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Special Inspection and Testing
Construction Observation•Engineering Consultants
CRPEX ENGINEERING INC.
--- R 0. Box 14198, Fremont, CA 94539 •Tel: (510) 668-1815• Fax: (510)490-8690
E-mail: capexinc888@gmail.com
SPECIAL INSPECTORS DAILY REPORT
PROJECT NAME: / t�t `"'"" f He AC¢�a v ) PROJECT#:
PROJECTADDRESS: I0 3pS 1 A' 4A"' y''• 6Ab-a'fdW • BUILDING PERMIT#:
r. e'. 0 /-rU
INSPECTOR: �A`N I. D. # n.9,u0 CONT UIN OZS PERIODIC
SPECIAL INSPECTION PERFORMED: $" � 6 se
DESCRIBE INSPECTIONS MADE INCLUDING LOCATIONS: V
Citi!/, CP1 ;'— ,N o ,�+c��a. � ,.„ bolls
LIST TESTS MADE::
/v^ I � L�
LIST ITEMS REQUIRING.CORRECTION
M-4
LIST CHANGES TOI/APPROVED PLANS AUTHORIZED BY ARCHITECT OR ENGINEER:
COMMENTS:
NOTE - USE REVERSE SIDE FOR ADDITIONAL SPACE FOR ANY ITEM
To the best of my knowledge work inspected was in accordance with the Building Department approved
design drawings, specifications & applicable workmanship provisions of the CBC except as noted above.
SIGNED: � ' VCi � DATE: " / //Z