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13040118CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 834 SEPTEMBER DR CONTRACTOR: EDWARD PERMIT NO: 13040118 CONSTRUCTION OWNER'S NAME:' ABHAY ACHAREKAR & NIRUPAMA PUJARE 2533 AMETHYST DR DATE ISSUED: 04/16/2013 OWNER'S PHONE: ;4082577919 SANTA CLARA, CA 95051 PHONE NO: (408) 985 -0731 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL License Class_ Lic. # 3.,7/;r REMOVE AND REPLACE 12" OF FOUNDATION STEM.. Contracto /1, _-5 J�oy1 PS. Date y: :_ _l WALL LOCATED ON THE LEFT SIDE AND INSTALL 7" SIMPSON I hereby affirm that I am licensed under the. provisions of Chapter 9 UFP 10 ON THE RIGHT REAR (commencing with Section 7000), of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self- insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $3500. I have and will maintain' Worker's Compensation Insurance, as provided for by APN Number: 36214020.00 Occupancy Type: Section 3700.of the LaborCode, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WIT 80 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA iOM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit: Additionally, the applicant understands and will comply with all'non, point source regulations per the Cupertino Municipal Code, Section RE- ROOFS: 9.18. Signature. Date % l3 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. 13 OWNER -BL ILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER . I, as owner of the property, or my employees with wages as their sole compensation, will dojthe work,'aiid.the structure is'got intendedlor offered for sale (Sec.7044, Business & Professions Code) I, as owner of the'property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE constrict the project (Se 0044, Business &:Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is 'issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Section 05, 25533, and 25534. Section 33700 of the :, Labor Code, for the performance of the work for which this 1. Owner or authorized agent Date: : ate: permit is. issued. I certify that m the perforinance of the work for which this permit is issued, I shall not employ any person ml, any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws,of Califoinia.:If, after making this certificate of exemption, I be come 'subject to the'Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with,such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I'agree to comply with all city, and - county : ordinances and state laws relating to building construction; and hereby authorize representatives of this city to enter upon the. above mentioned property for inspection. purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which, may accrue against said City inconsequence of the I understand my plans shall be used as public records. granting of this permit: Additionally; the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date i i CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildino cDcuaertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION /TI I I RAVIgiow /r)PPPTRRTI OT? TrTATATPVPXTTT44 PROJECT ADDRESS APN # OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OwNEP ❑ OwNER-BumDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO OR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME / EMAIL CVj rti C 'T GoAIP STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LTC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ,/f� -" E 4 4e AeA `i / ; oil :5jWe r c/ u /':9 /6 io r, EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTALDECK/PORCH AREA GARAGE AREA: DETACH I ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # []NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RECEI �— TOTA VALUATION: a my signature below, I certify to each of the following: I am the property owner or authoriz nt to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work erify it is accurate. I agree to comply with all applicable local ' ordinances and state laws relating to b nstru on. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: G� 16 V l✓ SUPPLEMENTAL INFOI&ATION REQUIRED PLAN TYPE ROUTING SLIP OVER- TAE COUNTER El _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildi - BUILDING PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD El PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. El MAJOR ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111 wil CITY OF CUPERTINO Ti FF. FCTYM A TnR — RI TIT ,PING DIVISION alech. Plan Check Plumb, Plan Check Elec. Plan Check aleck. I'errrrit pee: Plump. Permit Fee: Llec. Permit Pee: Other Alech. Insp. Other Plumb Insp. Other Elec. Insp, A3ech. Insp. Fee :: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include-fees due to other Departments (i a Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These ees are based on the preffinWha information available and are only an estimate. Contact the De t or aaan't to o. FEE ITEMS (Fee Resolution 11 -053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 1 hours Plan Check, Hourly Suppl. PC Fee: (E) Reg. 0 OT 0.0 1 hrs $0.00 $133.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? O.Yes Q No $0.00 Suppl. Insp. Fee O Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tiaa-: F71 r' dinlnistrative Fee, KeVisea: o4 /ovzuij ADDRESS: 834. September Dr DATE: 04/16/2013 REVIEWED BY: Mendez APN: BP #: "VALUATION: 1$3,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p PENTAMATION 1GENRES PERMIT TYPE: WORK remove and replace 12" of foundation stem wall located on the left side and install T' sim son UFP 10 SCOPE I on the Right rear alech. Plan Check Plumb, Plan Check Elec. Plan Check aleck. I'errrrit pee: Plump. Permit Fee: Llec. Permit Pee: Other Alech. Insp. Other Plumb Insp. Other Elec. Insp, A3ech. Insp. Fee :: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include-fees due to other Departments (i a Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These ees are based on the preffinWha information available and are only an estimate. Contact the De t or aaan't to o. FEE ITEMS (Fee Resolution 11 -053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 1 hours Plan Check, Hourly Suppl. PC Fee: (E) Reg. 0 OT 0.0 1 hrs $0.00 $133.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? O.Yes Q No $0.00 Suppl. Insp. Fee O Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tiaa-: F71 r' dinlnistrative Fee, KeVisea: o4 /ovzuij Building Department City Of Cupertino 10300 Torre Avenue La Cupertino, CA 95014 -3255 Telephone: 408- 777 -3228 C U P E RT I N O Fax: 408- 777 -3333 CONTRACTOR / SUBCONTRACTOR LIST *Our municipal code requires all businesses working in the city to have a City of Cupertino :business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: JOB ADDRESS: 'g3 "'l ,,, PERMIT # BUSINESS LICENSE # OWNER'S NAME: cle � - PHONE# Qlf GENERAL CONTRACTOR: iv� ✓� f oy fa BUSINESS LICENSE # Cement Finishing ADDRESS: 5 m 2 CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino :business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME- BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / Contractor Signature Date ICC -ES Evaluation Report ESR -1917* Reissued May 1, 2011 This report is subject to renewal May 1, 2013. www.icc- es.ora 1 (800) 423 -6587 1 (562) 699 -0543 A Subsidiary of the International Code Council° DIVISION: 03 00 00— CONCRETE Section1908 of the 2012 IBC and Section 1911 of the 2009 Section: 03 16 00— Concrete Anchors and 2006 IBC. The anchors may also be used where an engineered design is submitted in accordance with Section REPORT HOLDER: R301.1.3 of the IRC. HILTI, INC. 5400 SOUTH 122ND EAST AVENUE TULSA, OKLAHOMA^7,4146 (800) 879 -8000 www.us.hilti.com HiltiTechEn us.hil c FICE COP EVALUATION SUBJECT: ' HILTI KWIK BOLT TZ CARBON AND STAINLESS STEEL ANCHORS IN CRACKED AND UNCRACKED CONCRETE 1.0 EVALUATION SCOPE Compliance with the following codes: ■ 2012, 2009 and 2006 International Building Code® (IBC) ■ 2012, 2009 and 2006 International Residential Code® (IRC) Property evaluated: Structural 2.0 USES The Hilti Kwik Bolt TZ anchor (KB -TZ) is used to resist static, wind, and seismic tension and shear loads in cracked and uncracked normal - weight concrete and sand - lightweight concrete having a specified compressive strength, f,, of 2,500 psi to 8,500 psi (17.2 MPa to 58.6 MPa). The 3/8 -inch- and 112- inch - diameter (9.5 mm and 12.7 mm) carbon steel KB -TZ anchors may be installed in the topside of cracked and untracked normal- weight or sand - lightweight concrete - filled steel deck having a minimum member thickness, hmin,deck, as noted in Table 6 of this report and a specified compressive strength, f,,, of 3,000 psi to 8,500 psi (20.7 MPa to 58.6 MPa). The 3/8- inch -, 1/2 -inch- and 5/8 -inch- diameter (9.5 mm, 12.7 mm and 15.9 mm) carbon steel KB -TZ anchors may be installed in the soffit of cracked and untracked normal - weight or sand - lightweight concrete over metal deck having a minimum specified compressive strength, fc, of 3,000 psi (20.7 MPa). The anchoring system complies with anchors as described in Section 1909 of the 2012 IBC and Section 1912 of the 2009 and 2006 IBC. The anchoring system is an alternative to cast -in -place anchors described in 3.0 DESCRIPTION 3.1 KB -TZ: KB -TZ anchors are torque- controlled, mechanical xpansion anchors. KB -TZ anchors consist of a stud anchor body), wedge (expansion elements), nut, and washer. The anchor (carbon steel version) is illustrated in Figure 1. The stud is manufactured from carbon steel or AISI Type 304 or Type 316 stainless steel materials. Carbon steel KB -TZ anchors have a minimum 5 pm (0.0002 inch) zinc plating. The expansion elements for the carbon and stainless steel KB -TZ anchors are fabricated from Type 316 stainless steel. The hex nut for carbon steel conforms to ASTM A563 -04, Grade A, and the hex nut for stainless steel conforms to ASTM F594. The anchor body is comprised of a high- strength rod threaded at one end and a tapered mandrel at the other end. The tapered mandrel is enclosed by a three - section expansion element which freely moves around the mandrel. The expansion element movement is restrained by the mandrel taper and by a collar. The anchor is installed in a predrilled hole with a hammer. When torque is applied to the nut of the installed anchor, the mandrel is drawn into the expansion element, which is in turn expanded against the wall of the drilled hole. 3.2 Concrete: Normal- weight and sand - lightweight concrete must conform to Sections 1903 and 1905 of the IBC. 3.3 Steel Deck Panels: Steel deck panels must be in accordance with the configuration in Figures 5A, 5B and 5C and have a minimum base steel thickness of 0.035 inch (0.899mm). Steel must comply with ASTM A653/A653M SS Grade 33 and have a minimum yield strength of 33,000 psi (228 MPa). 4.0 DESIGN AND INSTALLATION 4.1 Strength Design: 4.1.1 General: Design strength of anchors complying with the 2012 IBC as well as Section R301.1.3 of the 2012 IRC, must be determined in accordance with ACI 318 -11 Appendix D and this report. Design strength of anchors complying with the 2009 IBC and Section R301.1.3 of the 2009 IRC must be determined in accordance with ACI 318 -08 Appendix D and this report. *Revised November 2012 ICC -ES Evaluation Reports are not to be construed as representing aesthetics or any other attributes not specifically addressed, nor are they to be construed as an endorsement of the subject of the report or a recommendation for its use. There is no warranty by ICC Evaluation Service, LLC, express or implied, as to any finding or other matter in this report, or as to any product covered by the report. Copyright © 2012 as xrruum�xu wocca+ :e Page 1 of 12 ESR -1917 ( Most Widely Accepted and Trusted Page 2 of 12 Design strength of anchors complying with the 2006 IBC and Section R301.1.3 of the 2006 IRC must be in accordance with ACI 318 -05 Appendix D and this report. Design parameters provided in Tables 3, 4, 5 and 6 of this report are based on the 2012 IBC (ACI 318 -11) unless noted otherwise in Sections 4.1.1 through 4.1.12.The strength design of anchors must comply with ACI 318 D.4.1, except as required in ACI 318 D.3.3. Strength reduction factors, ¢, as given in ACI 318 -11 D.4.3 and noted in Tables 3 and 4 of this report, must be used for load combinations calculated in accordance with Section 1605.2 of the IBC and Section 9.2 of ACI 318. Strength reduction factors, ¢, as given in ACI 318 -11 D.4.4 must be used for load combinations calculated in accordance with ACI 318 Appendix C. An example calculation in accordance with the 2012 IBC is provided in Figure 7. The value of fc used in the calculations must be limited to a maximum of 8,000 psi (55.2 MPa), in accordance with ACI 318 -11 D.3.7. 4.1.2 Requirements for Static Steel Strength in Tension: The nominal static steel strength, Nsa, of a single anchor in tension must be calculated in accordance with ACI 318 D.5.1.2. The resulting Nsa values are provided in Tables 3 and 4 of this report. Strength reduction factors 0 corresponding to ductile steel elements may be used. 4.1.3 Requirements for Static Concrete Breakout Strength in Tension: The nominal concrete breakout strength of a single anchor or group of anchors in tension, Ncb or Ncb9, respectively, must be calculated in accordance with ACI 318 D.5.2, with modifications as described in this section. The basic concrete breakout strength in tension, Nb, must be calculated in accordance with ACI 318 D.5.2.2, using the values of hef and kcr as given in Tables 3, 4 and 6. The nominal concrete breakout strength in tension in regions where analysis indicates no cracking in accordance with ACI 318 D.5.2.6 must be calculated with k,,,,cr as given in Tables 3 and 4 and with q-lc,N = 1.0. For carbon steel KB -TZ anchors installed in the soffit of sand - lightweight or normal - weight concrete on steel deck floor and roof assemblies, as shown in Figures 5A and 56, calculation of the concrete breakout strength is not required. 