HomeMy WebLinkAbout1372 SAPPHIRE DR; ; CB062124; PermitCity of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
10-27-2006 Residential Permit Permit No: CB062124
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
1372 SAPPHIRE DR CBAD
RESDNTL Sub Type:
Lot#:
SFD Status:
12 Applied:
Valuation:
2122501200
$413,580.00 Construction Type: VN
CT020007
Entered By:
Occupancy Group:
10/27/2006
# Dwelling Units:
Reference #:
Structure Type: SFD Issued:
Bedrooms: 4 Bathrooms: 3.5 Inspect Area:
Project Title: EMERALD POINTE, PLN 2, 3842 SF Orig PC#:
705 SF GAR,115 SF DECK,104 SF PORCH Plan Check#:
Applicant:
SADDLEVIEW L LC
16461 SHERMAN WAY #350
VAN NUYS CA 91406
Building Permit
Add'I Building Permit Fee
Plan Check
Add'l·Plan Check Fee
Plan Check Discount
Strong Motion Fee
Park in Lieu Fee
Park Fee
LFM Fee
Bridge Fee
Other Bridge Fee
STD #2 Fee
STD #3 Fee
Renewal Fee
Add'I Renewal Fee
Other Building Fee
HMP Fee
Pot. Water Con. Fee
Meter Size
Add'I Pot. Water Con. Fee
Reel. Water Con. Fee
$1,513.68
$0.00
$983.89
$0.00
$0.00
$41.36
$5,728.00
$0.00
$0.00
$0.00
$0.00
$14,070.00
$0.00
$0.00
$0.00
$0.00
$0.00
$3,188.00
D5/8
$201.00
$0.00
Owner:
SADDLEVIEW LL C
16461 SHERMAN WAY #350
VAN NUYS CA 91406
Meter Size
Add'I Reel. Water Con. Fee
Meter Fee
SDCWAFee
CFD Payoff Fee
PFF (3105540)
PFF (4305540)
License Tax (3104193)
License Tax (4304193)
Traffic Impact Fee (3105541)
Traffic Impact Fee (4305541)
Sidewalk Fee
PLUMBING TOTAL
ELECTRICAL TOTAL
MECHANICAL TOTAL
Housing Impact Fee
Housing lnlieu Fee
Housing Credit Fee
Master Drainage Fee
Sewer Fee
Additional Fees
TOTAL PERMIT FEES
ISSUED
10/28/2005
RMA
Plan Approved:
10/27/2006
PC050110
$0.00
$160.00
$4,313.00
$1,578.27
$7,527.16
$0.00
$0.00
$0.00
$720.00
$0.00
$0.00
$224.00
$60.00
$85.00
$0.00
$0.00
$6,428.58
$0.00
$1,047.00
$0.00
$47,868.94
Total Fees: $47,868.94 Total Payments To Date: $47,868.94 Balance Due: $0.00
Inspector: Clearance:
NOTICE: Please take NOTICE that approval of your project includes the 'Imposition" o fees, dedications, reservations, or other exactions hereafter collectively
referred to as "fees/exactions." You have 90 days from the date this pemiit 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 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
f I in fwhih rvi I b n iven Tl i ilr hi r ihh flimi in r i I ohrwi
. ·city of Carlsbad Bldg Inspection Request
For: 04/03/2009
Permit# CB062124 Inspector Assignment: MC
Title: EMERALD POINTE, PLN 2, 3842 SF
Description: 705 SF GAR,115 SF DECK,104 SF PORCH
Sub Type: SFD
---
Type: RESDNTL Phone: 6199484962
Job Address:
Suite:
Location:
1372 SAPPHIRE DR
Lot:
APPLICANT SADDLEVIEW L L C
Owner: SADDLEVIEW L L C
Remarks:
Total Time:
CD Description
19 Final Structural
29 Final Plumbing
39 Final Electrical
49 Final Mechanical
12
Comments
Inspector:
Requested By: JEFF
Entered By: KATHY
