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DEPUTY 1 INSPECTION SERVICE INC. <br />2512.1 OE SALLE ST, LAGUNA HII I S, CA 92653 <br />t - 800 - DEPUW 1 - I - 800 - 337 - 8891 <br />DEPT. OF BLDG. & SAFEW <br />cIrY oF santa Ana <br />COUNTYOF <br />SPECIAL INSPECTION REPORT <br />Buldlng I,crm[ No 101934 Job. No <br />J@ tndermncal6.r / Addra6s F-65iI6i-ce-,75IfS-. Lowell St, <br />Oatc 10116117 <br />Santa NA. CA <br />Gcnorat Contractor /Address Owner <br />Arch Zeferino Jimenez <br />WELOEN NECEIPT NUUBEB WEtl)ER MBER <br />hOURS SAMPLES <br />ATTORNEYS FtsES - ll ory.rttin rt be or ia cquiry i! 5roughr b aniolr d rfcflr olc E nl3 oa th.3 c.drtrd. 0B grrrEtE.tg parry <br />5|El be ctffi lo rcr$on$re atb'Iry3 ro€s, cDGrE atd moe$rry 4rnuttcm6oB in s.Eabn to r.lry ottE ,oi€,1 to trrradt !l.Eh pony ;160maiid. <br />SPECTAL INSPECTION REPORT <br />lnspeg,tor's Name:Peter Gilpin lngp€ctor's S ignaturc:\ <br />l.D. No.5232539 has bcen fil€d and l: $atcE that the abore vuork !o thp besi ol <br />profleian!: of lho Unilom Buildrg Codc and rneeE s)provcd pldrc and spccificabff!3. <br />hilhcr loatrlagr ccrp[as ri,r Orc <br />Bospocfi{y Subrim<1, <br />MASoNTY_ HI.TENSIIE g0l-Ilil6_ CHEMTCALANCTOBS'/ <br />WE-DING- GYPSUM COTTCRETE- OTHEF.- <br />DESCRIPNON OF WORK INSPECTED <br />10t16t17 Observed the placement of #4 rebar dowels at new to existing an ronsangsor room a <br />and porch per details I & 9/S-3. Placement using Hilti RE-500 SD epoxy i n teu o rmpson se t <br />(epoxy substitution is pending engineer approval)an proper tng es usrVerifiedmrn em <br />nylon brush and compressed air prior to placeme <br />OAIE Reg-OT Ime ln Ilme Ogl <br />10t16t17 Min 11.00 <br />IIrIrrrrr <br />Irr <br />I <br />Groqi Mo rtar ConcrElc Elosk <br />Prisms Deosrty <br />Arl lnroactbrE b.r.n qi t rn|at rrh oa a hdr6 & os a fbl,! - ! na,.!,nlnrriJ - Arry iE9€io .nr.dEr, F'n t,. noqr hogr rtat !a tintd ,, Ehqt mindr,r- lr a(,l,r'!dr. .n, irE+ocloi orttt.|lng Dan ]l|, tEr Frbd. d Sd.r6r, iEardo.r d[ b bohd d rrr. rtr6 r i.|l. <br />---I <br />I <br />-- <br />- <br />I <br />Aooroved bv: <br />I.roract SaDaritnaH <br />Sub - Cont a.ior / Ad&e6s _ <br />Struct ral Enginoor r naorccc@- <br />REINFOBCED @NCREIE <br />-PPFSTNESSID CONCRETE- <br />I