4.1.4 Requirements for Static Pullout Strength in Tension: The nominal pullout strength of a single anchor in accordance with ACI 318 D.5.3.1 and D.5.3.2 in cracked and uncracked concrete, Np,cr and Np,,,,,cr, respectively, is given in Tables 3 and 4. For all design cases q.'c,p = 1.0. In accordance with ACI 318 D.5.3, the nominal pullout strength in cracked concrete may be calculated in accordance with the following equation: Np,f,, — Np,c, f` (lb, psi) (Eq -1) 2,500 Np,fc = Np,cr f` (N, MPa) i1.2 In regions where analysis indicates no cracking in accordance with ACI 318 D.5.3.6, the nominal pullout strength in tension may be calculated in accordance with the following equation: Np,f� = Np,uncr f` (lb, psi) (Eq -2) 2,500 51-cli Np f� = Np uncr (N, MPa) Where values for Np,cr or Np,uncr are not provided in Table 3 or Table 4, the pullout strength in tension need not be evaluated. The nominal pullout strength in cracked concrete of the carbon steel KB -TZ installed in the soffit of sand - lightweight or normal- weight concrete on steel deck floor and roof assemblies, as shown in Figures 5A and 56, is given in Table 5. In accordance with ACI 318 D.5.3.2, the nominal pullout strength in cracked concrete must be calculated in accordance with Eq -1, whereby the value of Np,deckcr must be substituted for Nper and the value of 3,000 psi (20.7 MPa) must be substituted for the value of 2,500 psi (17.2 MPa) in the denominator. In regions where analysis indicates no cracking in accordance with ACI 318 5.3.6, the nominal strength in uncracked concrete must be calculated according to Eq -2, whereby the value of Np,deck, r, must be substituted for Np,,,r,cr and the value of 3,000 psi (20.7 MPa) must be substituted for the value of 2,500 psi (17.2 MPa) in the denominator. The use of stainless steel KB -TZ anchors installed in the soffit of concrete on steel deck assemblies is beyond the scope of this report. 4.1.5 Requirements for Static Steel Strength in Shear: The nominal steel strength in shear, V,,a, of a single anchor in accordance with ACI 318 D.6.1.2 is given in Table 3 and Table 4 of this report and must be used in lieu of the values derived by calculation from ACI 318 -11, Eq. D -29. The shear strength Vsa,deok of the carbon -steel KB -TZ as governed by steel failure of the KB -TZ installed in the soffit of sand - lightweight or normal- weight concrete on steel deck floor and roof assemblies, as shown in Figures 5A and 5B, is given in Table 5. 4.1.6 Requirements for Static Concrete Breakout Strength in Shear: The nominal concrete breakout strength of a single anchor or group of anchors in shear, Vcb or Vcb9, respectively, must be calculated in accordance with ACI 318 D.6.2, with modifications as described in this section. The basic concrete breakout strength, Vb, must be calculated in accordance with ACI 318 D.6.2.2 based on the values provided in Tables 3 and 4. The value of Pe used in ACI 318 Eq. D -24 must be taken as no greater than the lesser of hef or 8da. For carbon steel KB -TZ anchors installed in the soffit of sand - lightweight or normal - weight concrete on steel deck floor and roof assemblies, as shown in Figures 5A and 5B, calculation of the concrete breakout strength in shear is not required. 4.1.7 Requirements for Static Concrete Pryout Strength in Shear: The nominal concrete pryout strength of a single anchor or group of anchors, Vcp or VcP9, respectively, must be calculated in accordance with ACI 318 D.6.3, modified by using the value of kcp provided in Tables 3 and 4 of this report and the value of Ncb or Ncb9 as calculated in Section 4.1.3 of this report. For carbon steel KB -TZ anchors installed in the soffit of sand - lightweight or normal- weight concrete over profile steel deck floor and roof assemblies, as shown in Figures 5A and 56, calculation of the concrete pry-out strength in accordance with ACI 318 D.6.3 is not required. ESR -1917 I Most WdelyAccepted and Trusted Page 3 of 12 4.1.8 Requirements for Seismic Design: 4.1.8.1 General: For load combinations including seismic, the design must be performed in accordance with ACI 318 D.3.3. For the 2012 IBC, Section 1905.1.9 shall be omitted. Modifications to ACI 318 D.3.3 shall be applied under Section 1908.1.9 of the 2009 IBC, or Section 1908.1.16 of the 2006 IBC. The nominal steel strength and the nominal concrete breakout strength for anchors in tension, and the nominal concrete breakout strength and pryout strength for anchors in shear, must be calculated in accordance with ACI 318 D.5 and D.6, respectively, taking into account the corresponding values given in Tables 3, 4 and 5 of this report. The anchors may be installed in Seismic Design Categories A through F of the IBC. The anchors comply with ACI 318 D.1 as ductile steel elements and must be designed in accordance with ACI 318 -11 D.3.3.4, D.3.3.5, D.3.3.6 or D.3.3.7, ACI 318 -08 D.3.3.4, D.3.3.5 or D.3.3.6, or ACI 318 -05 D.3.3.4 or D.3.3.5, as applicable. 4.1.8.2 Seismic Tension: The nominal steel strength and nominal concrete breakout strength for anchors in tension must be calculated in accordance with ACI 318 D.5.1 and ACI 318 D.5.2, as described in Sections 4.1.2 and 4.1.3 of this report. In accordance with ACI 318 D.5.3.2, the appropriate pullout strength in tension for seismic loads, Np,eQ, described in Table 4 or Npdeck,a described in Table 5 must be used in lieu of Np, as applicable. The value of Np,eq or Np,deckcr may be adjusted by calculation for concrete strength in accordance with Eq -1 and Section 4.1.4 whereby the value of Np,deckcr must be substituted for Np,cr and the value of 3,000 psi (20.7 MPa) must be substituted for the value of 2,500 psi (17.2 MPa) in the denominator. If no values for Np,eQ are given in Table 3 or Table 4, the static design strength values govern. 4.1.8.3 Seismic Shear: The nominal concrete breakout strength and pryout strength in shear must be calculated in accordance with ACI 318 D.6.2 and D.6.3, as described in Sections 4.1.6 and 4.1.7 of this report. In accordance with ACI 318 D.6.1.2, the appropriate value for nominal steel strength for seismic loads, Vsa,eq described in Table 3 and Table 4 or Vsa,deck described in Table 5 must be used in lieu of Vsa, as applicable. 4.1.9 Requirements for Interaction of Tensile and Shear Forces: For anchors or groups of anchors that are subject to the effects of combined tension and shear forces, the design must be performed in accordance with ACI 318 D.7. 4.1.10 Requirements for Minimum Member Thickness, Minimum Anchor Spacing and Minimum Edge Distance: In lieu of ACI 318 D.8.1 and D.8.3, values of smin and cmin as given in Tables 3 and 4 of this report must be used. In lieu of ACI 318 D.8.5, minimum member thicknesses hmin as given in Tables 3 and 4 of this report must be used. Additional combinations for minimum edge distance, cmin, and spacing, sin, may be derived by linear interpolation between the given boundary values as described in Figure 4. For carbon steel KB -TZ anchors installed on the top of normal- weight or sand - lightweight concrete over profile steel deck floor and roof assemblies, the anchor must be installed in accordance with Table 6 and Figure 5C. For carbon steel KB -TZ anchors installed in the soffit of sand - lightweight or normal- weight concrete over profile steel deck floor and roof assemblies, the anchors must be installed in accordance with Figure 5A or 5B and shall have an axial spacing along the flute equal to the greater of 3hefor 1.5 times the flute width. 4.1.11 Requirements for Critical Edge Distance: In applications where c < cac and supplemental reinforcement to control splitting of the concrete is not present, the concrete breakout strength in tension for uncracked concrete, calculated in accordance with ACI 318 D.5.2, must be further multiplied by the factor qJcp,N as given by Eq -1: `Fcp,N = cac (Eq -3) whereby the factor Wcp,N need not be taken as less than 1.5 h8' For all other cases, gcp,N = 1.0. In lieu of cep using ACI 318 D.8.6, values of cac must comply with Table 3 or Table 4 and values of cac,deck must comply with Table 6. 4.1.12 Sand - lightweight Concrete: For ACI 318 -11 and 318 -08, when anchors are used in sand - lightweight concrete, the modification factor Aa or A, respectively, for concrete breakout strength must be taken as 0.6 in lieu of ACI 318 -11 D.3.6 (2012 IBC) or ACI 318 -08 D.3.4 (2009 IBC). In addition the pullout strength Np,cr, Np,uncr and Np,eq must be multiplied by 0.6, as applicable. For ACI 318 -05, the values Nb, Np,cr, Np,un,, Np,eq and Vb determined in accordance with this report must be multiplied by 0.6, in lieu of ACI 318 D.3.4. For carbon steel KB -TZ anchors installed in the soffit of sand - lightweight concrete - filled steel deck and floor and roof assemblies, this reduction is not required. Values are presented in Table 5 and installation details are show in Figures 5A and 56. 4.2 Allowable Stress Design (ASD): 4.2.1 General: Design values for use with allowable stress design (working stress design) load combinations calculated in accordance with Section 1605.3 of the IBC, must be established as follows: Tallowable,ASD = Nn a Vallowable,ASD = OV n a where: Tallowable,ASD = Allowable tension load (Ibf or kN). Vallowable,ASD = Allowable shear load (Ibf or kN). ON. = Lowest design strength of an anchor or anchor group in tension as determined in accordance with ACI 318 D.4.1, and 2009 IBC Section 1908.1.9 or 2006 IBC Section 1908.1.16, as applicable (Ibf or N). OVn = Lowest design strength of an anchor or anchor group in shear as determined in accordance with ACI 318 D.4.1, and 2009 IBC Section 1908.1.9 or 2006 IBC Section 1908.1.16, as applicable (Ibf or N). ESR -1917 1 Most Widely Accepted and Trusted Page 4 of 12 a = Conversion factor calculated as a weighted average of the load factors for the controlling load combination. In addition, a must include all applicable factors to account for nonductile failure modes and required over - strength. The requirements for member thickness, edge distance and spacing, described in this report, must apply. An example of allowable stress design values for illustrative purposes in shown in Table 7. 4.2.2 Interaction of Tensile and Shear Forces: The interaction must be calculated and consistent with ACI 318 D.7 as follows: For shear loads Vapplied <_ 0.2Vallowable,ASD, the full allowable load in tension must be permitted. For tension loads Tapplied <_ 0.2Tallowable,ASD, the full allowable load in shear must be permitted. For all other cases: Tapplied + Vapplied < 1.2 (Eq -4) Tallowable,ASD Vallowable,ASD 4.3 Installation: Installation parameters are provided in Tables 1 and 6 and Figures 2, 5A, 5B and 5C. Anchor locations must comply with this report and plans and specifications approved by the code official. The Hilti KB -TZ must be installed in accordance with manufacturer's published instructions and this report. In case of conflict, this report governs. Anchors must be installed in holes drilled into the concrete using carbide - tipped masonry drill bits complying with ANSI 8212.15 -1994. The minimum drilled hole depth is given in Table 1. Prior to installation, dust and debris must be removed from the drilled hole to enable installation to the stated embedment depth. The anchor must be hammered into the predrilled hole until Ilaom is achieved. The nut must be tightened against the washer until the torque values specified in Table 1 are achieved. For installation in the soffit of concrete on steel deck assemblies, the hole diameter in the steel deck not exceed the diameter of the hole in the concrete by more than 1/8 inch (3.2 mm). For member thickness and edge distance restrictions for installations into the soffit of concrete on steel deck assemblies, see Figures 5A and 5B. 4.4 Special Inspection: Periodic special inspection is required in accordance with Section 1705.1.1 and Table 1705.3 of the 2012 IBC, or Section 1704.15 of the 2009 IBC and Table 1704.4 or Section 1704.13 of the 2006 IBC, as applicable. The special inspector must make periodic inspections during anchor installation to verify anchor type, anchor dimensions, concrete type, concrete compressive strength, anchor spacing, edge distances, concrete member thickness, tightening torque, hole dimensions, anchor embedment and adherence to the manufacturer's printed installation instructions. The special inspector must be present as often as required in accordance with the "statement of special inspection." Under the IBC, additional requirements as set forth in Sections 1705, 1706 and 1707 must be observed, where applicable. 5.0 CONDITIONS OF USE The Hilti KB -TZ anchors described in this report comply with the codes listed in Section 1.0 of this report, subject to the following conditions: 5.1 Anchor sizes, dimensions, minimum embedment depths and other installation parameters are as set forth in this report. 5.2 The anchors must be installed in accordance with the manufacturer's published instructions and this report. In case of conflict, this report governs. 5.3 Anchors must be limited to use in cracked and uncracked normal- weight concrete and sand - lightweight concrete having a specified compressive strength, f'o, of 2,500 psi to 8,500 psi (17.2 MPa to 58.6 MPa), and cracked and uncracked normal - weight or sand - lightweight concrete over metal deck having a minimum specified compressive strength, f'o, of 3,000 psi (20.7 MPa). 5.4 The values of f'o used for calculation purposes must not exceed 8,000 psi (55.1 MPa). 5.5 Strength design values must be established in accordance with Section 4.1 of this report. 5.6 Allowable design values are established in accordance with Section 4.2. 5.7 Anchor spacing and edge distance as well as minimum member thickness must comply with Tables 3, 4, and 6, and Figures 4, 5A, 56, and 5C. 5.8 Prior to installation, calculations and details demonstrating compliance with this report must be submitted to the code official. The calculations and details must be prepared by a registered design professional where required by the statutes of the jurisdiction in which the project is to be constructed. 