Comments/Notices/Holds
Associated PCRs/CVs Original PC# PC050110
lns12ection Histo[Y
Date Description Act lnsp Comments
08/25/2008 19 Final Structural PA MC CHECK WITH DEVELOPER TO EXTEND PERMIT
02/26/2008 39 Final Electrical AP MC EMR
10/16/2007 17 Interior Lath/Drywall AP MC
10/16/2007 18 Exterior Lath/Drywall AP MC
10/16/2007 23 Gas/Test/Repairs co MC PROVIDE WORKING GUAGE
10/10/2007 16 Insulation AP MC APPR 10/09/07
10/10/2007 18 Exterior Lath/Drywall WC MC
10/09/2007 16 Insulation AP MC
09/24/2007 13 Shear Panels/HD's PA PC
09/24/2007 14 Frame/Steel/Bolting/Welding AP PC REVISED PLAN APPROVED
09/24/2007 24 Rough/Topout AP PC
09/24/2007 34 Rough Electric AP PC
09/24/2007 44 Rough/Ducts/Dampers AP PC
Inspection List
Permit#: CB062124 Type: RESDNTL SFD EMERALD POINTE, PLN 2, 3842 SF
705 SF GAR,115 SF DECK,104 SF PORCH
Date Inspection Item Inspector Act Comments
04/03/2009 89 Final Combo PC AP GMR
04/03/2009 89 Final Combo RI
08/25/2008 19 Final Structural MC PA CHECK WITH DEVELOPER TO EXTEND
PERMIT
02/26/2008 39 Final Electrical MC AP EMR
10/16/2007 17 Interior Lath/Drywall MC AP
10/16/2007 18 Exterior Lath/Drywall MC AP
10/16/2007 23 Gas/Test/Repairs MC co PROVIDE WORKING GUAGE
10/10/2007 16 Insulation MC AP APPR 10/09/07
10/10/2007 18 Exterior Lath/Drywall MC we
10/09/2007 16 Insulation MC AP
09/24/2007 13 Shear Panels/HD's PC PA
09/24/2007 14 Frame/Steel/Bolting/Weldin PC AP REVISED PLAN APPROVED
09/24/2007 24 Rough/Topout PC AP
09/24/2007 34 Rough Electric PC AP
09/24/2007 44 Rough/Ducts/Dampers PC AP
09/10/2007 11 Ftg/Foundation/Piers MC AP FOUNDATIONS REVISIONS ONLY
09/04/2007 21 Underground/Under Floor MC AP WASTE REVISIONS ONLY
03/07/2007 13 Shear Panels/HD's MC AP NEED STAMPED & WET AIGNED
LETTER FROM EOR ACCEPTING USE
OF TITEN ANCHORS AT 3X SILL
02/26/2007 15 Roof/Reroof PD AP
02/23/2007 15 Roof/Reroof cw NS ROLLED TO MONDAY
02/07/2007 15 Roof/Reroof MC CA PER CONTRACTOR, NO APPROVED
TRUSS CALCS
02/05/2007 15 Roof/Reroof MC co SEE NOTICE
12/12/2006 22 Sewer/Water Service MC AP WATER, BUILDING SUPPLY ONLY
12/1112006 22 Sewer/Water Service MC NR
12/08/2006 11 Ftg/Foundation/Piers MC AP RECEIVED PT, SOILS & BLDG.
12/08/2006 12 Steel/Bond Beam MC AP FOOTPRINT REPORTS
11/28/2006 21 Underground/Under Floor MC AP
11/27/2006 22 Sewer/Water Service MC CA PER CONTRACTOR
Monday, April 06, 2009 Page 1 of 1
~ cnv or Carlsbad ea Flnal Bullillni lnspacdan
Dept:• ~uildin~Planning CMWD St Lite
Plan Check#:
Permit#: CB062124
Project Name: EMERALD POINTE, PLN 2, 3842 SF
Fire
Date:
Permit Type:
Sub Type:
Address:
705 SF GAR, 115 SF DECK, 104 SF PORCH
1372 SAPPHIRE DR Lot: 12
Contact Person: Phone:
Sewer Dist: CA Water Dist: CA
MAR 2 4 2009
03/23/2009
RESDNTL
SFD
..........................................................................................................................................................
