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15070008CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15070008 10088 N WOLFE RD (316 20 108) LUIGI CEVOLA CABINETS 832 CHYNOWETH COURT SAN JOSE; CA OWNER'S NAME: (CUPERTINO PROPERTY DEVELOP LLC) I DATE ISSUED: 03/31/2016 OWNER'S PHONE: 415-518-0214 1 1 PHONE NO: 408-644-4351 LICENSED CONTRACTOR'S DECLARATION License Class B. C Lic. #923493 Contractor LUIGI CEVOLA CABINETS Date 10-31-2016 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. :by affirm under penalty of perjury one of the following two declarations: r. 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. o l I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 03/31/2016 hereby affirm that I am exempt from the Contractor's License Law for one of the two reasons: I, as owner of the property; or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: i. 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 BUILDING PERMIT INFO:. BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: STE 120 DOPPIO ZERO - T.I. TO BUILD OUT VACANT SPACE FOR (N) RESTUARANT (2,841 S.F) 12/15/15 PERMIT APP EXT'D TO 3/28/16 Sq. Ft Floor Area: I Valuation: $225000.00 "N Number: Occupancy Type: 316 20 108 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: ALEX VALLELUNGA RE -ROOFS: 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. Signature of Applicant: Date: 03/31/2016 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Section 3700 of the Labor Code, for the performance of the work for which this pen -nit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 t 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 03/31/2016 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9,12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 03/31/20 16 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinaC'ia.cuoertino.ora ❑ NEW CONSTRUCTION ❑ ADDITION X❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROTECT ADDRESS WOWIN.WOLFERD. -4, DPN# 316-20-148 J O d OWNERNPME�U �YL-j !VO P2�% % PHONE 415-518-0214 F-mAm DZPIZZERIA@GMAIL.COM '7 STREET ADDRESS, rr�J Za d CITY, STATE, ZIP, �!�/� ra �� ,5� f FAX CONTACT NAME ALEX MIRAMARE PRONE 415-866-4926 EMAII MIRAMARE@COMCAST.NET STREET ADDRESS 681 48TH AVE. #4 CITY, STATE, ZIP SAN FRANCISCO CA 94121 FAX CI OWNER D OWNER BUILDER D OWNERAGBNT 13 CONTRACTOR ❑ CONTPACTORAGENT M ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME TO BID LICENSE NUMBER LICENSE TYPE BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCkIITECT/BNGINEERNAME ROBERT FUKUDA LICENSENUMBER 029633 '04491405 NAME MIRAMAR E-MAM MIRAMARE@COMCAST.NET FAX ICOMPANY STREET ADDRESS 681 48TH AVE. #4 CITY, STATE, zIP SAN FRANCISCO CA 94121 PHONE 414.866-4926 DESCRIPTIONOFWOM TENANT IMPROVEMENT FOR RESTAURANT -INTERIORWORKONLY lu PLUMBING, ELECTRICAL, LIGHTING; MECHANICAL (Y—fT-I!'4XV) EXISTING USE RESTAURANT PROPOSED USE SAME CONSTR. TYPES [-A 5 USE TYPE OCC. SQ.FT. VALUATION E)(ISTG AREA 2,541 NEW FL R AREA SAME DEMO AREA 0 TOTAL NET AREA 2,841 RESTAURANT - 1-A A-2 2,541 r ? 225,00{} - BATHROOM KITCHEN - OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCHAREA DECKAREA TOTAL DECKTORCHAREA GARAGEAREA:. DETACH I ATTACH I #6DWELLINGUNITS: I3 A. SECOND UNIT ❑YES SECOND STORY 13YES BEINGADDED? QNO ADDITION? [3NO PRE APPLICATION ® YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES Y- TOTAL VALUATION: $ 225,000 PLANNINGAPPL# ®NO PLANNING APPROVAL LETTER EICHLERHOME? ®NO ;,,t3Zt, ie,;,,,,,,ty By my signature below, I certify to each of the following: I am the prop owner's be ve read this application and the information I have pro Wed is correct. I have read the Description o ork is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' construction. I authorize representatives upe o enter the above -identified property for inspection purposes. i 1 1 Signature of Applicant/Agent: Date: SUPPLEMENTAL, OBMA'HON REQUMD MAN Clivl TYPE. ROUTINGSLIP ❑ ,O� CO�mER ❑ B` ILDINGPLANREVmw _ New SM or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ ' PLAININIKC-PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WOVAO _ forum 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 ❑ NIA roR ❑ SANITARY sEwER DISTRICT submittal of Building Permit application. ❑ EINVJ12oPIRgiNTALEEALTa CITY OF CUPERTINO FM77 FEE ESTIMATOR — BUILDING DIVISION 100 N WOLFE RD DATE: 07/01/2015 REVIEWED BY: MELISSA jigADDRESS: APN: 316 20 108 BP#: *VALUATION: 1$225,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE; Tenant Improvement PRIMARY USE: Commercial Building Suppl. PC Fee: (j) Reg. Q OT PENTAMATION PERMIT TYPE: 1B TI WORK ZERO - T.I. TO BUILD OUT VACANT SPACE FOR N RESTUARANT (2,841 S.F SCOPE �DOPP10 OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) I-A,I-B 2,841 $3,544.66 IBTIPLNCK 1 $3,799.44 1BTHNSP I' TOTALS: I 2,841 I $3,544.66, - $3,799.44 sl ,Wech. Plan Check Plzamb, Plan € h ck Flec. Plan Check wech. Pel-rnil Fee: Pl imb. Permit Fee: Elec. Permit Fee: }cher ,-Wech, Imp. C�i7zaa-Pzw�zir harp. _ Other Elec. Inch. L1c ch. Itxsp. Fee:1'hsrnb. Insp.1 ec:: Elea. Insp. Fee: NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept_ for addn °l anjo. FEE ITEMS (Tee Resolution 11-053 T ff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,544.66 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (j) Reg. Q OT 0:0 hrs $0.00 PME Plan Check: $0.00 Permit Feer $3,799.44 Suppl. Insp; Fee: Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax.- *' dininistrative Fee 0 G Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Travel Documenta ion Fees: Strong Motion Fee: IBSEISMICO $63.00 Select an Administrative Item Bldg. Stds Commission Fee: IBCBSC $9.00 -SUBTOTALS_: $7,416.10 $0.00 3 TL F $7,416.10 Revised: 05/07/2015 STATEMENT OF SPECIAL INSPECTIONS, 2013 CBC COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA M14-3255 CUPERTINO 1 (408) 777-3228 -FAX (408) 777-3333 - buildinaliartmerUno.orci SITE ADDRESS 10088 N. WOLFE ROAD AIIN i6 :3 `trz -7000 ........ C.,,"CLO....7TI2 ... 0.10— .... ........... ... ....................... ............... . ... It fa -711, Address ....... ... ...... - Address ..................................................... . ............................ ------------------ ---- ... 41 .... ........ . PU,111518.42.14 .. . . ..........................._------_.----zip ..... . ............ Pro one...._.................. . ............ E .. k .......... .............. Address... Jw7.g.F ..................."T....r . ...... -.1 ......... _WIr/Archillect.4 .2gy ... i 4tii; .................... Address ... ............ :i�!� ... <�omkr.... -2 L� cityfslSfW�6& L ..... P Cityls,t_o. , r ----------- zip-.! h _••J -T]',.1... PROJECT DESCRIPTION: DOPPIO ZERO PIZZARIA Ti This 'STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This form is structured after and used by permission from the t�,soriatpn of Northern California"--; (SEAONC) made statement of Special Inspections. Also, included with this form is the following: ❑ -LIST OF SPECIAL INSPECTION AGENCIES (page 2)_ A list of testing agencies and other special inspectors, that will be retained to conduct the tests and inspections for this project ❑ "SCHEDULE OF SPECIAL INSPECTION' (page 3 — 6). The Schedule of Special Inspections summarizes the Special Inspections and tests, required. Special Inspectors wall refer to the approved plans and specifications for detailed special inspection requirements. Any additional tests and inspections required by the approved plans and specifications shall also be performed. Special Inspections and Testing will be performed in accordance with the approved plans and specifications, this statement and CBC Sections 1704. 1705. 17D6. 1707, anki 1708 Interim reports will be submitted to the Building Official and the Registered Design Professional in Responsible Charge in accordance with CBC Section 1704.1.2. A Final Report of Special Inspections documenting required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted priof to issuance of a Certificate of Use and Occupancy (Section 1704_1_2). The Final Report will document: • 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 developed with the understanding that the Building Official will: Review and approve the qualifications of the Special Inspectors who YAII perform the inspections. • Monitor special inspection activities on the rob 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 reports. • Perform inspections as required by the local building code. 1 have m.-vianriarrmn ia comply with the forms and conditions of this statement Prepared By DAYLO ,c,, Project Engirwer Q Architect 4 Registereo &sign Professional in Cha sS5r1 rcie Signature ... ...... .... ..................... I ......... ...... Date' jf Owner Narne- 61.&Htwil 7' 11 P" . .... ners Authorization ..... ... .................... ............ Signature . ........... .................. Date: iespothnn Name e Ac-AirucO it' loccrio"I Ouii,clroa rA1SC_-Ax nature ....... ....... ............................ . ....... SpeL-itilir.vprciiwtrrpnn_-?012.dor rtrifted 091TW12 LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF SPECIAL INSPECTORS: Each special 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 followina are the testino and special inspection agencies that will be retained to conduct tests and inspection on this project: EXPERTISE FIRM / INSPECTOR INFORMATION 1. Special Inspection (except for �% Firm.,A�c%.R....."..Sf. WY.:�f� 19 , .. .....Add,.Z ......./� .... .. .... 4.rr.. .... geotechnical) City......? .. v ..+. State A A�1.............Zip .. 5.�. 1....... �,.,.� Telephone."'ff![>!.�r.....1.�Ti.Fax... �. .. !� 2. Material Testing Firm.....................................................................Addr......................................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone....................................... Fax ............................................ Email......................................................... 3. Geotechnical Inspections Firm ............... ...................................................... Addr.......... ............................