5.9 Since an ICC -ES acceptance criteria for evaluating data to determine the performance of expansion anchors subjected to fatigue or shock loading is unavailable at this time, the use of these anchors under such conditions is beyond the scope of this report. 5.10 Anchors may be installed in regions of concrete where cracking has occurred or where analysis indicates cracking may occur (ft > f,), subject to the conditions of this report. 5.11 Anchors may be used to resist short-term loading due to wind or seismic forces in locations designated as Seismic Design Categories A through F of the IBC, subject to the conditions of this report. 5.12 Where not otherwise prohibited in the code, KB -TZ anchors are permitted for use with fire- resistance- rated construction provided that at least one of the following conditions is fulfilled: • Anchors are used to resist wind or seismic forces only. • Anchors that support a fire - resistance -rated envelope or a fire- resistance -rated membrane are protected by approved fire - resistance- rated materials, or have been evaluated for resistance to fire exposure in accordance with recognized standards. • Anchors are used to support nonstructural elements. 5.13 Use of zinc - coated carbon steel anchors is limited to dry, interior locations. 5.14 Special inspection must be provided in accordance with Section 4.4. ESR -1917 I Most Widely Accepted and Trusted Page 5 of 12 5.15 Anchors are manufactured by Hilti AG under an approved quality control program with inspections by UL LLC (AA -668). 6.0 EVIDENCE SUBMITTED 6.1 Data in accordance with the ICC -ES Acceptance Criteria for Mechanical Anchors in Concrete Elements (AC193), dated March 2012 (ACI 355.2 -07). 6.2 Quality control documentation. 7.0 IDENTIFICATION The anchors are identified by packaging labeled with the manufacturer's name ( Hilti, Inc.) and contact information, anchor name, anchor size, evaluation report number (ICC -ES ESR- 1917), and the name of the inspection agency (UL LLC). The anchors have the letters KB -TZ embossed on the anchor stud and four notches embossed into the anchor head, and these are visible after installation for verification. TABLE 1— SETTING INFORMATION (CARBON STEEL AND STAINLESS STEEL ANCHORS) SETTING Nominal anchor diameter (in.) INFORMATION Symbol Units 318 112 518 314 da In. 0.375 0.5 0.625 0.75 Anchor O.D. (Q2 (mm) (9.5) (12.7) (15.9) (19.1) Nominal bit diameter d& In. 3/8 1/2 5/8 3/4 Effective min. In. 2 2 3 -1/4 3 -1/8 4 3 -3/4 4 -3/4 embedment h� (mm) (51) (51) (83) (79) (102) (95) (121) Nominal in. 2 -5116 2 -3/8 3 -5/8 3 -9/16 4 -7/16 4 -5/16 5 -9116 embedment h"°" (mm) (59) (60) (91) (91) (113) (110) (142) In. 2 -5/8 2 -5/8 4 3 -314 4 -3/4 4 -1/2 5 -3/4 Min. hole depth ho (mm) (67) (67) (102) (95) (121) (114) (146) Min. thickness of In. 1/4 3/4 1/4 3/8 3/4 1/8 15/8 fastened part' t�"° (mm) (6) (19) (6) (9) (19) (3) (41) Required ft -lb 25 40 60 110 Installation torque T' (Nm) (34) 1 (54) (81) (149) Min. dia. of hole in do In. 7/16 9/16 11/16 13/16 fastened part (mm) (11.1) (14.3) (17.5) (20.6) Standard anchor In. 3 3 -3/4 5 3 -3/4 4 -1/2 5 -1/2 7 4 -314 6 8 -1/2 10 5 -1/2 8 10 lengths te"`n (mm) (76) (95) (127) (95) (114) (140) (178) (121) (152) (216) (254) (140) (203) (254) Threaded length In. 7/8 1 -5/8 2 -7/8 1 -5/8 2 -3/8 3 -318 4 -7/8 1 -1/2 2 -3/4 5 -1/4 6 -3/4 1 -1/2 4 6 (incl. dog point) t" e8d (mm) (22) (41) (73) (41) (60) (86) (124) (38) (70) (133) (171) (38) (102) (152) In. 2 -1/8 2 -1/8 3 -1/4 4 Unthreaded length funth (mm) (54) (54) 1 (83) 1 (102) IThe minimum thickness of the fastened part is based on use of the anchor at minimum embedment and is controlled by the length of thread. If a thinner fastening thickness is required, increase the anchor embedment to suit. 2The notation in parenthesis is for the 2006 IBC. ESR -1917 I Most Widely Accepted and Trusted Page 6 of 12 UNC thread I rim mandrel dog point expansion collar hex nut element bolt washer far FIGURE 1 —HILTI CARBON STEEL KWIK BOLT TZ (KB -TZ) FIGURE 2 —KB -TZ INSTALLED ho TABLE 2— LENGTH IDENTIFICATION SYSTEM (CARBON STEEL AND STAINLESS STEEL ANCHORS) Length ID marking A B C D E F G H I J K L M N O P Q R S T U V W on bolt head Length of From 1'/: 2 2'% 3 3'% 4 4'% 5 5'% 6 6% 7 7'% 8 8'% 9 9'h 10 11 12 13 14 15 anchor, 4-h Up to but (inches) not 2 2/: 3 3% 4 4% 5 5% 6 6/2 7 7/: 8 8% 9 9% 10 11 12 13 14 15 16 including FIGURE 3 —BOLT HEAD WITH LENGTH IDENTIFICATION CODE AND KB -TZ HEAD NOTCH EMBOSSMENT ESR -1917 ( Most Widely Accepted and Trusted Page 7 of 12 TABLE 3- DESIGN INFORMATION, CARBON STEEL KB -TZ For SI: 1 inch = 25.4 mm, 1 Ibf = 4.45 N, 1 psi = 0.006895 MPa. For pound -inch units: 1 mm = 0.03937 inches. 'See Fig. 2. 2For sand - lightweight concrete over metal deck, see Figures 5A, 513 and 5C and Table 6. 3See Section 4.1.8 of this report. °For all design cases Wc,P =1.0. NA (not applicable) denotes that this value does not control for design. See Section 4.1.4 of this report. ,See ACI 318 -11 D.4.3. "See ACI 318 D.5.2.2. 7For all design cases yj�,N =1.0. The appropriate effectiveness factor for cracked concrete (ka) or uncracked concrete (k„na) must be used. 8The KB -TZ is a ductile steel element as defined by ACI 318 D.1. eFor use with the load combinations of ACI 318 Section 9.2. Condition B applies where supplementary reinforcement in conformance with ACI 318 -11 D.4.3 is not provided, or where pullout or pryout strength governs. For cases where the presence of supplementary reinforcement can be verified, the strength reduction factors associated with Condition A may be used. 10Mean values shown, actual stiffness may vary considerably depending on concrete strength, loading and geometry of application. Nominal anchor diameter DESIGN INFORMATION Symbol Units 112 518 314 Anchor O.D. de(do) in. IZ45 0.5 0.625 0.75 mm 12.7 15.9 19.1 in. 2 3 -1/4 3-1/8 4 3 -3/4 4-3/4 Effective min. embedment' hey mm 51 83 79 102 95 121 Min. member thickness2 hmm in. 4 6 8 5 8 6 8 8 mm 2 127 102 152 5 152 203 127 203 152 203 203 in. t4;-3/8 4 5 -1/2 4 -1/2 7 -1/2 6 6 -1/2 E8-3/4 6 -3/4 10 8 9 Critical edge distance c� mm 1 102 140 114 191 152 165 171 254 203 229 In. 2 -1/2 2 -3/4 2 -3/8 3 -5/8 3 -1/4 4 -3/4 4-1/8 Cmin - (mm) 70 60 92 83 121 105 Min. edge distance in. in. 5 5 -3/4 5 -3/4 6 -1/8 5 -7/8 10 -1/2 8-7/8 fors 2: 127 146 146 156 149 267 225 in. 2 -1/2 2 -3/4 2 -3/8 3 -1/2 3 5 4 . Smin mm 64 70 60 89 76 127 102 Min. anchor spacing In. 3 -5/8 4 -1/8 3 -1/2 4 -3/4 4 -1/4 9-1/2 7 -3/4 for c? mm 92 105 89 121 108 241 197 in. 2 -5/8 2 -5/8 4 3 -3/4 4 -3/4 4-1/2 5 -3/4 Min. hole depth in concrete ho mn! 67 67 102 98 121 117 146 lb /in 100,000 84,800 84,800 84,800 Min. specified yield strength fr N /mm2 690 585 585 585 Ib/in2 125,000 106,000 106,000 106,000 Min. specified ult. strength ft. N /mm2 862 731 731 731 In 0.052 0.101 0.162 0.237 Effective tensile stress area 14MAf 2 mm 33.6 65.0 104.6 152.8 lb 6,500 10,705 17,170 25,120 Steel strength in tension N. kN 28.9 47.6 76.4 111.8 lb 3,595 5,495 8,090 13,675 Steel strength in shear S V. kN 16.0 24.4 36.0 60.8 Steel strength in shear, V.,.q lb 2,255 5,495 7,600 11,745 seismic3 kN 10.0 24A 33.8 52.2 Pullout strength uncracked NP.una lb 2;515 NA 5,515 NA 9,145 8,280 10,680 concrete (kN) (11.2) (24.5) (40.7) (36.8) (47.5) Pullout strength cracked N,1p lb 2,270 NA 4,915 NA NA NA NA concrete kN 10.1 21.9 Anchor category, 1 Effectiveness factor k_ uncracked concrete 24 Effectiveness factor ka cracked concretes 17 wc,N= knn lka 7 1.0 Coefficient for pryout strength, kip 1.0 2.0 Strength reduction factor 0 for tension, steel failure 0.75 modes8 Strength reduction factor 0 for shear, steel failure 0.65 modes' Strength reduction 0 factor for tension, concrete 0.65 failure modes or pullout, Condition B g Strength reduction of actor for shear, concrete 0.70 failure modes, Condition 139 Axial stiffness in service load Ona lb/in. 700,000 range10 p lb/in. 500,000 For SI: 1 inch = 25.4 mm, 1 Ibf = 4.45 N, 1 psi = 0.006895 MPa. For pound -inch units: 1 mm = 0.03937 inches. 'See Fig. 2. 2For sand - lightweight concrete over metal deck, see Figures 5A, 513 and 5C and Table 6. 3See Section 4.1.8 of this report. °For all design cases Wc,P =1.0. NA (not applicable) denotes that this value does not control for design. See Section 4.1.4 of this report. ,See ACI 318 -11 D.4.3. "See ACI 318 D.5.2.2. 7For all design cases yj�,N =1.0. The appropriate effectiveness factor for cracked concrete (ka) or uncracked concrete (k„na) must be used. 8The KB -TZ is a ductile steel element as defined by ACI 318 D.1. eFor use with the load combinations of ACI 318 Section 9.2. Condition B applies where supplementary reinforcement in conformance with ACI 318 -11 D.4.3 is not provided, or where pullout or pryout strength governs. For cases where the presence of supplementary reinforcement can be verified, the strength reduction factors associated with Condition A may be used. 10Mean values shown, actual stiffness may vary considerably depending on concrete strength, loading and geometry of application. ESR -1917 1 Most Widely Accepted and Trusted Page 8 of 12 TABLE 4- DESIGN INFORMATION, STAINLESS STEEL KB -TZ For SI: 1 inch = 25.4 mm, 1 Ibf = 4.45 N, 1 psi = 0.006895 MPa For pound -inch units: 1 mm = 0.03937 inches. 'See Fig. 2. 2See Section 4.1.8 of this report. NA (not applicable) denotes that this value does not control for design. 3For all design cases W p =1.0. NA (not applicable) denotes that this value does not control for design. See Section 4.1.4 of this report. 4See ACI 318 -11 D.4.3. 5See ACI 318 D.5.2.2. 6For all design cases W�,N =1.0. The appropriate effectiveness factor for cracked concrete (k,) or uncracked concrete (kun„) must be used. 7The KB -TZ is a ductile steel element as defined by ACI 318 D.1. "For use with the load combinations of ACI 318 Section 9.2. Condition B applies where supplementary reinforcement in conformance with ACI 318 -11 D.4.3 is not provided, or where pullout or pryout strength governs. For cases where the presence of supplementary reinforcement can be verified, the strength reduction factors associated with Condition A may be used. 9Mean values shown, actual stiffness may vary considerably depending on concrete strength, loading and geometry of application. Nominal anchor diameter DESIGN INFORMATION Symbol Units 318 112 518 314 Anchor O.D. de(do) in 0.375 0.5 0.625 0.75 mm 9.5 12.7 15.9 19.1 Effective min. embedment' haf in. 2 2 3 -1/4 3 -1/8 4 3 -3/4 4 -3/4 mm 51 51 83 79 102 95 121 Min. member thickness hm;" in. 4 5 4 6 6 8 5 6 8 6 8 8 mm 102 127 102 152 152 203 127 152 203 (152 203 (203 Critical edge distance cep in. 4 -3/8 3 -718 5 -1/2 4 -1/2 7 -1/2 6 7 8 -7/8 6 10 7 9 mm 111 98 140 114 191 152 178 225 152 254 178 229 in. 2 -1/2 2 -7/8 2 -1/8 3 -1/4 2 -3/8 4 -1/4 4 Min. edge distance cmi" mm 64 73 54 83 60 108 102 fors? in. 5 5 -3/4 5 -1/4 5 -1/2 5 -1/2 10 8 -1/2 (mm) 127 (146 ) (133 140 140 254 (216 in. 2 -1/4 2 -7/8 2 2 -3/4 2 -3/8 5 4 Min. anchor spacing smin mm 57 73 51 70 60 127 102 for c? in. 3 -1/2 4-1/2 3 -1/4 4 -1/8 4 -1/4 9 -1/2 7 mm 89 114 83 105 108 241 178 Min. hole depth in concrete ho in. 2 -5/8 2 -5/8 4 3 -3/4 4 -3/4 4-1/2 5 -3/4 mm 67 67 102 98 121 117 146 Min. specified yield strength fy lb/in 92,000 92,000 92,000 76,125 N /mm2 634 634 634 525 Min. specified ult. Strength fue lb /in 2 115,000 115,000 115,000 101,500 (N/mm 793 793 793 700 Effective tensile stress area Aw•N in 2 0.052 0.101 0.162 0.237 mm 33.6 65.0 104.6 152.8 Steel strength in tension N. Ib 5,968 11,554 17,880 24,055 kN 26.6 51.7 82.9 107.0 Steel strength in shear V_ lb 4,720 6,880 9,870 15,711 kN 21.0 30.6 43.9 69.9 Pullout strength in tension, NP•� lb NA 2,735 NA NA NA seismic2 kN (12.2) Steel strength in shear, V.•.' lb 2,825 6,880 9,350 12,890 seismic2 (kN) (12.6 30.6 41.6 57.3 Pullout strength uncracked NP' lb 2,630 NA 5,760 NA NA 12,040 concrete ° "� kN 11.7 25.6 53.6 Pullout strength cracked NP• lb 2,340 3,180 NA NA 5,840 8,110 NA concrete kN 10.4 14.1 26.0 36.1 Anchor category4 1 2 1 Effectiveness factor kuna uncracked concrete 24 Effectiveness factor k„ cracked concretes 17 24 17 17 17 24 17 Wc,N = kunaIk«6 1.0 Strength reduction factor 0 for tension, steel failure modes' 0.75 Strength reduction factor 0 for shear, steel failure modes' 0.65 Strength reduction 0 factor fortension, concrete failure modes, Condition B 6 0.65 0.55 0.65 Coefficient for pryout strength, kip 1.0 2.0 Strength reduction 0 factor for shear, concrete failure modes, Condition Be 0.70 Axial stiffness in service load {emu,, lb/in. 120,000 ranges a Win. 90,000 For SI: 1 inch = 25.4 mm, 1 Ibf = 4.45 N, 1 psi = 0.006895 MPa For pound -inch units: 1 mm = 0.03937 inches. 'See Fig. 2. 2See Section 4.1.8 of this report. NA (not applicable) denotes that this value does not control for design. 3For all design cases W p =1.0. NA (not applicable) denotes that this value does not control for design. See Section 4.1.4 of this report. 4See ACI 318 -11 D.4.3. 5See ACI 318 D.5.2.2. 