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12060061-FCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21869 GARDENVIEW LN CONTRACTOR: ERMIT NO: 12060061 OWNER'S NAME: RAJAGOPALAN KARPAKAM AND BALASUBRAM �� _ DATE ISSUED: 09/17/2012 OWNER'S PHONE: 6504347292 , PHONE NO: 7 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # q & }` G Contractor f Date ��' hereby affirm that I am licensed under the provisions of C apter, 9 (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. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of thi it. Additionally, the a ' ant understands and will comply with all non- oin source regulations p he upertino Municipal Code, Section 9.18. Signaturevry Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, wil I 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: 1 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. 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. 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 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. BUILDING PERMIT INFO: BLDG f— ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r— JOB DESCRIPTION: CONSTRUCTION OF A 3,872 SQFT TWO STORY RESIDENCE WITH 627 SQFT GARAGE AND A 52 SQFT COVERED PORCH Sq. Ft Floor Area: I Valuation: $700000 APN Number: 32619087.00 R Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D YS FROM T�jCALLED INSPECTION. Issued by4" (( �LZ Date: 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: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 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. Ownef 9fr authorized agegoV/� Date CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of %ork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date Licensed Professional -ItNEW CONSTRUCTION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE . CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 . buildingP-cupertino.org ❑ ADDITION ❑ ALTERATION / TT ❑ REVISION / DEFERRED ORIGINAL PERMIT # PR IECT 4DDRESS 2,#7 6 ek1/e/ , L� f/ APN OWNER NAME 5?2lAf/ $i�i4 /C I�I"%�l'fIW�L ��717w%Y 0 10/tJ 7/� 77 E-RAIL ER:EFr ADDRESS �x CITY, STATE, ZIP - FAX CONTACT NAME �ir�?T, PHONE E- �. STREET ADDRESS 4/� CITY, STATE, ZIP / �� p�O` y FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT > ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX . STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME 24454�P / � � � S6 LICENSE NUMBER � Z BUS. LIC # COMPANY NAME E MSILSG�pf% FAX STREET ADDRESS S�tv�I� CITY, STATE, ZIP PHONE t7� O DESCRIPTION OF WORK l a�7 /[�J <d /�� EXISTIN,G USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.Ff. VALUATION (S) EXISAREA %®f AREA NEW 5 DEMO ®� TOTAL AREA AREA NETAREA. _ BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA ��- V13 V `� / PORCH AREA DECK A697 REA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ,ATTACH / # DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? �r0 SECOND STORY YES ADDITION? O PRE -APPLICATION YES IF YES, PROVIDE COPY OF IS THE BLDG AN YES RECEIVED BY: TOTAL VALUATION: P G APPI. # NO PLANNING APPROVAL LETTER EICHLER HOME? 0 1A,� By my signature below, I certify to each of the following: I am the prope er or authorized agent to act on the prrperty owner's behalf. I hav read this application and the information I have provided is correct. I have rea t escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I au representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 66 i 7— SUPPLEMENTAL Tl UTRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER BUMDING PLAN REVIEW _ New SFD 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 PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure X STANDARD 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 ❑ MAJOR SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BtdgApp_201 Ldoc revised 06121111 C17Y OF cCUP EIlBTENG FEE IESTEMATD R — BUR LDRN G DRVISRON ADDRESS: 21 69 Gardenviewr i_n DATE: REVIEWED BY: Sean APN: %06611112012 ]BP#: go69OO(L' Z *VALUATION- 1$700,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: 1Vew Construction PRIMARY SFD or Duplex USE: 2nd Unit?Yes 0 No PENTAMATION 1 R3SFDW PERMIT TYPE: � WORK Construction of a 3872 sq ft two story residence with 627 sq ft garage and a 52 sq ft covered porch. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. F1LR AREA s.f. PC FEES PC FEE ID BP (FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 4,551 $3,026.30 IR3PLNCK $3,514.30 IR3INSP TOTALS: 4,551 $3,026.30 $3,514.30 :llech. Plan ("heck Plumb. flan Check _J Elec. Plan Check :llech. Permit Fee: Plumh. Permit Fee: Ehr Pennir Fee Other ;tlech. Insp. Other Plumb Imp.