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone...................................... Fax ............................................ Email......................................................... 4. Other: Firm.....................................................................Addr......................................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone...................................... Fax ............................................ Email......................................................... *All agencies specified on this form must be pre -approved and listed on the City of Cupertino's Approved Special Inspector's List. SEISMIC REQUIREMENTS (Section 1705.3.6) Description of seismic -force -resisting system and designated seismic systems subject to special inspections as per Section 1705.3: NON-STRUCTURAL EQUIPMENT ANCHORAGE The extent of the seismic -force -resisting system is defined in more detail in the construction documents. WINL) Description of main wind -force -resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: NON-STRUCTURAL EQUIPMENT ANCHORAGE The extent of the main wind -force -resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm_2012.doc revised 09/06/12 LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF SPECIAL INSPECTORS: Each special 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 following are the testing and special inspection aaencies that will be retained to conduct tests and inspection on this project: EXPERTISE FIRM / INSPECTOR INFORMATION' 1. Special Inspection (except for Firm.....................................................................Addr......................................................................................... geotechnical) City. ...................................................................................... .................. State .......................Zip ...................... Telephone...................................... Fax ............................................ Email......................................................... 2. Material Testing Firm.....................................................................Addr......................................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone.......................................Fax............................................ Email......................................................... 3. Geotechnical Inspections Firm.....................................................................Addr......................................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone...................................... Fax ............................................ Email......................................................... 4. Other: Firm.....................................................................Addr......................................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone...................................... Fax ............................................ Email......................................................... `All agencies specified on this form must be pre -approved and listed on the City of Cupertino's Approved Special Inspector's List. SEISMIC REQUIREMENTS (Section 1705.3.6) Description of seismic -force -resisting system and designated seismic systems subject to special inspections as per Section 1705.3: NON-STRUCTURAL EQUIPMENT ANCHORAGE 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 1705.4.2: NON-STRUCTURAL EQUIPMENT ANCHORAGE The extent of the main wind -force -resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm 2012.doc revised 09/06112 SCHEDULE OF SPECIAL INSPECTION SITE ADDRESS 10088 N. WOLFE ROAD APN BP# ��7 J PROJECT DESCRIPTION: G� DOPPIO ZERO PIZZARIA TI 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 regarding inspections and tests are provided in the project specifications or notes on the drawings. VERIFICATION AND INSPECTION C p REFERENCED IBC REFERENCE STANDARD INSPECTION OF FABRICATORS 1. ❑ Inspect fabricator's fabrication and quality control 1704.3 procedures. INSPECTION OF STEEL 1. Material verification of high-strength bolts, nuts and washers. ❑ Identification marking to conform to ASTM stds AISC 360, specified in the approved construction documents. --- X Section A3.3 and applicable ASTM material standards ❑ Inspect fabricator's fabrication and quality control -- X --- procedures. 