6For all design cases W�,N =1.0. The appropriate effectiveness factor for cracked concrete (k,) or uncracked concrete (kun„) must be used. 7The KB -TZ is a ductile steel element as defined by ACI 318 D.1. "For use with the load combinations of ACI 318 Section 9.2. Condition B applies where supplementary reinforcement in conformance with ACI 318 -11 D.4.3 is not provided, or where pullout or pryout strength governs. For cases where the presence of supplementary reinforcement can be verified, the strength reduction factors associated with Condition A may be used. 9Mean values shown, actual stiffness may vary considerably depending on concrete strength, loading and geometry of application. ESR -1917 I Most WidelyAccepted and Trusted Page 9 of 12 Sdesign Cdesign •v hmin Q Cmin at s y sdesi n -- -- ---------- ------ --- - -- s at C g � min i h > hmin Cdesign FIGURE 4- INTERPOLATION OF MINIMUM EDGE DISTANCE AND ANCHOR SPACING edge distance c TABLE 5 -HILTI KWIK BOLT TZ (KB -TZ) CARBON STEEL ANCHORS TENSION AND SHEAR DESIGN DATA FOR INSTALLATION IN THE UNDERSIDE OF CONCRETE - FILLED PROFILE STEEL DECK ASSEMBLIES''",'," DESIGN INFORMATION Symbol Units Loads According to Figure 5A Loads According to Figure 5B Anchor Diameter Anchor Diameter 318 1/2 5/8 3/8 1/2 5/8 Effective Embedment Depth hot in. 2 2 3 -1/4 3 -1/8 4 2 2 3 -1/4 3 -1/8 Minimum Hole Depth ho in. 2 -5/8 2 -5/8 4 3 -3/4 4 -3/4 2 -5/8 2 -5/8 4 3 -3/4 Pullout Resistance, uncracked concrete) N deck,. p lb. 2,060 2,060 3,695 2,825 6,555 1,845 1,865 3,375 4,065 Pullout Resistance (cracked concrete)3 Np,dock,cr lb. 1,460 1,460 2,620 2,000 4,645 1,660 1,325 3,005 2,885 Steel Strength in Shear4 Vsado k lb. 2,130 3,000 4,945 4,600 6,040 2,845 2,585 3,945 4,705 Steel Strength is Shear, Seismic V.,,deck,eq lb. 1,340 3,000 4,945 4,320 5,675 1,790 2,585 3,945 4,420 'Installation must comply with Sections 4.1.10 and 4.3 and Figure 5A and 5B of this report. 2The values listed must be used in accordance with Section 4.1.4 of this report. 3The values listed must be used in accordance with Section 4.1.4 and 4.1.8.2 of this report. 4The values listed must be used in accordance with Section 4.1.5 of this report. 5The values listed must be used in accordance with 4.1.8.3 of this report. Values are applicable to both static and seismic load combinations. 6The values for op in tension and the values for 0se in shear can be found in Table 3 of this report. 7The characteristic pullout resistance for concrete compressive strengths greater than 3,000 psi may be increased by multiplying the value in the table by (fV3,000)' "2 for psi or (fa120.7)112 for MPa. "Evaluation of concrete breakout capacity in accordance with ACI 318 D.5.2, D.6.2, and D.6.3 is not required for anchors installed in the deck soffit. TABLE 6 -HILTI KWIK BOLT TZ (KB -TZ) CARBON STEEL ANCHORS SETTING INFORMATION FOR INSTALLATION ON THE TOP OF CONCRETE- FILLED PROFILE STEEL DECK ASSEMBLIES ACCORDING TO FIGURE 5C' 2.a4 DESIGN INFORMATION Symbol Units Nominal anchor diameter 318 1/2 Effective Embedment Depth hot in. 2 2 Minimum concrete thickness5 hmin,deck in. 3 -1/4 3 -1/4 Critical edge distance cec,deck,top in. 9 9 Minimum edge distance cmin,deck,top in. 3 4 -1/2 Minimum spacing Smin, deck, top in. 4 6 -1/2 'Installation must comply with Sections 4.1.10 and 4.3 and Figure 5C of this report. 2For all other anchor diameters and embedment depths refer to Table 3 and 4 for applicable values of hmin, Cmin, and smin• 3Design capacity shall be based on calculations according to values in Table 3 and 4 of this report. 4Applicable for 3' /4 -in _< hmin,&& < 4-in. For hmin,de k Z 4 -inch use setting information in Table 3 of this report. 5Minimum concrete thickness refers to concrete thickness above upper flute. See Figure 5C. ESR -1917 I Most Widely Accepted and Trusted Page 10 of 12 to MIT#,. X GAUGE S1£ELW -DECK g I TRIM, 12'TYP_ I - LOWER FLUTE - ► MAX. I- (RIDGE) OFFSET; 1YP. FIGURE 5A— INSTALLATION IN THE SOFFIT OF CONCRETE OVER METAL DECK FLOOR AND ROOF ASSEMBLIES' 'Anchors may be placed in the upper or lower flute of the steel deck profile provided the minimum hole clearance is satisfied. Anchors in the lower flute may be installed with a maximum 1 -inch offset in either direction from the center of the flute. z o`. I <, v MIN. 1060 PSI NORMAL OR SAND - r LIGHTWEIGHT CONCRETE UPPER ,._ FLUTE MIN (VALLEY] MIN, 20 GUAGE 1 33a � E MAX 3-10 STEEL W -DECK . MIN. 2-1/7' 3W MIN. - MIN 6" TYP -------------------- . LOWER FLUTE (RIDGE) FIGURE 5B— INSTALLATION IN THE SOFFIT OF CONCRETE OVER METAL DECK FLOOR AND ROOF ASSEMBLIES – B DECK'' 'Anchors may be placed in the upper or lower flute of the steel deck profile provided the minimum hole clearance is satisfied. Anchors in the lower flute may be installed with a maximum 1/8-inch offset in either direction from the center of the flute. The offset distance may be increased proportionally for profiles with lower flute widths greater than those shown provided the minimum lower flute edge distance is also satisfied. 2Anchors may be placed in the upper flute of the steel deck profiles in accordance with Figure 513 provided the concrete thickness above the upper flute is minimum 3'/4 -inch and the minimum hole clearance of 5/8 -inch is satisfied. MIMIN, PSI NORMAL CDR SAND- LIGHTWEIGHT CONCRETE 1 UPPER , .......... .......... i LUTE 1 Z (VALLEY) 1 `....... MIN.20GUAGE MtN STEEL W-DECK 1 -314 MIN 3 -90 M €N. 2 -112" MIN W TYP LOWER FLUTE (RIDGE) FIGURE 5C— INSTALLATION ON THE TOP OF CONCRETE OVER METAL DECK FLOOR AND ROOF ASSEMBLIES',2 'Refer to Table 6 for setting information for anchors in to the top of concrete over metal deck. 2Applicable for 3- 1 /4 -in <_ hmj� < 4-in. For hmj, >_ 4 -inch use setting information in Table 3 of this report. ESR -1917 I Most Widely Accepted and Trusted Page 11 of 12 TABLE 7— EXAMPLE ALLOWABLE STRESS DESIGN VALUES FOR ILLUSTRATIVE PURPOSES For SI: 1 Ibf = 4.45 N, 1 psi = 0.00689 MPa 1 psi = 0.00689 MPa. 1 inch = 25.4 mm. 'Single anchors with static tension load only. 2Concrete determined to remain uncracked for the life of the anchorage. 3Load combinations from ACI 318 Section 9.2 (no seismic loading). "30% dead load and 70% live load, controlling load combination 1.21) + 1.6 L. 5Calculation of the weighted average for a = 0.3 *1.2 + 0.7 *1.6 = 1.48. 6f'� = 2,500 psi (normal weight concrete). Cat = Ca2 ? cac eh 2 hmin 9Values are for Condition B where supplementary reinforcement in accordance with ACI 318 -11 D.4.3 is not provided 1. Hammer dd1 a #ibie to ft same nominal 2.Man, hide. diameter as the rAk Bolt TZ. The hole depth must equal the anchor embedment listed in Table 1. The fixture may be used as a drilling template to ensure proper anchor location. 3. Drive ttia Kwik Wt1Z into the hole using 4. Tighten the nut to the requited a hammer. The and must be drivels ' installation torque. until the nominal embedment is achieved, FIGURE 6— INSTALLATION INSTRUCTIONS Allowable tension (Ibf) Nominal Anchor diameter (in.) Embedment depth (in.) Carbon Steel I Stainless Steel f'� = 2500 psi Carbon Steel Stainless Steel 3/8 2 1105 1155 1/2 2 1490 1260 3 -1/4 2420 2530 3 -1/8 2910 2910 5/8 4 4015 4215 3!4 3 -3/4 3635 3825 4 -3/4 4690 5290 For SI: 1 Ibf = 4.45 N, 1 psi = 0.00689 MPa 1 psi = 0.00689 MPa. 1 inch = 25.4 mm. 'Single anchors with static tension load only. 2Concrete determined to remain uncracked for the life of the anchorage. 3Load combinations from ACI 318 Section 9.2 (no seismic loading). "30% dead load and 70% live load, controlling load combination 1.21) + 1.6 L. 5Calculation of the weighted average for a = 0.3 *1.2 + 0.7 *1.6 = 1.48. 6f'� = 2,500 psi (normal weight concrete). Cat = Ca2 ? cac eh 2 hmin 9Values are for Condition B where supplementary reinforcement in accordance with ACI 318 -11 D.4.3 is not provided 1. Hammer dd1 a #ibie to ft same nominal 2.Man, hide. diameter as the rAk Bolt TZ. The hole depth must equal the anchor embedment listed in Table 1. The fixture may be used as a drilling template to ensure proper anchor location. 3. Drive ttia Kwik Wt1Z into the hole using 4. Tighten the nut to the requited a hammer. The and must be drivels ' installation torque. until the nominal embedment is achieved, FIGURE 6— INSTALLATION INSTRUCTIONS ESR -1917 I Most Widely Accepted and Trusted Page 12 of 12 A t T,, A Given: Two 1/2 -inch carbon steel KB -TZ anchors under static tension AN load as shown. ! 1,5 heft he 3.25 in. tt! Normal weight concrete, t', = 3,000 psis !` No supplementary reinforcement (Condition B per ACI 318 -11 T r, ,. D.4.3 c) Assume cracked concrete since no other information is available." z 1.5 he, Needed: Using Allowable Stress Design (ASD) calculate the �t allowable tension load for this configuration. 1.5 tier _ A-A Calculation per ACI 318 -11 Appendix D and this report. Code Ref. Report Ref. Step 1. Calculate steel capacity: ON = OnA f, = 0.75 x 2 x 0.101 x 106,000 = 16,0591b D.5.1.2 §4.1.2 Check whether f,,,a is not greater than 1.9fya and 125,000 psi. D.4.3 a Table 3 Step 2. Calculate concrete breakout strength of anchor in tension: A Nc Ncbg = Y' ec,N9' ed,NY' c,N9' cp,NNb D.5.2.1 § 4.1.3 Nco Step 2a. Verify minimum member thickness, spacing and edge distance: hmfn = 6 in. <_ 6 in.:. Ok Smin 2.375, 5.75 2.375-5.75 D.8 Table 3 slope = _ -3.0 Fig. 4 3.5-2,375 For c=4in=> 2.375 controls 3.5, 2.375 8m;,, = 5.75 - (2.375 - 4.Ox -3.0)] = 0.875 < 2.375 in < 6 in :. ok 0.875 4 cmin Step 2b. For AN check 1.5ha, = 1.5(3.25) = 4.88 in > c 3.01a, = 3(3.25) = 9.75 in > S D.5.2.1 Table 3 Step 2c. Calculate ANA and ANA for the anchorage: ANw = 9h2 f = 9 X (3.25)2 = 95.1in.2 D.5.2.1 Table 3 ANA _ (1.5hef + c)(3haf + s) _ [1.5 x (3.25) + 4][3 x (3.25) + 6] = 139.8in.2 < 2ANco :. ok Step 2d. Determine yrec,N : eN = 0 • Y%c,N =1.0 D.5.2.4 - Step 2e. Calculate Nb:Nb = k,A. fc hef = 17 x 1.0 x 3,000 x 3.251.5 = 5,456 lb D.5.2.2 Table 3 Step 2f. Calculate modification factor for edge distance: Yl d,N = 0.7 +0.3 4 = 0.95 D.5.2.5 Table 3 1.5(3.25) Step 2g. Calculate modification factor for cracked concrete: Vc,N =1.00 (cracked concrete) D.5.2.6 Table 3 Step 2h. Calculate modification factor for splitting: t =1.00 (cracked concrete) - § 4. 1.10 Y' cp,N Table 3 Step 2i. Calculate 0 Ncbg : 0 Ncbg =0.65 x 139.8 x 1.00 x 0.95 x 1.00 x 5,456 = 4,952 lb D.5.2.1 § 4.1.3 95.1 D.4.3 c) Table 3 s000 _ Step 3. Check pullout strength: Table 3, ¢ nNpn,Pc = 0.65 x 2 x 5,515 lb x - 7,852 lb >4,952 .'. OK D.5.3.2 § 4.1.4 2,soo D.4.3 c) Table 3 Step 4. Controlling strength: 0 Ncbg = 4,952 lb < OnNp„ < ON$ :. ON',g controls D.4.1.2 Table 3 Step 5. To convert to ASD, assume U = 1.2D + 1.6L: Ta„o". = 4,952 = 3,346 lb. - § 4,2 1.48 FIGURE 7- EXAMPLE CALCULATION Stem wall repair detail 5e 14 r 5 %t r S Part # WA12512 Diameter 12" Length 512" Minimum Embedment 2114" Torque 50.60 FVLbs —71F o� �;�.._...d The UFP maybe used in place of the FA, HFA and FAP Milecbrs. I MIItENAt • 14 gauge FINISH: GaWanized. May be ordered HOG, contact Simpson Strong -Tie. See Corrosion IrdormaUon, page 10.11. ; INSTALLATION: • Use all specified fasteners; we General Notes. • Loads are based on test results using Simpson Strong Ties j SOS v: x3• screws, which are supplied with the 010. • Alternate lag screws will not achieve published bads. • Refer to technical bulletin T- ANCHORSPEC or flier F -PLANS for post-irlstalled anchorage solutions (seepage 191 for detl4s). CODES: See page 12 for Code Reference Key Chart. UFP10 installed on a Slralght Foundation with %, Onset Modslll Model Mu Spacing to reph I AgeMr BoH 1M1 dis. F88111018 AlloWWI Lad ParapM 10111111111 1861 Reuel War Bon Pig Qty. Big. UFP10 -SDS3 6' 2 1i 5•SDSM0 1340 120.1.26,1`19 1. Allowable loads have Iran (named 00% for wind or earthquake loading with no further Increase allowed; reduce where other bad durations apply. 2. Each anchor bolt reeuins a standard cut washer. U.S. Pawl 5,732,519 UFPID fostalled on a Trapezoid Fandation -S4 o��ta�`J Anchor Bolt Repair Area One story "),9%41 m&C Scope of work 1. The selected contractor proposes to complete a voluntary upgrade to a single story family residence. 2. Remove and replace approximately 12 feet of the upper fractured portion of perimeter foundation stem wall, located on the left front side of the garage. 3. Install Simpson Universal Foundation Plates (per manufactures instructions) to the right side of the rear foundation wall. These plates are only being install in this area because the original 1/2 inch foundation anchors were bent over during original construction. 4. Contractor shall make himself familiar with all site conditions before starting work. All foundation work is to be inspected by the City of Cupertino Building Department and comply with 2010 CRC: Owner Abha Acharekar 834 S Drive Phone # (408-1) 257 -7919 zoo � � J 2 CO m v) c o 0 > o m U U :•= O C CD �7 �? ro O V) 'p CO .N IaU C s<3 p ca (n d O c m rO () 0 - co a) G0 (G Q? v— J= c7 O in 2 Car garage 12' ReDair area m A 16 2013 Ca W Z UJ Y E "j zo 0 � °0 Ir ' cif I— ° '3 O t7) .a' ccto tt5 O p �f.. ti 7 �.,. U Qi 42 U p tp a3t.c i -0 pi oa r F == n C C= mom � t J �0 co 0 Q} �LI~ zoo � � J 2 CO m v) c o 0 > o m U U :•= O C CD �7 �? ro O V) 'p CO .N IaU C s<3 p ca (n d O c m rO () 0 - co a) G0 (G Q? v— J= c7 O in 2 Car garage 12' ReDair area Z W W a Page 1 of 1 A 16 2013 Z W W a Page 1 of 1 STATEMENT OF SPECIAL INSPECTIONS, 2010 CBC COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTMO t (408) 777-3228 • FAX (408) 777-3333 • buildinc0cupertino.or4 SITE APN Registered Design Professional in Charge BP# ADDRESS 0�ypgr Name* 0 Owner... ........................................... .... .. . .. ....... Addr,:SST..`.e. e ..... c1f ...................................... Contractor ...... eeo �4 ... 41419 ..1 ..... Address.. ... ..... �.�J6.0_nl ... ...... ..................... ...................... ty/S U.,..... :...... Zip . .........:................Phone l� fttylst.4:54 .. . ... . ..........:g•. ......... 49 ip.7:.S' Phoneo... Applican Js ............./........ ............................... Address .... . .... ... ...'C.!/' ....................... �K Engineer/Architect ............................................................................. Address ... ........ I ............... Lic.# ..... ........ Date: . 