=7- Otter F.lec. In C A,Icch. Insp. Fee: Plmnb. Insp. Fee: E/cc. Lisp. F«e: NOTE: This estimate does not include fees 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'1 info. ]FEE ITEMS (Fee Resolution 11-053 E,ff. 7/1/11) IFIEE QTY/IFIEIE MffSC I'TEI>'i[S Plan Check Fee: $3,026.30 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,514.30 Suppl. Insp. Fee:Q Reg. ®OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 k new units $590.16 rldininisrrarive Fee: O r Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: PLLONGRNGR $591.63 Select a Non -Residential E) Building or Structure O a 7'ruvel Docuinentatior,, F'cses: Stronp, Motion Fee: IBSEISMICRg$7,82 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC SUBTOTALS: $0.00 TOTAL FEE: $7,820.39 Revised: 06/05/2012 Builafing 11Dep2u-tment cuF>E NT ir.5o CONTRACTOR / SUBCONTRACTOR LEST City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax:408-777-3333 JOB ADDRESS: �- IW PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR o 9,BUSINESS LICENSE # ADDRESS: U CITY/ZIPCODE: *Our municipal core requires all (businesses working in the city to have a City of Cupertino business license. NO BUILDING ]FINAL OR (FINAL OCCUPANCY INSPECTIONS) WELL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPlERTINO ]BUSINESS LICENSE. I am not using any subcontractors: Signature ID Please check applicable subcontractors and complete the following infformati ^"�"� y� c% SUBCONTRACTOR BUSl1INlESS NAME AUSI NESS LICENSE # Cabinets & Millwork `I 'a NC0j tK'�-P f 9 J Cement Finishing `-,� 7 Ov\CdS "%A i Electrical Ca Gjl oYt Excavation Fencing Nt A Flooring / Carpeting gcro r Linoleum / Wood Glass / Glazing Heating Insulation Landscaping NIA Lathing fir' w CA , cy) �� G Masonry Painting / Wallpaper Co (\,Ibl'k-rt.t e +,,0-,7 G Paving Plastering `'\:a ,�� c+7C;" 'r,1,c Plumbing t C e, S, $P, r P1 L,^ Q 0 Y 21105 Roofing 1 dW-w Gkc-q - ` c Septic Tank N A Sheet Metal` Sheet Rock Miuc ow c' ' Tile i I` Owner / Contractor Signature Date CUPERTINO STATEMENT OF SPECIAL INSPECTIONS, 2010 CBC COMMUNITY DEVELOPMENT DEPARTMENT ^BUILDING DIVISION1 ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 ,1 (408) 777-3228 . FAX (408) 777-3333 o building .cuoertino.org SITE APN BP# ADDRESS Owner... S�cvt✓A ri1�l ....... Contractor....................................................................................................... Address..a.��6`(...... .................................................... Address.................. ......................................................................................... City/St... C!!P.ff.&.T11Y.9.................. Z-ip.... `� � ........ Phone+1,5 30 City/St...................................... ........... Zip ................... Phone ........................ Applicant .$t;�a�.td !y..... gar.. �V82A.M!bdw .............................. Engineer/Architect. ... ,;F,..%e.-....4.%............................. Address.? 1.r..6q.......� W. . ! b!....Ld.............................................. Address ..%... ✓ .PC.................... City/St...................... Zip .....`.15!' )4.......Phone/j-.IS7 Cit /St.. ..:............zi hone IB.:1,0� Y J p ... .. PROJECT DESCRIPTION: 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 Structural Engineer Association of Northern California's (SEAONC) mode 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 will 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, 1706, 1707, and 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 prior 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 approv pe b ��dnts and to implement this program of special inspections. In partial fulfillment of these obligations, the Ow i ta�a� 'directly pay for the Special Inspections as required in CBC Section 1704.1. "� This plan has been developed with the understanding that the Building Officia(, vill• • Review and approve the qualifications of the Special Inspectors who will th inspections. • Monitor special inspection activities on the job site to assure that the Special l sl3ectors 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 read and acres to comoly with the terms and conditions of this statement Prepared By: Project 41 Engineer ❑ Architects e_ os�b 89 /� Registered Design Professional in Charge Si nature ................l� d / f!>r,..................... Lic.# ............ OwnerName- ° Owner's Authorization 2......... .......l. Si nature ..... .............................................. Lic.# ................ . Date:i Inspection Agency / Inspector Name: £i nature.................................................................... Lic.#....................................... Date:.......................... Building Official: BuildingOfficial's Acceptance I Signature ........................ ..................... I ...................... Lic.#....................................... Date:.......................... SpecialnspectionForm_2012.doc revised 03121112 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 testinq and special inspection aqencies that will be retained to conduct tests and inspection on this project: EXPERTISE FIRMA I INSPECTOR INFORMATION ° 1. Special Inspection (except for firm ............... ....................................................... Add r......................................................................................... 