Inspected
~UviU
Date 3/z~1o1 By: ~\J\ Inspected: Approved: )< Disapproved: __
Inspected Date
By: Inspected: Approved: Disapproved: __
Inspected Date
By: Inspected : Approved: Disapproved: __ ............................. , ............................................................................................................................ ,
Comments: ______________________________ _
BE:ST COtJY
PY .GEOTECHNICAL EXPLORATIONI INC.
SOIL & FOUNDATION ENGINEERING
GROUNDWATER • ENGINEERING GEOLOGY
FIELD REPORT ON OBSERVATION OF FOUNDATIONS DATE: --------
TIME:
CLIE NT: __________________ _ JOB NO.
PROJECT NAME: _________________________ _
PROJECT ADDRESS:
□
□
□
□
The footing excavations listed below were bottomed on material for which the bearing val ues
recommended in the foundation report are applicable.
The cast-in-pl ace drilled friction piles listed below penetrated material for which the
allowable supporting capacities recommended in the foundation report are applicable. The
piles were excavated to diameters at least as large as specified and the excavations extended
at least to the depths indicated on the Foundation Plans.
The excavations for the cast-in-place belled piers listed below were bottomed on material for
which the bearing values recommended in the foundation report are applicable. The
excavations were at least as large as specified on the Foundation Plans.
The driven piles listed below were observed to be driven to the specified lengths and/or
driving resistances to obtain the suppo rting capacities recommended in the foundation
report.
Based upon observations, it is our opinion that t he foundation recommendations presented in the
report of the foundation investigation, Job No. ______ , dated _________ (are)/(are
not) applicable to the conditions observed. Foundation Plans bY-----------,-----
dated __________ were used as a reference for our observations.
NOTE:
1. The observations reported above do not constitute an approval of foundation location,
footing size or depth, reinforcement, or foundation design.
2. Loose, soft, or disturbed soils must be removed prior to placement of reinforcement or
concrete.
3. The opinions and recommendations presented in this report were based upon our observa-
tions and are presented in accordance with generally accepted professional engineering
practice. We make no other warranty, either express or implied.
BY: __________________ _
7420 Trade St. San Di'ego, Ca . 92 121 • (858) 549-7222 • FAX: (858) 549-1604
'
SOil • TISTING, INC SOUTHERN ·CALIFORNIA SOIL & TESTING, INC.
6280 RIVERDALE STREET. SAN DIEGO. CA 92120 • 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
63?13
.. 1~---,, __ SCS&T FILE NO._· _•....:;.)_~·.:..~L....e~::.c•....:'~-.;:::?:__t-.-.;,.._ __
P.O. NO.·~---------
I C I ; l I PL I I I NC I I I FIX I I PAGE OF
FIELD INSPECTION REPORT FOR: 0 REINFORCED CONCRETE 0 REINFORCED MASONRY 0 WELDING 0 FIREPROOFING
=:J Q. C. CONCRETE 0 ROOFING / WATERPROOFING ;[l P.l CONCRETE I STRESS 0 EPOXY ANCHORS □ H.S BOLTING □
PROJECT TITLE: / / /__ -:,-I PHASE#/ 0SA FILE NO.: DSA APP. NO.: .. ,4 .... .1;.,r / -,,H.-.-,, ..r.'•,·-~,,,,.rt: I , (
PROJECT AJDRE/4 / I ,I'-,~-• / PERMIT NO.: ~5/,-:._ I PIAN FILE NO.:
,:::-;, I'/ ✓" .,(/' / ... ; ,
./,-, .... "' C ,,,·~.-L " • .r"'"'"'~ _r ., ., ,,,
ARCHITECT: < ' . ENGINEER: "'/~.-:-✓--;"' / -/,..l--i' I * 1/.. .
GENERAL CONTTlA~: Ii.,,,, SUB CO~CTO!l: /-_ Afa/ __ /.,,. .. • _/;: , /1//<,_,.. I 14,_.:,-,-4 ~, -. --:
LOCATION OF WORK INSPECTED: 7--,--;,---.,.. ' '.../ ,_ / / hf_:,;.,,,,._,_, c~_ .. --,.. .. -( "' ·-·=.r. I
MATERIAL CLASSIFICATION: __j. , I
..:-_ .. /",., ~~. -,--I' ...•• ..., ;r' ---4'.. 4-' / (' L; ,-,.f'.A ~-.~ >
--? /' <I -,f.:.:--:,;, ,/ .,..,--, c;; ~ I ,,t-6, • ,/, ' /4 • ,· ,.(,/,<' . c~~~· -,.