2. Inspection of high-strength bolting: ❑ Snug -tight joints. --- X ❑ Pretensioned and slip -critical joints using tum -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 tum -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 360. Section M2.5 ❑ For other steel, identification markings to conform to Applicable ASTM ASTM standards specified in the approved -- X material standards construction documents. ❑ Manufacturer's certified test reports. -- X SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTIONC 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 --- ❑ 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 welds. X --- ❑ Single -pass fillet welds > 5/16" X --- ❑ Plug and slot welds. X --- M Single -pass fillet welds <= 5/16" FOR ANY FIELD WELDING X ❑ Floor and roof deck welds. --- X AWS DU 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 and shear reinforcement. X __ ❑ Shear reinforcement. X --- ❑ Other reinforcing steel. -- I 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 VERIFICATION AND INSPECTIONC P REFERENCED STANDARD IBC REFERENCE INSPECTION OF WELDING 1. ❑ Welded studs when used for structural diaphragms. --- X -- 1704.3 2. ❑ Welding of cold -formed steel framing members. --- X 3. ❑ Welding of stairs and railing systems. -- X SpecialnspeclionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTIONC P REFERENCED STANDARD IBC REFERENCE INSPECTION OF CONCRETE 1. ❑ 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 1704.3 Item 5b. _– -- 3.5.2 3. ❑ Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowable X –_ ACI 318: 8.1.3, 1911.5, 1912.1 loads have been increased or where strength design 21.2.8 is used. 4. ❑ Inspection of anchors installed in hardened concrete. -- 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 concrete. ACI 318: 5.6, 5.8 7. ❑ Inspection of concrete and shotcrete placement for X -- ACI 318: 5.9, 5.10 1913.6, 1913.7, proper application techniques. 1913.8 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 seismic force -resisting system. 10. ❑ Erection of precast concrete members. -- X ACI 318: Ch. 16 — 11. ❑ Verification of in-situ concrete strength, prior to stressing of tendons in posttensioned concrete and X ACI 318: 6.2 -- prior to removal of shores and forms from beams and structural slabs. 12. ❑ Inspect formwork for shape, location, and dimensions _ X ACI 318: 6.6.1 of the concrete member being formed. 13. 14 Bolts Installed in Existing Masonry or Concrete (PER MANUFACTURER'S RECOMMENDATIONS. SEE PRODUCT ICC REPORT) ❑ Direct tension testing of existing anchors. --- X See ICC ES Reports form special inspection requirements for proprietary ❑ Direct tension testing of new bolts. --- X N Torque testing of new bolts. __ X products ❑ Prequalification test for bolts and other types of -- X anchors. 14. M Other: NON-DESTRUCTIVE TESTING IS REQUIRED PRIOR TO INSTALLATION OF ALL POST -INSTALLED ANCHORS TO ENSURE THAT NO REINFORCEMENT WILL BE DAMAGED. SpecialnspectionForm_2012.doc revised 09/06/12 SpeciainspeclionForm_2012.doe revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION I 530/ASCE 5 530/ASCE 6 INSPECTION OF LEVEL 1 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved --- X — -- Art. 1.5 submittals shall be verified. 2. ❑ Verification of fm and fA„c prior to construction X __ --- Art. 1.46 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 self 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 ❑ Location of reinforcement, connectors, --- X __ --- Art. 3.4, 3.6A prestressing tendons, and anchorages. ❑ Prestressing technique. --- X --- --- Art. 3.613 ❑ Grade and size of prestressing tendons and X __ __ Art. 2.413, 2.4H anchorages. 5. During construction the 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 size, grade, and type of reinforcement, anchor bolts, prestressing tendons and -- X -- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ Welding of reinforcing bars. X -- -- • Preparation, 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 90 degrees F). ❑ Application and measurement of prestressing X --- -- --- Art. 3.613 force. 6. Prior to grouting the following shall be verified to ensure compliance: ❑ Grout space is clean. -- X --- -- Art. 3.2D ❑ Placement of reinforcement and connectors and X -- Sec. 1.3 Art. 3.4 prestressing tendons and anchorages. ❑ Proportions of site -prepared grout and X -- --- Art. 2.613 prestressing grout for bonded tendons. ❑ Construction of mortar joints. --- X -- -- Art. 3.313 7. Grout placement: ❑ Grout placement shall be verified ensure X --- -- -- Art. 3.5 compliance. ❑ Observe grouting of prestressing bonded X --- -- -- Art 3.6C tendons. SpeciainspeclionForm_2012.doe revised 09/06/12 SpecialnspectionForm_2012.doc revised 09/06112 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 530/ASCE 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 fR, and f,Ac prior to construction and for every 5,000 square feet during --- X --- --- Art. 1.413 construction. 3. ❑ 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. 1.513.1.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 grout for bonded tendons. ❑ Placement of masonry units and construction of X -- -- Art. 3.313 mortar joints. ❑ Placement of reinforcement, connectors and X -- Sec. 1.15 Art. 3.4, 3.6A prestressing tendons and anchorages. ❑ Grout space prior to grouting. X --- -- --- Art. 3.2D ❑ Placement of grout. X --- --- --- Art. 3.5 ❑ Placement of prestressing grout. 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. ❑ Welding of reinforcing bars. X --- _ Sec. 2.1.9.7.2, --- 3.3.3.4 (b) ❑ Preparation, construction, and protection of masonry during cold weather (temperature below – _ X Sec. 2104.3, Art. 1.8C, 1.81) 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X --- -- -- Art. 3.613 force. 6. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be X --- 2105.2.2, -- Art. 1.4 observed. 2105.3 SpecialnspectionForm_2012.doc revised 09/06112 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 drilling 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 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 surface for accordance with the approved fire - resistance design and the approved manufacturer's -- -- written instructions. ❑ Verify minimum ambient 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 approved fire-resistant design and ASTM E605. (Ref. -- --- Section 1704.12.5) 4. ❑ Test cohesive/adhesive bond strength per Section 1704.12.6. _ 5. ❑ Condition of finished application. MISCELLANEOUS 1. Mastic and Intumescent Fire -Resistant Coating. --- --- -- 1704.13 2. Exterior Insulation and Finish Systems (EIFS). Water - resistive barrier coating when installed over a sheathing -- --- -- 1704.14 substrate. 3. Special Cases --- -- --- 1704.15 4. Smoke Control System -- -- --- 1704.16 5. Seismic Resistance ❑ Suspended ceiling systems and their anchorage. --- --- --- 1705.3 [4.3] SpecialnspectionForm_2012.doc revised 09106112 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. ❑ Roof and floor diaphragm systems, including collectors, 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, including wood shear walls, wood diaphragms, drag struts, braces and hold-downs. 2. Cold -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 wind -force -resisting system including shear walls, -- X braces, diaphragms, collectors (drag struts) and hold- downs. 3. Wind -resisting components ❑ Roof cladding. --- X --- 1706.4 ❑ Wall cladding. --- X SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE 1. ❑ Special inspection for welding in accordance with theX _ 1707.2 quality assurance plan requirements of AISC 341. 2. Structural Wood ❑ Inspect field gluing operations of elements of the X —_ seismic -force -resisting system. ❑ Inspect nailing, bolting, anchoring, and other fastening 1707.3 of components within the seismic -force -resisting system, including wood shear walls, wood --- X diaphragms, drag struts, braces, shear panels and hold-downs. 3. Cold -Formed steel light -frame construction ❑ Welding of elements of the seismic -force -resisting X 1707.4 system. SpecialnspectionForm_2012.doc revised 09/06/12 ❑ Inspection of screw attachments, bolting, anchoring, and other fastening 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 ❑ Inspect 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. ❑ Inspect erection and fastening of all interior non- bearing walls 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 stand-by power 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 materials. ❑ Inspect installation of vibration isolation systems —_ X where required by Section 1707.7. 7. ❑ Verify that the equipment label and anchorage or mounting conforms to the certificate of compliance ___ --- __ 1707.8 when mechanical and electrical equipment must be seismically qualified. 8. ❑ Seismic isolation system: Inspection of isolation X --- 1707.9 system per ASCE 7 — Section 17.2.4.8 9. ❑ Obtain mill certificates for reinforcing steel, verify compliance with approved construction documents, -- --- --- 1708.2 and verify steel supplied corresponds to certificate. 10. ❑ Structural Steel: Invoke the QAP Quality Assurance 1708.3 requirements in AISC 341. _-- --- 11. ❑ Obtain certificate that equipment has been seismically --- 1708.4 qualified. 12. ❑ Obtain system tests as required by ASCE 7 Section 1708.5 17.8. SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTIONC P REFERENCED STANDARD IBC REFERENCE INSPECTION OF WOOD 1. ❑ 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 thickness of sheathing. -- --- ❑ Verify nominal 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 restraint/bracing and the permanent individual truss -- X --- 1704.6.2 member bracing are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify materials below footings 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. ❑ Verify use of proper materials, densities and lift thicknesses during placement and compaction of X -- compacted fill. 5. ❑ Prior to placement 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 with the requirements. 2. ❑ Determine capacities of test elements and conduct X --- additional load tests, as required. 3. ❑ Observe driving operations and maintain complete X and accurate records for each element. 4. ❑ Verify locations of piles and their plumbness, confirm type and size of hammer, record number of blows per --- Table 1704.8 foot of penetration, determine required penetrations to X --- achieve design capacity, record tip and butt elevations and document any damage to foundation element. 5. ❑ For steel elements, perform additional inspections in accordance with Section 1704.3. 6. ❑ For concrete elements and concrete filled elements, perform additional inspections in accordance with --- --- Section 1704.4. SpecialnspectionForm_2012.doc revised 09/06/12