11 1)3 ...... City/st.....!3 � Zip.._JiP_ Phones� `. ............................................................................................. Zip Phone ... ......................... ... City/St .......................................... ............... .................... PROJECT DESCRIPTION: This "STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This Jorm is structured after and used by permission from the Structural Engineer Association of Northern California's (SEAONC) mode statement of Special Inspections. Also, included with this form is'th"514ollowing: ❑ "LIST OF SPECIAL INSPECTION AGENCIES list of testing agencies and other special inspectors that will be retained to conduct the es sp ect ❑ "SCHEDULE ,O" I. T N" a The Schedule of Special Inspections summarizes the Special Inspections af1dStes0-%,. es la e will e 'r to the approved plans and specifications for detailed special inspection re ' 1 � mi, ts., and inspect ns required by the approved plans and specifications shall also q.0 re I a ona ests ns be performed." Special Inspections and Testing Will be performed in accordance with the approved plans an I pecifications, this statement and CBC Sections 1704,. 1705, 1706, 1707, and 1.708. Interim reports will be submitted to the Build* X�' fficial and the Registered Design Professional in Responsible Charge -in accordance with CBC Section 1704.1.2. t 4 t A Final Report of Special Inspections documenting required Special Inspections, t ingr%correction' of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and 0 cuDanckSection'l 704.1.2). The Final Report will document:.. a 'Required special inspections. • Correction of discrepancies noted in inspections. The Owner recognizes his.or her obligation to ensure that the construction complies with the approved permit documents and to implement this:program of special inspections. In partial fulfillment of these obligations, the Owner will retain and directly pay for the Special Inspections as required in CBC Section 1704.1. This plan has been developedwith the understanding that the Building Official will: 0 Review and approve the qualifications of the Special Inspectors who will perform the inspections. 0 Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties as called for in this Statement of Special Inspection. Review submitted inspection rep6rts. Perform inspections as required by the local building code. I have read and agree to compiy with the terms and conditions of this statement Prepared By: Project U Engineer ❑ .! Architect -2 IF Registered Design Professional in Charge Signa re ...... . ...... Date.: . .. 0�ypgr Name* �31wner's Authorization. Signature ....... OM4 .................................................................................... Date:.......................... Inspection Agency / Inspector Name: 13,64j- 6u& Ariac. inature . ....... . .. . ........... Si 4 ... ........ I ............... Lic.# ..... ........ Date: . 11 1)3 ...... Building Official or designee: I. Signature . . ...... .. .......... ......... .. .................. Date: .... ....... !4 ............ SpeciaInspectionForn, - revised 02113113 �e LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF, SPECIAL INSPECTORS: Eachspecia� inspection agency, testing facility, and special inspector shall be recognized by the Building Official prior to performing.any duties., Special Inspection, agency's listed on this form must be pre- approved and listed on Cupertino 's approved Special Inspector's list. Special inspectors shall carry approved identification when performing the functions of a special inspector. Identification cards shall follow the Criteria set by the California Council of Testing and Inspection Agencies. No personnel changes shall be made without first obtaining the approval' of the Building Official. Any unauthorized personnel changes may result in a "Stop Work Order" and possible permit revocation.' To be pre approved by the City of Cupertino, refer to the SPECIAL INSPECTION CRITERIA handout. Please allow two weeks to complete the application process. The followinglabs.the testing ands ecial inspection agencies that will be retained to conduct tests and inspection on this project: EXPERTISE FIRM I INSPECTOR INFORMATION T. Special Inspection (except for Firm..I.10 491....... ....f..lO. R............Addr... 40.6S..TO .A&-. �t0maA ............................ geotechnical) City... ' �uL.:. �iOdF ... ............................... ... State .... CA ............. Zip 9V... Telephone." $j%.�... Fax. ..W .....Email�4tpa+ ..e..�j L. 2. Material Testing Firm ..................................................................... Addr.......................................................... ............................... City........................................................................... ............................... State .......................Zip ...................... Telephone........ ............................... Fax............. ............................... Email.......................... ............................... 3. Geotechnical Inspections Firm ..................................................................... Addr.......................................................... ............................... City........................................................................... ......:........................ State .......................Zip ...........:....,....; Telephone....... ............................... Fax............. ............................... Email..... ............................... .......... . 4: Other: :. F. irm ::................................................................... Addr........................................................... ,............................,. City..............:. ....................... ............................... State .................. .....Zip ...................... Telephone....... ............................... Fax............. ............................... Email.......................... ............................... -AU agencies, specmea on mrs rorm muse De pre - approves ana nsteu Un uie t.uy vi %1UPWl Ln w b MPIJI U V VU %jNV.,101 1QNV�LVI SEISMIC' REQ, IKEMENTS': (Section 1705.3.6) Description of seismic force- resisting system and designated seismic systems subject to special inspections as per Section 1705.3: hei- ' �55 ��i � j��e�� %I� �GI,y � �s w "s ;Z i eesi ai i0 -/0 ha /d awn �f �-� �r� r �fy -F e. � �lD�li7�es Uhf° ». The extent of the seismic- force- resisting system is defined in more detail in the construction documents$ Description of main wind -force- resisting system and designated wind resisting components subject to special inspections in accordance with Section 1,705.4.2' The extent of the main wind- f6rce-resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm - revised 02113113 . CVM SCHEDULE OF SPECIAL INSPECTION SITE APN BP# ADDRESS PROJECT DESCRIPTION.' < Notation 6sed� in Table: Column headers: C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and /or contract documents should clarify. Box entries X Is placed in the appropriate column to denote either "C" continuous or "P" periodic inspections. - Denotes an activity that is either a one -time activity or one whose frequency is defined in some other manner. Additional detan regaraing Inspections ana tests are provlueu in ute piuJeMi sNeuncauviw vi I FVIGJ vi ILI .c uIavruIy0. REFERENCED VERIFICATION AND INSPECTION C P IBC REFERENCE STANDARD INSPECTION OF FABRICATORS ❑ Inspect fabricator's'fabrication and quality control 1704.3 procedures.,:,, INSPECTION OF STEEL 1. Material verification of high strength bolts, nuts and washers. 13 1 Identification marking to conform to ASTM stds AISC 360, Section A3.3 and specified in the approved construction documents. - -_ X applicable ASTM material standards ❑ Inspect fabncato?ilabri.cation and quality control X procedures 2. Inspection of high - strength bolting: ❑; Snug -tight joints. - -- X ❑ Pretensioned and slip- critical joints using turn -of -nut wltKmatchmarking; twist -off bolt or direct tension -- X AISC 360, indicator methods of installation. Section M2.5 1704:3..5 ❑: Pretensioned and slip = critical joints using turn -of -nut without match'Marking or calibrated wrench methods X of installation. 3. 'Material' verification,of structural steel and -cold- formed steel deck. ❑' For structural steel, identification markings to conform X AISC 360, to AISC 360. '' ...! Section M2.5 For other steel; ' Identifcation markings to conform to Applicable ASTM ASTM: standards Specified in the approved - -' X material standards construction documents.. �i :''' ❑ Manufacture 's cerkified': test reports. - -- X VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE 4. Material verification'of weld filler materials: ❑' .Identification marking to conform to AWS specification in the. approved construction documents. -- X AISC 360, Section A3.5 and applicable AWS A5 documents 1704.3 ❑ ' Manufacturer's certificate of compliance required. - -- X -- - -- 5. !'Inspection of welding: a. Structural steel and: cold-formed steel deck: d Complete and partial joint penetration groove welds. X --- AWS D1.1 1704.3.1 0: Multipass fillet .welds. X - -- ❑ Single -pass fil,lef'welds > 5/16" X - -- ❑ I Plug and slot; welds. X - -- ❑' Single, pass fillet welds <= 5/16 ": - -- X ❑ Floo l and roof deck welds.. -- X AWS D1.3 b.' Reinforcing steel; ❑ Verification of weldability of reinforcing steel other than ASTM A:706. X AWS D1.4 ACI 318: Section 3.5.2 _ — ❑ Reinforcing ;steel resisting flexural and axial forces in intermediate and special moment frames, and boundary elements: of special structural walls of concrete an d shear reinforcement. X - -- ❑ .. Shear;reinforcement. X -- ❑ . ether .reinforcing steel -- X 6.;' Inspection of steel frame joints details for compliance: ❑ Details such asbracing'and stiffening. -- X - -- 1704.3.2 ❑ Member locations.: - -- X ❑ Application of:joint details at each connection. - -- X VERIFICATION AND INSPECTION C P REFERENCED STANDARD IB R INSPECTION OF WELDING 1'. ❑ Welded stu4s when use! d for structural diaphragms. -- X -- 1704.3 2.', ❑ Welding' of cold'- formed !steel framing members. - -- X ❑ UVelding'; of stairs and', railing systems. - -- X C EFERENCE SpecialnspectionForm - revised 02/13113: VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE <' INSPECTION OF CONCRETE ❑ Inspection of reinforcing steel, including prestressing ten dons and placement X ACI 318:3.5,7.1 -7.7 1913.4 2: '. ❑ Inspection of reinforcing steel welding in accordance with Table 1704;3 Item 5b, -_- AWS D1.4 ACI 318: 3.5.2 3. ❑ Inspection of bolts. to be installed in concrete prior to and during placement ofconcrete where allowable loads have been. increased orwhere strength design is' use d. X -- ACI 318: 8.1.3, 21.2.8 1911.5, 1912.1 4. ❑ Inspection ection of anchors installe6in hardened concrete. - -- X ACI 318: 1912.1 5.'. ❑ Verifying used required design mix. X ACI 318: 1904.2.2,1913.2, 1913.3 6. ❑ At time fresh concrete is sampled to fabricate specimens for strength tests, perform slump and air content tests and determine the temperature of the concrete. X __ ASTM C 172 ASTM C 31 ACI 318: 5.6, 5.8 1913.10 7: ❑ Inspection of concrete and'shotcrete placement for proper application techniques. X __ ACI 318: 5.9, 5.10 1913.6,1..8 913.7,: 1913.8 ❑ Inspection for'maintenance of specified curing temperature and techniques. X ACI 318: 5.11 -5.13 1913.9 9. Inspection. of prestressed; concrete: ❑ Application of prestressing forces. X - -- ACI 318:18.20 _ ❑ Grouting of bonded prestressing tendons in the seismic,force- resisting system: X __ ACI 318:18.18.4 10, ❑ L= rection,of precastconcrete members. -- X ACI 318: Ch. 16 1:1,; ❑ Verifc'ation of in- situ concrete strength, prior to stressing of tendons in posttensioned concrete and prior to remi of';shores and forms from beams and structural slabs. X ACI 318: 6.2 -- ❑' inspect formwork for: shape, location, and dimensions „' * O the iconcrete member being formed. _ X ACI 318: 6.6.1 - -- 13. ❑ . Bolds Installed;'n1Existing Masonry or Concrete . ❑ Direct tension testing! of existing anchors. - -- X See ICC ES Reports form special inspection requirements for proprietary products v ❑ .!Direct tension: testing of new bolts. - -- X ❑ Torque testing of new bolts. __ X ❑ Prequalification testfor bolts and other types of anchors; X 14 b: Othera 1 1 SpecialnspectionForm - revised 02/13/13 s l REFERENCE FOR CRITERIA 7"VERIFICATION `AND ;INSPECTION C P IBC TMS 402 1ACI TMS 402/ACI SECTION 530 /ASCE 5 530 1ASCE 6 '! INSPECTION OF LEVEL 1 MASONRY 1 ❑ . Compliance w6'required inspection provisions of the construction A66uments and the approved --- X - -- - -- Art. 1.5 'submittals shall be verified. 2.: ❑ Verification of f,,, and f A c prior to construction X ___ __ Art. 1.41 except where specifically exempted by this code. 3. ❑ ! Verification of slump flow and VSI as delivered to X ___ __ ___ Art. 1.56.1.b.3' the site for self consolidating grout. 4. As masonry:construction begins, the following shall be verified to ensure compliance: El of site - prepared mortar. -- X -- - Art. 2.6A ❑ Construction of "mortar joints. - -- X - -- Art.3.36 ❑ Location of reinforcement, connectors, X __ -_- Art. 3.4, 3.6A prestressing tendons, and anchorages. !' ❑ Prestressing technique.; : - -- X - -- Art. 3.613 ❑ : Grade and sjze;of prestressing tendons and X __ ___ Arta 2.46 2.411 anchorages" 5 During ponstructionjthe: inspection program shall verify: ❑ Size and. location of structural elements. - X - -- -- Art. 3.3F ❑ Type, size, and location of anchors, including Sec. 1.2.2(e), other, details of anchorage of masonry to - -- X --' 1.16.1 _ structural members, frames: or other construction. ❑ Specified srze „grade; and type of reinforcement, ancjtor bolts, p,'restressing tendons and - -- X -- Sec. 1.15 Art 2.4;,3.4-:',,* I, anq prages!; , it i! ❑ Welding of reinforcing bars.. X -- -- �� , ❑' Pre�ara ion�l construction and protection of masonry during`cold weather (temperature below __ X Sec. 2104.3, __ Art. 1.8C, 1.8D . 40 degrees F) or hot weather (temperature above 2104.4 1, gQudegrees F). I, ❑` Application and - measurement of prestressing X ___ __ Art. 3.613 force. l . . 6: Prior'to grouting the following shall be verified to ensure compliance: ❑ Grout space islclean.