--.,_c''>f "' -I'"· ;f:-,
DATE I DESCRIPTION 01;. WORK INSPECTED: TIME ARRIVED: • TIME DEPARTED: fl,._
I I-~:.,, ,.:. -~ -.. -
-,..,,,, --/ _/ ,.,,,,T / >--✓ ,.( --
/,~/-•• .. 1. ll, .• ..-2.c ~/",;~ .L:? .A'.-y·k --: ... ' ,{,;_-,<.. ,5 < ·,.,.__,i ,_ .-,.i I
{__ ~/. -~ .✓ /' ' ... .s/~_.:., .;.7,,11/~,: , -'_ --~',',A:,,,'/ "!!,t~ .... ;-~--,./ /_ .. -, ~---
L.-~~ .. ,-/ 0~
1')~.,,.-..--:,;;.,: -,/-, .2 " ,-:r;✓-/,
/ :' _,,_.I' I'!'.'...-?,,,.[ ........... .!",,r{-~ .. ~ ... ,, I" ,/ , .. ,::r,.;:e-. ".,;~/4'-",'/,,,_:,,.._:s
/' ,&-, fF /,,3 ,· ,..,.-· / /
., ,
.,-~'" . / I .J/r/--t• 7<,w ("' '"v6--., ::,; ,.,~.; , .. 7 ~~-'!"';'.'~..,..,.;._,.~~-,--~ . -
-✓,,. ,' ,"'/ ... ,. .,..,, -/-· . ...-· .. // / .'7 .. .-/:.<'~ ,.., ~-;-:, /__: 4"',..,' ~ /., :..r ~--~-z, ,,t_~ ,,:,,,c_,
// / ,.
_✓-:-./-~ /i?--5,..¢,u/-1"o/ /~'7" -,/,&~"I'?,'-:;,y-c1 &..z. /"?7Z ,t..,/< --✓ J. ,(;,_ -•,7 / _-,,~}-,-•,-:,,
,,. __
3 -/.. /',, ., , ✓
, , "':'T-"',._I'::.--Y.7_3 I , .. ,,~
P.E. REVIEW:
UBC 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 plans, ---specifications and applicable sections of the governing building laws. ... JI/ ---I , -. _)J -✓ I
.... -Inspector Initials INSPEE;;TORS . .S4GNATURE ; REGISTRATION NO,
DSA I hereby certify that I have Inspected the above reported work in accordance with the ( --<'-. .
requirements of DSA approved documents, Sampling and testing were conducted in v '>< c;~=-I ,:.. ,-·
accordance with the requirements of the DSA approved documents. The work inspected 'SUPERINTENDENTS SIGNATURE DATE
complies with the DSA approved documents.
Yes: No: Inspector Initials: •signature outnorlzes ffle above wo,k
SGS&.! 205 llEV 2/06
PLANNING
ENGINEERING
SURVEYING
IRVINE
LOS ANGELES
RIVERSIDE
SAN DIEGO
HUNSAKER
&ASSOCIATES
S A N D I E G 0, I N C.
November 29, 2006
City of Carlsbad
Engineering Department
1635 Faraday Avenue
Carlsbad, CA 92008-7314
Re: Building Form Setback Certification
Emerald Pointe Estates
Carlsbad Tract 02-07
Drawing No. 406-3A
Lots 3 through 6 and 10 through 13
Dear City Inspector:
Please be advised the building foundation forms are in conformance with the
precise grading plans as to horizontal and vertical location. The building
setbacks were measured in relation to the property lines and were found to be in
conformance with the approved precise grading plans for this property.
