- General I Subcontractor ~ v ~ C crw:as£: i?.M Building Permit# eB, '11,Gl C!.8.'J >Y;}-'7 DSA# _______________ _ Plan File# -~}J_/~Pr-__________ OSHPD # _______________ _ Government Contract # _____________ Other--------------------- INSPECTION MAT'L SAMPLING QTY MATERIAL DESCRIPTION INSPECTION CHECKLIST --Concrete __ Soil --__ Cone: Mix #/psi --±lans ~ft~~~ __ Prestress Cone __ Base --__ Cone: Mix #/psi pecifications ./JJ.ifj/) \l'{}) __ Masonry __ Subgrade --__ Cone: Mix #/psi __ Sizes -X Struct Steel __ Asphalt Concrete --__ Rini: Rebar __ Slump __ Fireproofing __ Concrete Cylinders --__ Rini: W.W.F. __ Air Content __ Pile Driving __ Cone Flex Beams --__ Rini: Tendons __ Temperature --Non-Destructive __ Rein!. Steel --__ Grout: Mix #/psi __ Unit Weight --Batch Plant __ Tendon (PT Strands) --__ Mortar: Type/psi Consolidation --Soils Technician __ Mortar Samples ----Units: Block =xElectrode Storage O-\le1J --Mechanical __ Grout Samples --Units: Block __ Torque Applied --Electrical __ Masonry Prisms --~Steel t--,3.{: __ Load (Pounds) I __ Bolt Pull-Out __ Masonry Block ----H.S. Bolts * Thw7iQ t kJQ~ __ Roofing __ Steel --__ Metal Decking __ Waterproofing __ H.S. Bolts -ll-Electrodes/!!.;JO I B ---- __ DSA __ Fireproofing --__ Fireproofing -- --OSHPD __ Roofing ----Other __ Corrective action required --Specialty __ Other --__ Corrections completed ___ Remarks /N~ ~ o-A-.fM/J C.c,Lleci.ae_ (bc.-'.2.', Le@.i 1-,, ,.,,,,a.ea, Ji.S J J.J s/kB f/ weW>-t~ /s!lA.s;s, ~olLrzcJeia (1Jc.-Ll] As .shrJuH'AJ (!) AJ Field Representative# ~ Testing Engineers -San Diego, Inc. Date: Job No: Job Name: Address: Report No: FIELD INSPECTION AND TEST REPORTS 11/11/99 99-486 ACUSHNET 2819 East Locker A venue Carlsbad, California Plan Number: Permit Number: 2408 NIA CB993663 Field Supervisor: GREGORY SMITH, PE Established 1946 Enclosed are field inspection and/or test reports, for the above referenced project, for work performed on 10/25/99-10/27 /99. These reports cover the locations of work inspected and/or tested following recognized standards and do not constitute engineering opinion or project control. These reports do not relieve the contractor of his responsibility to build per the plans, specifications and all applicable codes. Should you have any questions regarding these reports, please contact our office at ( 619) 715- 5800. Reports enclosed (2) Testing Engineers -San Diego, Inc .. 7895 Convoy Court, Suite 18 San Diego, CA. 92111 [858] 715-5800 Fax [858] 715-5810 Testing Engineers -San Diego, Inc. 7895 Convoy Ct, Suite 18 San Diego, CA 92111 INSPECTION REPORT Page_1_of_f_ Project Name A C!__v rJ ld: Nf..,+-C a Address 2({;3 I ct_ ~ A£: f-L; keL TESD Project# _q~~~--c../~8~G~--- General I Subcontractor ~ llllE;)-ut..-(!__~J._, Building Permit# e._,3 qc.,, 3'-~.3 DSA# ______________ _ Plan File# ________________ OSHPD # _________________ _ Government Contract # _____________ Other ____________________ _ INSPECTION MAT'L SAMPLING QTY MATERIAL DESCRIPTION INSPECTION CHECKLIST ~Concrete __ Soil --__ Cone: Mix #/psi --__ Plans __ Prestress Cone __ Base --__ Cone: Mix #/psi __ Specifications __ Masonry __ Subgrade --_hl_conc: Mix #/psi __ Sizes ~ Struct Steel Asphalt Concrete ~ ~Rinf: Rebar 4;>0 6-lc _J)(_s1ump '112// __ Fireproofing ~ Concrete Cylinders --Rinf· WW F. __ Air Content re) __ Pile Driving __ Cone Flex Beams ----Rini. Tendons ~ Temperature V --Non-Destructive --Reinf. Steel --__ Grout: Mix #/psi __ Unit Weight --Batch Plant __ Tendon (PT Strands) --__ Mortar: Type/psi -Xe-Consolidation g t?etb --Soils Technician __ Mortar Samples ----Units· Block __ Electrode Storage --Mechanical __ Grout Samples ----Units: Block __ Torque Applied --Electrical __ Masonry Prisms ----Steel __ Load (Pounds) __ Bolt Pull-Out __ Masonry Block ----H.S. Bolts --Thickness __ Roofing __ Steel --__ Metal Decking -- __ Waterproofing __ H.S. Bolts --__ Electrodes -- __ DSA __ Fireproofing --__ Fireproofing -- __ QSHPD __ Roofing --_}l_~t!A~ ~~ __ Ccrrectwe action required ___ __ Specialty __ Other --__ Corrections completed ___ fjj{ ' Field Representative#<~ I a£ CERTIFICATION OF COMPLIANCE: All of the observed work, unless otherwise stated, is in conformance with the approved plans and specifications and the workmanship provisions of the applicable code. INSPECTOR'S NAME e, ~ nnt cieariyj INSPECTOR'S SIGNATURE------- CERT. NO. SMl>tll.g O 7:;..8 Form#003 Testing Engineers -San Diego, Inc. 7895 Convoy Ct., Suite 18 San Diego, CA 92111 INSPECTION REPORT Page_1_of _J_ Project Name _ _,_A_c_u_s_,_~_IJ_Q,A' ___ ---=(j"-Q)_.· ________ TESD Project# Cf_ '1-4,8(:, Address _@.,._,,,6,:_,c__l9.....____,=_~~'--J----'L'--=-'-"-o~k~~~~--(D-"--L-~!5'-+,------------ General I Subcontractor f)u IU(Jt:/L LON'>± Building Permit# C. B qq 'l "-6 & DSA# __________________ _ Plan File# _________________ OSHPD # __________________ _ Government Contract # _____________ Other _____________________ _ INSPECTION MAT'L SAMPLING QTY MATERIAL DESCRIPTION INSPECTION CHECKLIST +concrete __ Soil --__ Cone: Mix #/psi --_k_ Plans '1-r_}i_ __ Prestress Cone __ Base --~ Cone: Mix #/psi 1_60-"E> ~Specifications y-e.z Masonry __ Subgrade --I Cone: Mix #/psi ~Sizes -X Struct Steel Asphalt Concrete ~ Rini: Rebar &A b-0 Slump '-i 7t_~tf __ Fireproofing ~ Concrete Cylinders __ Rini: W.W.F. __ Air Content __ Pile Driving __ Cone Flex Beams __ Rini: Tendons + Temperature 78 --Non-Destructive -¥-Rein!. Steel ~ __ Grout: Mix #/psi Unit Weight =:g;: Consolidation §GO}S --Batch Plant __ Tendon (PT Strands) --__ Mortar: Type/psi --Soils Technician __ Mortar Samples ----Units: Block __ Electrode Storage Mechanical --__ Grout Samples ----Units: Block __ Torque Applied --Electrical __ Masonry Prisms ----Steel __ Load (Pounds) __ Bolt Pull-Out __ Masonry Block ----H.S. Bolts --Thickness __ Roofing -ii..-steel --__ Metal Decking -- __ Waterproofing __ H.S. Bolts --__ Electrodes -- --DSA __ Fireproofing --__ Fireproofing -- __ OSHPD __ Roofing --~Other fi..Po"rxA/ J.A.hfn :;? Ccrrective action required ___ __ Specialty __ Other --Le./),o JJ&?Ji 1 ~4'£ __ Corrections completed ___ ; Remarks l~ jtfKt-At-e-Ar#: d:fi -~./JU) P/k.U<.Cwt--~ /f.J'Lco-~e A-.s lu-ef2e__ G..-re&b e o: I. Is Al?; 1 w sfie--clw w €.{\ ~ u-1-&-e-44-lf_ ~ C!.d I cJ f4bl(8 M S /t.,,oJ,w "',v ,L}, 1!4 vej, I> tU w ~ C ~ t,4..J.':/ (..,-~ b 2 A-, I-,4..,I / CERTIFICATION OF COMPLIANCE: All of the observed work, unless otherwise stated, is in co formance with the approved plans and specifications and the workmanship provisions of the applicable code. .51J,.tv ) IJ::.fJ O 7 ?..., 43 CERT. No.5o0 :g<..J~1,'S'..,,8.b DATE_t~, O_-_L_£_--,___.j_q_-=---c= Form#003