15090124-SPECIAL INSPECTION REPORT TO: CITY OF CUPERTINO, CA
INSPECTION DEPARTMENT
FROM: FRANCISCO M. LACSINA, JR. �
DATED: 12 MARCH 2
SUBJEC HOLDDOWN ANCH R BOLT CERTIFICATION PERMIT# 15090124
10529 Johnson Ave., Cupertino, CA 95014
The following was an actual observation by the undersigned at the above jobsite
on Murch 12„ 2016:
Anchor bolts holes were drilled with a minimum 9" depth into existing concrete
foundation and properly cleaned with pressurized air afterward. Then Simpson
Set-XP Epoxy was properly injected into the holes at an appropriate depth, then
inserted the 5/8 full treaded' anchor bolt.
1 certify that the procedure described above was correctly administered and
anchor bolts adequately installed.
This certification is issued for reference purposes.
C 34945
EXP. 09.3CL 17
S�9r el v I L RSP
Ee c � '
FRANCISCO M. LACSINA JR., PE