DAVE HAMMAR
LEX WILLIMAN
ALISA VIALPANDO
DAN SMITH
RAY MARTIN
CHUCK CATER
10179 Huennekens St.
San Diego, CA 92121
(858) 558-4500 PH
(858)558-1414 FX
www.HunsakerSD.com
lnfo@HunsakerSD.com
Sincerely,
12 ... ~ Daniel P. Smith ~-6854
Hunsaker & Associates San Diego, Inc.
TS :ts k:\2339\2008\1>49.doe
WO 23311-0018 11/29/200e 9:33 AM
SOIL & TISTING, INC SOUTHERN CALIFORNIA SOIL & TESTING, INC. 63216
6280 RIVERDALESTREET, SAN DIEGO. CA92120 • Phonc(619)280-4321 Fax(619)280-4717
83-740 CITRUS AVENUE. SUITE G, INDIO, CA 92201 • Phone (760) 775-5983 Fax (760) 775-8362
SCS&T FILE NO.. (?&? /Z,l z &,
P.O. NO._· _________ _
C X PL NC FIX PAGE / OF /
FIELD INSPECTION REPORT FOR: D REINFORCED CONCRETE D REINFORCED MASONRY D WELDING D FIREPROOFING
Q. c. CONCRETE D ROOFING I WATERPROOFING ,81 P.T. CONCRETE I smEss D EPOXY ANCHORS D H.s. BOLTING O __ _
PHASE#: DSA FILE NO.: I ,t ~¢
PERMIT NO.: 6e:t.,,v:.I -✓ . /5~ -/
A/lCHITECT: ENGINEER:
, . (
-/ .__·-r,, / ~.-/ /,.v:c;
UBC I hereby certify lhol I have Inspected lhe above reported wOII<. Unless noted othelwlse.
the woo: Inspected is to the best of my knowledge In comptlonce with the approved plans.
speclflCotions ond opptlcob~secllons of the governing building lows.
Inspector Initials .._ · '
DSA I hereby certify !hot I hove Inspected the above reported work In occordonce with the
requirements of DSI'-. approved documenls. Sampling ond testing were conducted In
occordonce with the requirements of the DSI'-. approved documents. The work Inspected
complies with the DSA approved documents.
Yes: __ No: __ Inspector Initials:
•SUPERINTENDENTS $GNATURE
•s1gnoture CXJtllortes Ille oOOYe wo,k
DSAAWNO.: y
PIAN FllE NO.:
~ /
TIME DEPMrnD: --:-Jfrl. , . .:--r. / , I->
A ••
P.E. REVIEW:
SCS&T 205 R£V 2/06
Southern Caiifornia Soil and Testing, Inc.
6280 Riverdale Street, San Diego, CA 92120 (619) 280-4321
P.O. Box 600627, San Diego, CA 92160-0627
83-740 Citrus Avenue, Suite G, Indio, CA 92201-3438 (760)775-5983
Concrete (6x12) Compressive Strength Test Report
File Number: 0612226
Project Title: Emerald Pointe Estates -PTCC Phase: 1
Project Location: 13n Sapphire Dr
Architect: Mark W Kiner
Engineer: Martin Permit No: CB06-2124
Contractor: RWR Homes Plan File No:
Location In Structure: Lot: 12 Northside of PT Slab on Grade 20 Feet From the North West Corner
Material Supplier: Superior
Mix Designation: 8375P
Admixture(s): Fly Ash, Pozz
Time In Mixer: 90 minutes Slump Inches: 3.50
Air Content: Unit Weight Plastic/Dry, pcf: I
Air Temp: 64 degrees F Concrete Temp: 68 degrees F
Truck Number: 673 Ticket Number: 62497
Samples Made By: JG Samples Tested By: CN
Laboratory Number 0617104 0617105 0617106
Mark On Samples 1
Date Made 12/11/2006 12/11/2006 12/11/2006
Date Received 12/12/2006 12/12/2006 12/12/2006
Date Tested 12/16/2006 1/8/2007 1/8/2007
Diameter, Inches 6.00 6.00 6.00
Area, Square Inches 28.27 28.27 28.27
Maximum Load, Pounds 116880 161610 159630
Compressive Strength, psi 4130 5720 5650
Age Tested 5 Days 28 Days 28 Days
Required 28 Day Strength, psi 4500 4500 4500
Fracture Type 1 2
Specimen sampling, transportation and compressive strength testing were performed by this agency in accordance with the applicable
A5TM 09 standards. This agency makes no other warranties express or implied.