- -- X -- -- Art. 3.21) ❑ Placement of reinforcement and connectors and ___ X __ Sec. 1.3 Art. 3.4 Il:I prestressing tendons;and anchorages. ❑I Proportions 'of site'= prepared grout and X ___ __ Art. 2.66 prestressing grout,for bonded tendons. El:, Construction of rmortar joints. - -- X -- - -- Art. 3.38 7 : Grout�placement ❑ ;Grout placement shall'be verified ensure X - -- -- - -- Art. 3.5 co mpliance;'; ❑' , ;Obserrve grouting of prestressing bonded X ___ __ w Art 3.6C tendons. revised 02/13/13 SpecialnspeetionForm - j REFERENCE FOR CRITERIA "VERIFICATION AND.INSPECTION C P IBC TMS 402 /ACI TMS 402/ACI j SECTION 530 /ASCE 5 530 1ASCE 6 8 ❑ Preparation.of any required'grout specimens, Sec. mortar specimens;; and /or prisms shall be -- X 2105.2.2, -- Art. 1.4 observed. 2105.3 INSPECTION OF LEVEL 2 MASONRY 1. ❑ . Compliance with required inspection provisions of the construction documents and the approved - -- X -- - -- Art. 1.5 submittals. 2. ❑ Verification of fm and. f, Ac prior to construction and for.every 5,000 square feet during - -- X -- -- Art. 1.46 construction. 3. ❑ Verification of proportions of materials in i. premixed or preblended mortar and grout as -- X -- -- Art.1:5B delivered .to the site. 4. ❑ Verification :of slump flow and VSI as delivered to X ___ - -- ___ Art. 1.513.1.b.3 the site for self consolidating rout. 5. The following shall be verified to ensure compliance: ❑ Proportions of site= prepared mortar, grout, and X __ __ Art. 2.6A prestressing groutfor bonded tendons. ❑ Placement of masonry units and construction of -- X __ __ Art. 3:36 mortar joints ! ❑ Placement of reinforcement, connectors and prestressing tendons:and anchorages. X _ Sec. 1.15 Art. 3.4; 3.6A ❑, Grout space prior, to grouting. X - -- -- - -- Art. 3.2D ❑, Placement of grout. X - -- --- - -- Art. 3.5 nment of 'restressin rout. ❑ F?lacq , . p 9 9 X - -- -- - -- Art. 3.6C ❑' Size and;location of'structural elements. - -- X - -- -- Art. 3:3F ❑ Type; size, And'location of anchors, including other ,details of anchorage of masonry to X - -- -- Sec.1.2.2(e) structural members, frames and other construction. ❑ : Specified size, grade; and type of reinforcement, anchor bolts,' prestressing tendons and -- X -- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ W1 !ding of reinforcing ,bars. X __ __ Sec. 2.1.91.2, _ 3.3.3.4 (b) b,:: . Preparation, construction, and protection of ma onry' duringcoldweather (temperature below h� - -- X Sec. 2104.3, -- Art. 1.8C, 1.8D . � 40 degrees F);or, hot weather (temperature above 2104.4 1. 9Q,degrees F). 1. ❑ Application and,fnie',asurement of prestressing X ___ __ __ Art. 3.66 j force. 6 : O P.Xeparationiof any required,grout specimens, Sec. rnortar!s'pecimets;'avd /or prisms shall be X -- 2105.2.2, - Art 1_:4 observed ;!I ° 2105.3 ' VERIFICATION AND. INSPECTION FC P REFERENCED STANDARD IBC REFERENCE INSPECTION OF WOOD 1: ❑ ' Inspect 'prefabrieated'wood structural elements and assembliesin.accordance with Section 1704.2. -- 1704.6 m.2. ❑ Inspect site built: assemblies: --- - -- 3. Inspect high '-load diaphragms: ❑ Verify !grade and thickness of sheathing. - -- al, Verify Inominal'size,of framing members at adjoining - -- panel edges. -- 1704.6.1 ❑ Verify 'nail or staple diameter and length, -- -- ❑ Verify, !number of fastener lines, - -- --- ❑ Verify spacing between fasteners in each line and at edge margins. ; 4. '. ❑. Metal- plate - connected wood trusses spanning 60 feet or, greater. Verify, temporary installation 1704.6.2 restraint/bracingand the:permanent individual truss - -- X - -- member bracing;:are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify ;materialsbelow',footings are adequate to _ -_ X achieve ithe'tlesired bearing capacity. 2.' ❑ Veri, excavatio.ns�are extended to proper depth and fy X have reached proper'material. 3. ❑ Perform classification and testing of compacted fill X materials. -- Table 1704.7 4: r ❑ Ve.rify,use. of proper materials, densities and lift thicknesses during'placement and compaction of X -- compacted fill. 5.. Prior to:placement,ofcompacted fill, observe subgrade X and verify that site has been prepared properly. REQUIRED:VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. ❑ Verify element materials; sizes and lengths comply X with the requirements.' 2 !, ❑ Determine cappaties of test elements and conduct X ___ additional load „tests', as required. 3.1 O Observe: driving operations and maintain complete X j and ,accurate recortls for; each element. 4. ❑ Verify ;locations!.of piles and -their plumbness, confirm type and size of hammer, record number of blows per foot of penetration; ;determine required penetrations to X - -- -- Table 1704.8 achieve design 'capacity,. record tip and butt elevations and'dQcument'ianyjchmage to foundation element. 5', ❑l' ! Fpr�st ' l elements,! perform' additional inspections in accor ance,witfa,Section 1704:3. �. ' 6 ❑ i=on concret ';elements and concrete filled elements, perform :additional inspections in accordance with -- - -- . S,gctio'n 1704.4!;; SpeciainspectionForm - revised 02113113 ' VERIFICATION AND INSPECTION C p REFERENCED STANDARD IBC REFERENCE 7. ❑ For specialty piles, perform .additional inspections as determined by the registered design professional in -- -- -- Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTION OF CAST -IN -PLACE DEEP FOUNDATION ELEMENTS 1 ❑ . Observe drillrng': operations and maintain complete and X accurate records for. each element. 2.;: ❑ Venfy'placement locations and plumbness, confirm element diameters, bell diameters (if applicable), lengths,' embedment into bedrock (if applicable), and X -- -- Table 1704.9 adequate end - bearing strata capacity. Record concrete or grout volumes. 3. ❑ For concrete elements, perform additional inspections i n accordance ;with .Section 1704.4. HELICAL PILE FOUNDATIONS 1.. ❑ Record' installation equipment used, pile dimensions, X 1704.10 tip elevations,.final.depth, final installation torque. SPRAYED FIRE - RESISTANT MATERIALS Physical and visual tests .1.' Condition of substrates.: ❑: Inspect.surface4or accordance'with the approved fire- resistance design and the approved manufacturer's -- - -- written instructions. ❑ V.erify!minimum ambient temperature before and after X application. 1704.12:1 ❑ Verify' ventilationi of area during and after application. -- X ❑ age thickness per ASTM E605 and 2. ! ; Measu'rel aver Section': 7P4.1Z4 ❑ Venfy'density of material for conformance with the approved fire - resistant design and ASTM E605. (Ref. -- - -- Sgction,1704.1�2 5) , � ' 4. ❑ Test cohesive %adhesive bond strength per Section -- - -- 1704:12'.6 5 ❑ Condition of finished 'application. ;p MISCELLANEOUS 1 Mastic ano_Intumescent Fire'Resistant Coating. -- —_ -- 1704.13 2 j Exterior lnsulaiion;;and Finish Systems (EIFS). Water- resistive barrier coating when installed over a sheathing _— __ ___ 1704.14 subsrate I„ t 3' ' Special Cases I I' - -- -- - -- 1704.15 4. Smoke Control System -- —_ -- 1704.16 5J' Seismic,Resistance;, � ; ❑ suspended ceiling systems and their.anchorage. -- -- -- 1705.3 (4,3] SpecialnspectionForm - revised 02113113 i' VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE 6. Wind Resistance ❑ Roof cladding and;.roof framing connections. - -- - -- --- Wall connections to'roof and floor diaphragms and fuming.' ❑ R oof and floor diaphragm systems, including C6llectors, drag 'struts and boundary elements. ❑ Vertical wind- force resisting systems; including braced -_- frames, moment frames, and shear walls. ❑ Wind- force - resisting system connections to the ___ -__ foundation ❑ Fabrication and installation of systems or components required to meet the impact resistance requirements - -- - -- - -- of Section 1609.1.2. SPECIAL INSPECTION FOR WIND REQUIREMENTS 1 Structural Wood ❑ Inspect field gluing operations of elements of the main X wind- force - resisting system. -- 1706.2 ❑ : Inspect nailing, bolting, anchoring, and other fastening of components within. the main windforce- resisting X system., incIpdino wood. shear walls, wood diaphragms„ drag struts, braces and hold- downs. COId- Formed Steel ;Framing ❑ . Welding) of elements of'the main wind- force - resisting X system. -� 1706.3 ❑ Inspection of,screw attachments, bolting, anchoring, and other fastening of components within the main X wind -force resisting system including shear walls, -- Braces,'tliaphragms,, collectors (drag struts) and hold - downs: 3 Wind'- resisting componeP ts ❑ Roof cladding - -- X w 1706.4 ❑ Wali cladding ;: - -- X SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE 1.' ❑ Special' inspection for welding in accordance with the X 1707.2 g.uality assurance plan; requirements of AISC 341. 2. !; Structural Wood f ,' ❑ Inspect field ;gluing operations of elements of the X seismic- force = resisting system. 1707.3 IT :Inspect nailing, bolting, anchoring, and other fastening of components within; the seismic- force - resisting I ystem, ,including wood shear walls, wood -- X diaphragms, drag struts; braces, shear panels and hold- downs. .:' Cold- Formed steellight -frame construction ❑ We1ding of elements of the seismic- force - resisting X 1707.4 SpecialnspectionForm - revised 02113113 ❑ Inspection of screw attachments, bolting, anchoring, an'd other lbstening of components within the seismic- ___ X force - system 'including shear walls, braces, resisting diaphragms, collectors (drag struts) and hold- downs. 4. Storage racks and access floors ❑ Anchorage of storage racks 8 feet or greater in height X 1707.5 and .access floors 5. Architectural components ❑ Inspect erection and: fastening of exterior cladding weighing more than .5 psf and higher than 30 feet - -- X above grade orwalking surface. ❑ Inspect erection 'and fastening of veneer weighing more than 5 psf.and higher than 30 feet above grade -- X or walking surface.: ` 1707.6 ❑ . Inspect erection and fastening of all exterior non - bearing walls higher than 30 feet above grade or -- X walking surface, EV Inspect erection and fastening of all interior non - beann'g;walls weighing more than 15.psf and higher - -- X , th'an 30 feet above grade,orwalking surface. 6. . Mechanical and' Electrical Components ❑ Inspect anchorage of, electrical equipment for X emergency or stand- by spower systems. ❑ inspect anchorage of non - emergency electrical __ X equipment ❑ Inspect installation, of piping. systems and associated mechanical units carrying flammable, combustible, or -- X -- 1707.7 highly toxic contents. ❑ Inspect installation' of HVAC ductwork that contains -__ X hazardous aterials.'; m I„ [31 inspect nstallation of vibration isolation systems 'required X where by:Section 1707.7. 7.' ❑! Ver'fy;that the equipment label and anchorage or mown mg conforms to the certificate of compliance when echanical and ,electrical equipment must be - -- 1707.8 seism,'ically qualified:. ; 8 ❑ : Seismic isolation system: Inspection of isolation X ___ 1707.9 system per ASCE 7 - Section 17.2.4.8 9.' ❑ : Obtairi' mill certificates for reinforcing steel, verify compliance with approved construction documents, -- -- - -- 1708.2 i:: and. ve rify steel rsupplied'corresponds to certificate. 10 ❑ :Structural Steel: Invoke the QAP Quality Assurance 1708.3 requirements iKAISC 341..' 1!1 ❑ ' Obtain certificate that equipment has been seismically __ ___ 1708.4 qualified 12 ❑ '.'Oj�tain system!,tests as required by ASCE 7 Section ___ 1708.5 �i, ' ;17118 1 BIGGS CAROOSA ASSOCIATES INC STRUCTURAL ENGINEERS B 6 S The Alameda San Jose, CA 95126 -3133 Telephone 408- 296 -551 5 Facsimile 40B-296-8114 SPECIAL Project Name: Project Address: Location of Inspection: Inspections made: Samples Taken: Items Complete: Deficiencies/Items Pending: Comments: � FILE RT \ Date: Time Arrived: Time Departed: JOB #: _ Page 1 of To the best of my knowledge, the work completed or in progress for this report was done in general conformance with the intent of the approved design documents and specifications and applicable workmanship provisions of the C.B.C. except as noted above. INSPECTOR: � ` � �� K� ' . ~°"��°~~��~°~. ~~. SPECIAL ~~'_''-~'-_,_—'— _--- DIVISION ALBERT . ' -COMMUNITY . PE. C.Ei{l. BUILDING OFFICIAL ' ' | 1o3VVTORRE AVENUE ^CUPERTNO.CA85O14'3255 C:UPERTn�«u� | � , (408) 777-3228 - FAX (408) 777-3333 - building � ^ ' � This "STATEMENT OF SPECIALINSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This '�,onnm structured after and used oy permission fro . m the Structural Eng . ineer Association of Northern California's (SEAONC) mode statement of Special Inspection s *�n.mcvpeowunm��nnmur/�mw//g: ] ST INSPECTION AGE C A list of testing oieo and uthe special inspecto that will be Wct retained to conduct the tes sp "SCHEDULE ()�4006 I T N" a The Schedule of Special Inspections summarizes the Special [] te ' deappmvodp�noand upeo�oaUunuhnde�Uadopeu�| ona sts and inspect ns required by the approved plans and specifications shall also he � _-,_'-..__ ' Special Inspections and Testing will be performed in accordance with the approved plans Sections 1704, 1:705, 1706, 1707 and 1708. me P_-----`-R�--- Charge accordance with CBC Section 1704.1.2. A Final Report of Special Inspections documenting required Special Inspections, t, in correctrion' of any discrepancies noted in the inspections shall be submitted . . . prior to issuance of a Certificate of Use and 066upa Section, 1704.1.2). The Final Report will Required special inspections. ' oonrectm»cxdiscrepancies � �o the construction pUeow�h�eapproved � and to . ` '—r__--__-~ ' `. . `:Special Inspections as required mCpC S::ow/ 1704.1. � This plan has been - Review ~and approve the qualifications _ the Special 'Inspectors who will ° Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties p" called, for ~this Statement of Special Inspection. Review submitted inspection reports. Perform inspections ne required by the local building code. 'I have rea and agree to comply with the terms and conditions of this statement ` ` � Prepared By: Project U Engineer 13 Architect �26 Registered Desiqh Professional in Charge Signature -1� . ...... eal. Lic.# .... ..... ...... Date: 0 Name: 24,4 fe)K Inspection Agency / Inspector Name: 13164.r Q4:P&,r*-AfJ4CjL—' 'Signature .... J..4 ...... �— -.1 ............... Lic.