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DON CARD
Deputy Inspection 5'elwces
218 W. Ave. Cordoba
San Clemente, Calif. 92672
Phone (949) 413-6248 Fax (949) 361-2118
Report of Special Inspection
Project Name & Address -- -.
Permit Number _
Inspection Types t —
InspectiinDnte(�) -- -- [ ) Periodic [ ) Continuous
Describe Inspection �b1 ade, including Locutions:
List'lcsts Made:
Total Inspection Time Each Day:
Date
Hours
List Items Requiring Correction. include. uncorrected items previously listed
Comments
To the hest of my knowledge, the work inspected was in accordance with the Building Department approved
design drav, ings, specifications and applicable workmanship provisions of the U.B.C. except as noted above. All
nspection, bayed nn four hour minimum. Inspections exceeding four hours will he billed at eight hours. Any
inspections beginning before 12:(X) noon and end after 12:00 noon will be billed as eight hours
Signed: Date
Print Full Name' Registration No. - -
FORM 51-02.01