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 9705.3.6) Description of seismic -force -resisting system and designated seismic systems subject to special inspections as per Section 1705.3: The extent of the seismic -force -resisting system is defined in more detail in the construction documents. WIND REQUIREMENTS Section 1705.4.9 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 2012.doc revised 03121112 SCHEDULE OF SPECIAL 1INSPECTIOM SITE APW 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 regarding inspections and tests are provided in the project specifications or notes on the drawings. VERIFICATION AND INSPECTION C P REFERENCED IBC IREFEREMCE 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 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 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 Specia(nspectionForm 2012.doc revised 03121112 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IIRC IREFEREMCE 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 > 5116" X — ❑ Plug and slot welds. X -- ❑ 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 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. --- 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 INSPECTION C P REFERENCED STANDARD IB �REFEREHCE 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 SpecialnspectionForm 20/2.doc revised 03121112 VERIFICATION AND INSPECTION C P REFERENCED IBC STANDARD 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. 1904.2.2,1913.2, — X ACI 318: 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. ❑ Bolts Installed in Existing Masonry or Concrete ❑ Direct tension testing of existing anchors. -- X See ICC ES Reports form special inspection requirements for proprietary ❑ Direct tension testing of new bolts. --- X ❑ Torque testing of new bolts. ___ X products ❑ Prequalification test for bolts and other types of _ X anchors. 14. ❑ Other: SpecialnspectionForm_2012.doc revised 03121112 REFERENCE FOR CRITIERA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI THS 402/ACI S(ECI'ION 530/ ,SCE 5 530/ASCfE 6 INSPECTION OF LEVEL 1 MASONRY Y 1. ❑ Compliance with required inspection provisions of the construction documents and the approved --- x -- --- Art. 1.5 submittals shall be verified. 2. ❑ Verification of f,,and fAAc prior to construction X -_ --- Art1.413 except where specifically exempted by this code. 3. ❑ Verification of slump flow and VSI as delivered to X __ __ ___ Art. 1.5I3.1.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.3.31B ❑ 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 """ -- -- 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 "-- 1 161 — 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. 1.3C, 1.31) 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X - --- Art3.613 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 __ _-_ Art2 6B 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. SpecialnspectionForm 2012.doc revised 03121112 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IISC YMS 4402 ACI T42faS 4402IACI 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 ftwc 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. 1.56.1.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 -' -- --- 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, 1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X ___ __ — Art. 3.65 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 03121112 VERIFICATION AMD INSPECTION C P REFERENCED STANDARD IIBC (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 restraintibracing and the permanent individual truss — X — 1704.6.2 member bracing are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INISPECTIORI OF SOL 1. ❑ Verify materials below footings are adequate to X achieve the desired bearing capacity. 2. ❑ Verify excavations are extended to proper depth and _r 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 VEIRIFICA71OM AND INSPECTION OF DEEP DiRilflEN FOUMDATIOM (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. SpeciainspectionForm_2012.doc revised 03121112 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IIBC REFERENCE 7. ❑ For specialty piles, perform additional inspections as determined by the registered design professional in -- --- - Table 1704.E 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, perfo: m 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 03121112 VERIFICATION AND INSPECTION C P REFERENCEDI(�C REFERENCESTANDARD 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 INSPEC710H FOR WIND REQUlREMEM7S 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. ❑ Inspection of screw attachments, bolting, anchoring, and other fastening of components within the main -- 1706.3 wind -farce -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 the _ 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 of components within the seismic -force -resisting 1707.3 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 _ 1707.4 system. SpeciainspecaonForm 2012.doc revised 03121112 ❑ Inspection of screw attachments, bolting, anchoring, and other fastening of components within the seismic- force -resisting system including shear walls, braces, --- X diaphragms, collectors (drag struts) and hold-downs. 