# ................. ..................... Date: I.Building Officral or designee: /7 // / � ' revised 021131Ij » ADDRESS Address.' M. ... ... ... ...................................... A Address.. 1P.15- Phone 51:1 This "STATEMENT OF SPECIALINSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This '�,onnm structured after and used oy permission fro . m the Structural Eng . ineer Association of Northern California's (SEAONC) mode statement of Special Inspection s *�n.mcvpeowunm��nnmur/�mw//g: ] ST INSPECTION AGE C A list of testing oieo and uthe special inspecto that will be Wct retained to conduct the tes sp "SCHEDULE ()�4006 I T N" a The Schedule of Special Inspections summarizes the Special [] te ' deappmvodp�noand upeo�oaUunuhnde�Uadopeu�| ona sts and inspect ns required by the approved plans and specifications shall also he � _-,_'-..__ ' Special Inspections and Testing will be performed in accordance with the approved plans Sections 1704, 1:705, 1706, 1707 and 1708. me P_-----`-R�--- Charge accordance with CBC Section 1704.1.2. A Final Report of Special Inspections documenting required Special Inspections, t, in correctrion' of any discrepancies noted in the inspections shall be submitted . . . prior to issuance of a Certificate of Use and 066upa Section, 1704.1.2). The Final Report will Required special inspections. ' oonrectm»cxdiscrepancies � �o the construction pUeow�h�eapproved � and to . ` '—r__--__-~ ' `. . `:Special Inspections as required mCpC S::ow/ 1704.1. � This plan has been - Review ~and approve the qualifications _ the Special 'Inspectors who will ° Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties p" called, for ~this Statement of Special Inspection. Review submitted inspection reports. Perform inspections ne required by the local building code. 'I have rea and agree to comply with the terms and conditions of this statement ` ` � Prepared By: Project U Engineer 13 Architect �26 Registered Desiqh Professional in Charge Signature -1� . ...... eal. Lic.# .... ..... ...... Date: 0 Name: 24,4 fe)K Inspection Agency / Inspector Name: 13164.r Q4:P&,r*-AfJ4CjL—' 'Signature .... J..4 ...... �— -.1 ............... Lic.# ................. ..................... Date: I.Building Officral or designee: /7 // / � ' revised 021131Ij » /7 // / � ' revised 021131Ij » LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF, SPECIAL INSPECTORS: Each„speciat inspection agency, testing facility, and special inspector shall be recognized by the Building Official prior to performing any. duties. Special Inspection, agericy's listed on this form must be pre- approved and listed on Cupertino's approved Special Inspector's list. Special inspectors shall oarry- approved identification when performing the functions of a special inspector. Identification cards shall follow the criteria set by the: California Council of Testing and Inspection Agencies. No personnel changes shall be made without first obtaining the i approval of the Building Official. Any unauthorized personnel changes may result in a "Stop Work Order" and possible permit revocation.: To be pre- approved by the City of Cupertino, refer to the SPECIAL INSPECTION CRITERIA handout. Please allow two weeks to complete the application process. The followinq are the tesitiing ands cial inspection agencies that will be retained to conduct tests and inspection on this project: EXPERTISE FIRM /INSPECTOR INFORMATION 1 Special Inspection -All agencies: specinea on finis Torm must De pre - approves ana iisiea on me i ui %,.upw tH iu s rypluvou P iQ i wi a 0. SEISMIC REQUIREMENTS: (Section 1705.3.6) Descnption of seismic-fa rce. resisting system and designated seismic systems subject to special inspections as per Section 1705.3: a lei re fCJ /holy ;Z 4-11 V The extent of the seismio- force - resisting system is defined in more detail in the construction documents. WIND REQUIREMENTS Section 1705.4.1 Description of main wind- force- resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: The extent of the main wind- force - resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm - revised 02113113 (except for �' ... ,E.iO. � . Addr... ��S ...IT..f>ff..�/.�'�!%�'�f�.fl: .••••......•••• ••• geotechniceq Ci ry...% t ..:.�+o,t¢F ...................... ......... State ..:.(,;�........... Zip !! .......................... .. p $�".'zia... . , Telephone.j�o$�y� .. Fax.... �.!! "1l......... Emaile4t�vya+ ..C..j /.. 2. Material Testing Firm ..................................................................... Addr.......................................................... ............................... City........................................................................... ............................... State .......................Zip ...................... Telephone........ ............................... Fax............. ............................... Email.......................... ............................... 3. Geotechnical Inspections Firm ..................................................................... Addr.......................................................... ............................... City........................................................................... ......:........................ State .......................Zip .....................; Telephone....... ............................... Fax............. ............................... Email...... ............................... :.......... 4: Other: .... F1rm ::................................................................... Addr.......................................................... ............................... City.; ............................................................................... s ........................ State .......................Zip ...................... Telephone....... ............................... Fax............. ............................... Email .......................... ............................... EXPERTISE FIRM /INSPECTOR INFORMATION 1 Special Inspection -All agencies: specinea on finis Torm must De pre - approves ana iisiea on me i ui %,.upw tH iu s rypluvou P iQ i wi a 0. SEISMIC REQUIREMENTS: (Section 1705.3.6) Descnption of seismic-fa rce. resisting system and designated seismic systems subject to special inspections as per Section 1705.3: a lei re fCJ /holy ;Z 4-11 V The extent of the seismio- force - resisting system is defined in more detail in the construction documents. WIND REQUIREMENTS Section 1705.4.1 Description of main wind- force- resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: The extent of the main wind- force - resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm - revised 02113113 SCHEDULE OF SPECIAL INSPECTION SITE APN BP# ADDRESS' PROJECT DESCRIPTION: Notation Used in Table: Column headers: C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and /or contract documents should clarify. Box entries. X Is placed in the appropriate column to denote either "C" continuous or "P" periodic inspections. Denotes`an activity-that is either a one -time activity or one whose frequency is defined in some other manner. , Additional detail reaardina inspections and tests are provided in the project specifications or notes on the drawings. INSPECTION OF STEEL 1. Material verification of high = strength bolts, nuts and washers. 13 Identification marking to conform to ASTM stds i AISC 360, Section A3.3 and specified in the approved construction documents. - -- X applicable ASTM material standards ❑ ' Inspect fabncator's,fabrication and quality control X procedures. 2.: Inspection of high- strength bolting: ❑ '' Snug -tight joints. j - -- X ❑ Pretensioned and slip- critical joints using turn -of -nut with, matchmarking; twist -off bolt or direct tension - -- X AISC 360, indicator methods of installation. Section M2.5 1704:3.3 Pretensioned and slip = critical joints using turn -of -nut without matchmarking or calibrated wrench methods X of installation. 3. Material verification of structural steel and.cold- formed steel deck. ❑ ! For structural steel,; identification markings to conform X AISC 360, to AISC:3 !'•; ., ; Section M2.5 ❑ I For other steel 'Identification markings to conform to Applicable ASTM ASTM standards specified in the approved X material standards construction documents., !' ❑ Manui?acturer's eerkifi' test reports. a - -- X ICI i i. T VERiF.IGATION AND INSPECTION C P REFERENCED STANDARD IREFERENCE IBC 4. Material verification :of Weld! filler materials: q .Identification marking to conform to AWS specification in the.approved construction documents. _— X AISC 360, Section A3.5 and applicable AWS A5 documents ❑ Manufacturer's certificate of compliance required. - -- X --- -- 5. , inspection of welding: a. Structural steel and' cold- formed steel deck: ❑ Complete and partial joint penetration groove welds. X - -- AWS D1.1 1704.3.1 ❑ . Multipass fillet,vitelds. X --- ❑ Single -pass fillet welds > 5/16" X - -- ❑ Plug and slot,welds. X -- I ❑' Single, pass fillet welds <= 5/16" -- X ❑ Floor':and roof deck welds.. -- X AWS D1.3 b.' Reinforcing steel', ❑ Verification of weldability of reinforcing steel other than ASTM A 7061 . -- X AWS D1.4 ACI 318: Section 3.5.2 _ — ❑ Reinforcing' steel resisting flexural and axial forces in intermediate and special moment frames, and boundary elements of special structural walls of concrete and shear reinforcement. X _— ❑ Shear; reinforcement. X - -- Other! reinforcing steel, -- X 6. Inspection 'of steel frame joints details for compliance: ❑ Details such'as bracing and stiffening. - -- X -- 1704.3.2 ❑ Member locations.. - -- X :❑ Application of joint!details at each connection. - -- X IBC SpecialnspectionForm - revised 02113113.. REFERENCED VERIFICATION AND INSPECTION C p STANDARD REFERENCE J ' INSPECTION OF WELDING ... 1: ❑, Welded studs when used for structural diaphragms. -- X -- :1704.3 12. ❑; Welding' of cold'- formed .steel framing members. - -- X 0 UVeldiiigi of stairs and; railing systems. - -- X IBC SpecialnspectionForm - revised 02113113.. ' VERIFICATION AND INSPECTION C P REFERENCED IBC STANDARD REFERENCE INSPECTION OF CONCRETE ❑ Inspection of.reinforcing steel, ,including prestressing X ACI 318:3.5,7.1-7.7 1913.4 tendons and placement. 2.'. ❑ Inspection of reinforcing steel welding in accordance ___ __- AWS D1.4 ACI 318: _ with Table .1704 Z Item 5b, 3.5.2 3 ❑ Inspection of bolts Ro be installed in concrete prior to and during placement of lconcrete where allowable X -- ACI 318: 8.1.3,; 1911.5, 1912-.1:A loads have been: increased or where strength design 21.2.8 is'used f anchors installedin hardened concrete. 4. ❑ Inspection 4:a; - -- X ACI 318: 1912.1 5.''. ❑ Verifying use of required design mix. X ACI 318: 1904.2.2,1913.2, 1913.3 6. ❑ 'At time fresh concrete is sampled to fabricate ASTM C 172 specimens for strength tests, perform slump and air X - -- ASTM C 31 1913.10 content tests and determine the temperature of the ACI 318: 5.6, 5.8 concrete. 7. ❑ inspection of concrete and shotcrete placement for X ___ ACI 318: 5.9, 5.10 1913.6, 1913.7, . proper application techniques. 1913.8 ❑ : Inspection for maintenance of specified curing - -- X ACI 318: 5.11 -5.13 1913.9 temperature and techniques. 9. Inspection, of prestressed concrete: ❑ Application of prestressing forces. X - -- ACI 318:18.20 ❑ Grouting of bonded prestressing tendons in the X __ ACI 318:18.18.4 sei . ic, force- resisting system. 1. 0.z ❑ Erection of precast concrete members. -- X ACI 318: Ch. 16 — 1:1: ❑ ,Verification of in -situ concrete strength, prior to sires of tendons in posttensioned concrete and __ X AC1318:6.2 -- pnor'to removal of shores and forms from beams and ;structural slabs: 112.' ❑' lnspect!formw,orkfor. shape' location, and dimensions -- X ACI 318: 6.6.1 of the ,concrete member being formed. Bol xisting Masonry or Concrete 13. ❑ #s t nstalled;'n . O D�rect tension lesting of, existing anchors. - -- X See ICC ES Reports form special ❑ i Direct; tension'testing of new bolts. --- X inspection requirements for proprietary ❑ testing of new bolts. ___ X .Torque products ❑ Prequalifcation?test.for bolts and other types of X anchors, 14. ❑ Other , :1 1, SpecialnspectionForm - revised 02113113 SpeciainspectionForm - revised 02113113 i REFERENCE FOR CRITERIA VERIFICATION AND ;INSPECTION C P IBC TMS 402 /ACI TMS 402/A . SECTION 530 1ASCE 5 5301ASCE 6 INSPECTION OF LEVEL 1 MASONRY 1. ❑ Compliance with required inspection provisions of the cohstructiori documents and the approved - -- X - -- - -- Art. 1.5 submittals shall; a verified. 2. ❑ Verification of fm and f'Aac prior to construction X __ w Art. 1.413 except where specifically exempted by this code. 3 ' ❑ Verification of slump flow and VSI as delivered to X Art. 1.513.1.b.3 the site for se: lf consolidating grout. 4. As masonry construction begins, the following shall be verified to ensure compliance: ❑ ,Proportions of site-, prepared mortar. -- X -- - Art. 2.6A ❑ Construction of'mortar. joints. - -- X __ - -- Art.3.313 on of reinforcement, connectors, 0:,, Location X __- _ -_ Art. 3.4, 3.6A prestressing tendons, and anchorages. ❑ Prestressing technique. - -- X - -- Art. 3.613 ❑ .Grade, and size;of prestressing tendons and _ X __ ___ Arta 2,4B .2.4H anchages'' 5, `, During construciion',jthe inspection program shall verify: ❑ Size and location of structural elements. - -- X - -- — Art. 3.3F 0I.: Type, size, and location of anchors, including Sec. 1.2.2(e), other details of anchorage of masonry to -- X -- 1.16.4 _ structural members;, frames, or other construction. ❑ Specified ik6l,il grade, and type of reinforcement, . anchon.k?olt5, prestressing tendons and -- X -- Sec. 1.15 Art. 2A-,3.4::: anchorages u, , ❑ 1Ne�dirig,of,reirjforcing bars..: X ❑ Preparations construction and protection of . masonry duringicold weather (temperature below -_ X Sec. 2104.3 __ Art. 1.8C, 1.8D. 40 degrees F), or hot weather (temperature above 2104.4 oll .de F). : 9(i9 ❑ : Application arid!measurement of prestressing X Art. 3.6B force.., 6. Prior to grouting the; following ,shall be verified to ensure compliance: ❑ Grout space isclean.' -- X ~- -- Art. 3.2D ❑, Placement of reinforcement and connectors and X __ Sec. 1.3 Art. 3.4 prestressing tendons and anchorages. ❑I Propoitions'of site= prepared grout and X ___ ___ Art. 2.6B prestressing gr',out.for, bonded tendons. ❑ Construction of mortar joints. - -- X -- - -- Art. 3.3B T, Grout placement ❑ ,Grout placement shall'be verified ensure Compliance il' X - -- -- - -- Art. 3.5 ❑ ,06s: erve grouting�6f prestressing bonded X ___ __ __ Art 3.6C tendons: SpeciainspectionForm - revised 02113113 i , REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402 /ACI TMS 402/ACI SECTION 530 1ASCE 5 530 /ASCE 6 8.:::11 Preparation of any required grout specimens, Sec. mortar specimens,; and /or prisms shall be -- X 2105.2.2, -- Art. 1.4. observed. 