Legend: fracture TyPe -1; 2; 3; 4; '.:i; G
Distribution:
(1) City of Carlsbad -Building Inspection Department
(1) RWR Homes, Inc. -Brendan Farrelly
Reviewed By:
e------~·
Gordon T.M. Wo6dard RCE # 60481
SOIL a TalTINO, INC SOUTHERN CALIFORNIA SOIL & TESTING, INC. 69091
6280 RIVERDALE STREET, SAN DIEGO, CA 92 120 • 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 -/") .,., '1( _ SCS&T FILE NO._· __,;..:..;..":.:......:....~=~:;..:;..;.·...:...... , __
P.O. NO._· _________ _
I C I i I I PL I I I NC I I I FIX I I I I
PAGE OF i
FIELD INSPECTION REPORT FOR: D REINFORCED CONCRETE D REINFORCED MASONRY D WELDING D FIREPROOFING
] Q, C. CONCRETE D ROOFING / WATERPROOFING D P.T. CONCRETE , smEss '~ EPOXY ANCHORS D H.S. BOLTING D
PROJECT (E~ ~ I PHASE#: DSA FILE NO.: DSAAPP NO ..
?_,,.t ('I ✓\ "C • -PROJECT .A£>00ESS PEllMlT NO.: PIAN FILE NO,:
., . ~ l t,. \ ' ~1C ,,_
AACHITECTc J . _· l ,:, t--• P{-.. ' J ,,,.., ' •.,-, ;> f"
ENGINEER:
•.,_ I-~ \ I{ \/-.A~ ' l(
GENEllAI. CONTilAC!Ql. ((~
SU! CONTilACTOll: i t" 1r-:P , ---. , ~ .
LOCATION Of WOllK INSPECTED:
MATERIAi. CLASSIFICATION:
-~r I I n-I DESCRIPTION OF WORK INSPECTED: TIME ARRIVED: TIME DEPARTED:
i . I \ I v\
-C,) , ' .,. I r I ) .l, l f.,J ~ •~ A .1t ..... f f .,; 0-:J.•
1 -~p_ \ ~ --\._ ,\ \ ~ : _ . .-) \ \ ' , _oo;::...,f \J• h, . .J v \..::, A.h~
I ~!\ R. r t-1 \(. \ I,, i (C \ <. ' J ': ,Y,~,j,_
. \_r., -L t I ! f ?\ ' _.,(, I ,._I
I \., \ , I A·!f'1· .. _ ,g,,..,-,_-:,,... --I
ic:::F''<\. '-o£"T"' ... -\ .--" ... , .. t::-. -~.,-~:1 I, d . ,~\-·
~ ' l ,,'\ tt •.,_ -l f -A. I •• • ., I ,1,,i\
µ
I ) '( (
' I I
'""
. i ~ I . l I J :>1'-{1 ,I--, '1'? ;,..,,__, ,z_ I"" ,{ ., -1.} :P-, I . .... ' ' ,.. I
L I \~ \ ,f'..: .,... .:) i \\ ~ • ►i .I ,;~ .r
'7 I I ) , . t.\
'-) j •..J-.
.
j ·' I./ I \ f'li, P.E. REVIEW: 1), '' J
UBC I hereby certify that I hove Inspected the abOve reported work. Unless noted otherwise: I/' the work inspected ~* best at my knowledge In compliance with the approved plans,
specifications and a t'le sections of the governing building laws. ' -~" lnspectOf lnlttols ..-INSPECTORS SIGNATURE REGISmAnbN NO,
DSA I hereby certify that I hove Inspected the aoove reported work In occOJdonce with the
requirements of DSA approved documents. Sampling and testing were conducted In
•SUPERINTENDENTS SIGNAiuliE accOJdonce with the requirements of the DSA opproved documents. The WOfk Inspected DATE
complies with the DSA approved documents.
Yes: No: Inspector lnlttols: •$1gnOftX8 outr>oriles tne ClOOl"8 work
SCS&T 205 RfV WI>