2105.3 INSPECTION OF LEVEL 2 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved -- X - -- - -- Art. 1.5 submittals. 2. ❑ Verification of in and fAAC prior to construction and for every 5,000 square feet during -- X -- -- Art. 1,46 construction. 3. i.13. Verification of proportions of materials in premixed or preblended mortar and grout as - -- X -- - -- Art 1.513 delivered to the site. 4. ❑, Verification:of slump flow and VSI as.delivered to X ___ __ ___ Art. 1.5131:b.3 the site for self consolidating rout. 5. I' The following shall be Verified to ensure compliance: ❑ Proportions of site= prepared mortar, grout, and X __ __ Art. 2.6A prestressing groyffor bonded tendons. ❑ Placement of masonry units and construction of - __ X Art. 3:38 mortar' joint s "' ❑ Placement of reinforcement, connectors and X __ Sec. 1.15 Art. 3.4, 3.6A . piestressing tendons'and anchorages. ❑ Grout space prior #o grouting, X - -- — -- Art. 3.2D ❑ Flaoement of grout: ! ; X - -- -- - -- Art. 3.5 '; ❑ P;lacernent of prestressing grout: X - -- -- - -- Art. 3.6C ❑' 'Size an., d; location of'structural elements. - -- X --- -- Art. 3.3F ❑ Type, size, and'location of anchors, including other. details of anchorage of masonry to -" -- Sec.1,2.2(e) structural members, frames and other X construction: ❑ Specified size, grade, and type of reinforcement, anchor bolts,' prestressing tendons and - -- X -- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ We ding of reinforcing , bars. 9 g X -_ -- Sec. 2.1.9.7.2, 3.3.3.4 (b) ❑ Pre*ation, construction, and protection of ma on durin scold weather (temperature below . r� ►Y 9, ( P X Sec. 2104.3, ___ Art. 1.8C, 1.8D 4q degrees F} or hot weather (temperature above 2104.4 90 ',degrees F). ❑j i Appiication and; measurement of prestressing force.I X - -- — -- Art. 3.613 j 6 ❑ Preparation ofany, required:grout specimens, Sec. M61 tar'•s'peciment,;! and /or prisms shall be X -- 2105.2.2, -- Art .1 :4 observed a 2105.3 VERIFICATION AND INSPECTION C P REFERENCED —T STANDARD IBC REFERENCE INSPECTION OF WOOD 1: 13, Inspect prefabricated'wood structural elements and assemblies in,accordance with Section 1704.2. __ 1704.6 2. ❑ Inspect site built assemblies. -- - -- 3. Inspect high -load diaphragms: ❑ Verify:grade and 'thick ness of sheathing. -- -- ❑ Verify nominal ;size of framing members at adjoining panel edges.. ❑ Verify nail or staple diameter and length, - -- - -- ❑ Verify number: of fastener lines, ❑ ...Verify spacing opt#een fasteners in each line and at edge margins. :: 4. 0. Metal -plate connected wood trusses spanning 60 feet or; greater: Verify temporary installation restraint/bracing and thepermanent individual truss -- X - -- 1704.6.2 mem iber. bracing' are installed in accordance with the approved truss sub'mitkal package. 'REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify': materials, belowlfootings are adequate to X achieve',the desired bearing capacity. 2. ! ❑ Verify,excavations,are extended to proper depth and X have reached proper material. 3: ❑ Perform'classification and testing of compacted fill __ X materials. -- Table 1704.7 4.1 ❑ Verify ;use.of proper materials, densities and lift thicknesses during placement and compaction of X -- compacted ,fill. 5.:. ❑ Prior, to:plaeement of;compacted fill, observe subgrade X and .verify that site'has been prepared properly. REQUIRED'VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. ❑ Verify:element materials, sizes and lengths comply X -- %withltFe requirements.: 2 ❑ Determine capacities; of test elements and conduct X ___ addonal iti load tests, as required. 3 ❑ Observe; driving operations and maintain complete X and, accUrate! reCOrds for;each element. 4: ❑ Verify iocations',of les;and their plumbness, confirm type and size of hammer, record number of blows per foot of, penetration,, determine required penetrations to X - -- -- Table 1704.8 achieve design 'capacity,; record tip and butt elevations and;d cument'ai damage to foundation element. 5. , ❑ F.or steel elements, perform' additional inspections in — ;! accorgancewVith'!Scction 1704.3. .; ❑ For'concretg'element6 and concrete filled elements, perform additional l'mspections in accordance with -- - -- SpecialnspectionForm - revised 02113113 ' VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE 7. ❑ For•specialty, piles, perform additional inspections as determined by the .registered design professional in - -- -- -- Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTION OF CAST -IN -PLACE DEEP FOUNDATION ELEMENTS 1 ❑ Observe drdlrng'.operations and maintain complete and X accurate. records for; each element. 2.. ` ❑ verify'placement locations and plumbness, confirm element diameters, bell'diameters (if applicable), lengths,'embedment into bedrock (if applicable), and X -- - -- Table 1704.9 adequate end - bearing, strata capacity. Record concrete or grout Volumes. 3. ❑ For concrete elements, perform additional inspections in' accordance vrith ;Section 1704.4. HELICAL PILE FOUNDATIONS 1.: ❑ Record installation equipment used, pile dimensions, X ___ __ 1704.10 ti0l, 'elevations, final depth, final installation torque. SPRAYED FIRE - RESISTANT MATERIALS Physical and visual tests 11: Condition of substrates. ❑ . inspect surface-46r accordance' with the approved fire resistance design and the approved manufacturer's -- - -- written instructions. ❑ Verify minimumambient temperature before and after - -- X application. 1704.12.1 ❑ Verify';ventilation of:area during and after application. -- X 2. !' , ❑ ! Measure, average thickness per ASTM E605 and Section '1704.12 4' 3 ❑ ;Verify density'of,material for conformance with the I pproved fire - resistant design and ASTM E605. (Ref. -- - -- S'ection ,1704.12 5), 4. ❑ Test cohesive /adhesive bond strength per Section 1704,12.6 5. 11 Condition of finished 'application. MISCELLANEOUS Masto anti Intumescent Fire- Resistant Coating. -- —_ __ 1704.13' 2 Exterigr� Insulation, antl� Finish Systems (EIFS). Water- resistive barrier coating when installed over a sheathing -- -- - -- 1704.14 is ub 3. Special Cases " " f - -- -- -- 1704.15 4.:' Smoke Control System -- -- -- 1.704.16 5 Seismic,Resistance;, ❑ S.uspende.d ceiling systems and their anchorage. -- -- --- 1705.3 G4.3] SpecialnspectionForm - revised 02113113 VERIFICATION,AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE 6. ! Wind Resistance ❑. Roof cladding and roof framing connections. - -- - -- --- ❑ Wall connections to'roof and floor diaphragms and framing.' ' gm systems, including ❑ R oo and floor dia p hra f , collectors, dra struts and boundary elements. . g ❑ Vertical wind -force asisting systems; including braced frames; moment frames, and shear walls. ❑ : Wind- force - resisting system connections to the ___ ___ foundation. . ❑ Fabrication and installation of systems or components required to meet the impact resistance requirements -- - -- - -- of Section 1609.1.2.' SPECIAL INSPECTION FOR WIND REQUIREMENTS 1. Structural Wood ❑, Inspect field gluing operations of elements of the main X wind- force - resisting system. — 1706.2 ❑. ; Inspect nailing, bolting, anchoring, and other fastening of components within. the main windforce- resisting X system.,, including wood shear walls, wood diaphragms, drag struts, braces and hold- downs. 2.. Cold- Formed Steel Framing 1 ❑ .1Nelding'. of elements of the main. wind-force-resisting X system. — 1706.3; ❑ Inspectiion of,screw attachments, bolting, anchoring, and other fastening of components within the main wind -force resisting system including shear walls, -- X braces,; hragms;; collectors (drag struts) and hold - downs. 3 Wind= resisting, components ❑ Roof cladding I' X 1706.4 ❑ Wall cladding. ! - -- X SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE 1. a ❑ Special inspection,for welding in accordance with the X __ 1707.2 quality assurance plan requirements of AISC 341. 2. Structural Wood ❑ Inspect field 'gl,uing operations of elements of the X ___ seismic- force -resisting system. 1707.3 ❑ Inspect nailing, bolting, anchoring, and other fastening of c' omponents within; the seismic- force - resisting system „including wood,shearwalls, wood -- X diaphragms, drag struts, braces, shear panels and hold- downs. 3.' Cold - Formed steellgtit -frame construction ❑ Wejding of elements of the Seismic- force - resisting X 1707.4 py SpecialnspectionForm - revised 02113113 ❑ Inspection of screw attachments, bolting, anchoring, and other hastening of components within the seismic- X force - resisting system including shear walls, braces, diaphragms, collectors (drag struts) and hold- downs. 4. Storage racks and access floors ❑ Anchorage of storage racks 8 feet or greater in height X 1707.5 and access floors.: 5,' Architectural components ❑ Ins. pect erection and fastening of exterior cladding weighing' more than .5 psf and higher than 30 feet - -- X above' grade or walking surface. ❑ Inspect erection'and fastening of veneer weighing more than 5 psf.and higher than 30 feet above grade -- X or walking surface.; 1707.6 ❑ . Inspect erection and fastening of all exterior non- bearing Walls higher than 30 feet above grade or -- X Walking surface,: ❑ In'spect' erection :,and fastening of all interior non - bearin'6*alls weighing more than 15.psf and higher -- X „ than 30 feet above grade or walking surface. 6: Mechanical 'and Electrical Components ❑ Inspect,anchorage of electrical equipment for ___ X emergency or.stia -by power systems. ❑ Inspect anchorage of non - emergency electrical X equipment ❑ Inspect installation, of piping systems and associated nieChanical units carrying flammable, combustible, or -- X -- 1707.7 highly',toxic contents. nspect installation' of HVAC ductwork that contains ❑ In: __ X hazardous materials: (i ❑ Inspect installation of vibration isolation systems __ X where required'by;Section 1707.7. 7 ❑ Verlfy;that the �e' 60ment label and anchorage or mounting conforms to the certificate of compliance -- ___ 1707.8 when %mechanical' and !,electrical equipment must be -- i seismically qualified. 8" ❑, Seism.ic'isolation system: Inspection of isolation X __ 1707.9 system per ASCE 7 - Section 17.2.4.8 9.'. ❑ Obtaih' mill certificates' for reinforcing steel, verify compliance :with approved construction documents, -- —_ ___ 1708.2 and. 6rify.steel aupplied'corresponds to certificate. 10 . Structural Steel. Invoke the QAP Quality Assurance - -- 1708.3 requirements in`'AI;SC 341., 1;1 ❑ Obtain certificate that equipment has been seismically ___ 1708.4 qualified 12 ❑ � O taro . 4i required by ASCE 7 Section s stem tests as r Y 1708.5 � II I I ,�!� i ,;17,,8• �, , � '',' i BIGGS CAROOSA ASSOCIATES INC STRUCTURAL ENGINEERS 865 The Alameda San Jose, CA 95126 -3133 Telephone 408- 296 -5515 Facsimile 406- 296 -8114 JOB #: Zo i36 -7(a Page 1 of f SPECIAL INSPECTION DAILY REPORT Project Name: /T '`�1� if Apy ' a� �- Date: /¢�� -, C- ! I, Z6 13 Project Address: 7bwiQ ba . Time Arrived: 1!5',P,W Zirvv . C* Time Departed: Location of Inspection: ;5CA JIM — ft�n r7- 13 0 P� v Inspections made: c� 39 0 tff��►�JE�°�o °�f 60%f &TZJ At &6*- c%u, vF 64 &A✓o i "O /fu�zi ��°�d✓ y FP I/ A9.ft Qle . �fl�JC.�' (/ a� "AAa0&W7- Cur�9i+/G«IIf T� Samples Taken: Items Complete: 7— Deficiencies/Items Pending: 3 0 I d. ' "46 I-iQ -TZ A-r % 16,r`,,� APR 2 3 2013 Comments: 191�`d it No . To the best of my knowledge, the work completed or in progress for this report was done in general conformance with the intent of the approved design documents and specifications and applicable workmanship provisions of the C.B.C. except as noted above. INSPECTOR: BIGGS CARDOSA ASSOCIATES INC STRUCTURAL ENGINEERS 8B5 The P.lameda San Jose, CA 95126 -3133 Telephone 408- 296 -5515 Facsimile 408- 296 -81 14 Edwards Construction 2533 Amethyst Drive Cupertino, CA 95051 Attention: Chris Jones RECEIVED APR 2 3 2013 Name: Subject: Special Inspections and Materials Testing — Final Report Acharekar Residence 834 September Drive Cupertino, CA Permit No. 13040118 Gentlemen: April 19, 2013 2013076 In accordance with Section 1701.1 of the California Building Code and as specified in the structural contract drawings, Biggs Cardosa Associates, Inc. has performed the following special inspections. Adhesive anchor /dowel installation Expansion anchor installation and testing The completed inspections were performed under the supervision of the undersigned Registered Engineer. Based both upon inspections performed and our substantiating reports, it is our professional judgement that, to the best of our knowledge, the inspected work was performed in accordance with the applicable workmanship provisions of the California Building Code and the approved plans and specifications. Should you have any questions, please do not hesitate to call. Sincerely, BIGGS CARDOSA ASSOCIATES, INC. Mark A. Cardosa Vice President cc: Building Division, City of Cupertino M:\2013 \076\Inspection \Sp Insp Final Ltr Acharekar Resid.doc QROFESS /04/ CA�p� F No. S2279 '♦ Exp. 3 31 14 `!'9�. STRUCT��P��P OF CA�-�F