4. Storage racks and access floors ❑ Anchorage of storage racks 8 feet or greater in height -_ 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 M 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. F2. ❑ Obtain system tests as required by ASCE 7 Section 1708.5 17.8. SpecialnspectionForm 2012.doc revised 03121112 tCUPERTIIMO COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 o buildingO-cupertino.orq The following list of Special Inspection Agencies and their special inspectors are approved by the CiV of Cupertino to provide specific inspection in their respective field/ until the expiration date listed. Agency Hairpne, Address and/ expiration datee SpeCi�ii Inspectors Special irnspeCtiorn Field/ RC I PC I SM SS SW FP S W Cr. Advanced Testing & Inspection, LLC 540 Brunken Ave Suite B Salinas, CA 93901 Tel: (831) 422-2272, Fax: (831)597-2004 Expires: David Bor en X X Marshall Hislop X X X X X Mike Marshall X X X X Reza Mavashti X X X X X X C.T Powell X Mo taba Tavakolian X ++ Darwin Zacha +d X Apex Testing Laboratories, Inc. 3450 Third St., Ste. 3E San Francisco, CA 94124 Tel: (415) 550-9800 Fax: (415) 550-9880 Expires: 3/03/2012 Abdel Khelifa X X X X X X X X BAGG Engineers 847 W. Maude Ave. Sunnyvale, CA 94085 Tel: (408) 852-9133 Fax: (408) 852-9138 Expires: 3/03/2012 Christian Brown X X X X Alvin McManus X X X X Douglas Metzger X X X X X Steve Sommerfield X X X X Biggs Cardosa Associates, Inc. 1871 The Alameda, Suite 200 San Jose, CA 95126 Tel: (408) 296-5515 Fax: (408) 296-8114 Expires: David Chan X X Bardan Gurung X John Harlander X Yu -Chen Lin X Stanley O humu X Hardik Patel X Tyson Tano X Claudiu To an X X Deepen Upadhyay X Mark Wooley X X X X Robert Yamane X RC = Reinforced Concrete SS = Structural Steel Welding/Bolting S = Soils PC = Pre-stressed/Post-tensioned Concrete FP = Spray -Applied Fireproofing W = Wood SW = Structural Mason SIN = Structural Welding CG = CalGreen Code SpeciallnspectionList.doc revised 07106112 agency Name, Address and expiration dateRC Special Inspectors Special Inspection FWdl PC SM SS S FP S UV CG BSK Associates 1181 Quarry Lane Bldg 350 Pleasanton, CA 94566 Tel: (925) 462-4000 Fax: (925) 462-6283 Expires: 3/10/2012 Jim Auser X X X Mike Clary X X X X X Kevin Evans X X X Joe Ho elian X X X Dennis Ness X X X X Darrell Richmond X X X Peter Schurman X Capex Engineering Inc. 571 Seville Place Fremont, CA 94539 Tel: (510) 668-1815 Fax: (510) 490-8690 Expires: 6/25/2014 Gary Hsu X X X X X X Chow, Erwin 1105 Belmont Ave. Long Beach, CA 90804 Tel: (562) 449-7491 Expires: 4/24/2014 Erwin Chow X X Construction Testing & Engineering, Inc. 242 W. Larch Rd., Ste. F Tracy, CA 95304 Tel: (209) 839-2890 Fax: (209) 839-2895 Expires: 3/15/2012 Cathy Bedford X X Dottie Hughes X X X Eldon Carl Johnson X X X X Kirk Kyle X X X Robert Leon X X X Dave Martinez X X X X Lana Ribeiro X X X Steve Sommerfeld X X X RC = Reinforced Concrete SS = Structural Steel WeldinglBolting S = Soils PC = Pre-stressed/Post-tensioned Concrete FP = Spray -Applied Fireproofing W = Wood SM = Structural MasonLy SW = Structural Weldinq CG = CalGreen Code SpeciallnspectionList.doc revised 07106112 Agency Name, Address and expiration date Special inspectors special lnspection field special Pc SM SS SWFP S tid cG Consolidated Engineering Laboratories 2001 Crow Canyon Road, Suite 100 San Ramon, CA 94583 Tel: (925) 341-7100 Fax: (925) 855-7140 Expires: 6/25/2014 Ahmed, Badaruddin Alexander, David X X X . X Andersen, Calvin X X X Bartlett, Dennis X X Bobrovitsk , Edward X X X Bolen, Michael X X X X Brooks, Brendan X X X X X X Brown, Ronald X X X X X X Buchmiller, Kenn Coffin ham, Paul Currier, James X X Eschliman, Duaine Eschliman, Kevin Fuller, Mark X X X Halloran, James X X X X X X Harrington, Wayne X X X Hassebrock, Scott X X X X X X Healy,Michael X X Heilmann, Mark X X X X Hornyak, John X X X X X Hyslop, John X X X X X King, Phillip X X X X X Kmitt, Stanley X X X Liebold, Jeffrey X X X X X X Lozano, Alfonso Art Ma, Steven X Marlik, William X X X McCutcheon, Thurmond X X X McKenzie, Quinten McLaughlin, Lori X X X Miner, Dwight X X X Murphy, Don X X Pastora, George X X X X X Rodriguez, Sandra X X X Si mon, Josephine Sisson, James X X X X Small, Michael X X Van Horn, Bradford X X X X Walters, Michael Zuerner, Robert X X X RC = Reinforced Concrete SS = Structural Steel WeldinglBolting S = Soils PC = Pre-stressed/Post-tensioned Concrete FP = Spray -Applied Fireproofing W = Wood SM = Structural Masonry SW = Structural Welding CG = CalGreen Code SpeciallnspeclionLfsi.doe revised 07106112 Agency Name, Address and expiration date Special inspectors Special Inspection Held RC PC SM SS SW FP S UV CG Construction Testing Services 2174 Rheem Dr., Ste. A Pleasanton, CA 94588 Tel: (925) 462-5151 Fax: (925) 462-5183 Expires: 6/26/2014 Brian Arnold X X X X Edward Bindert X X X X X Jeremy Brown X X X X James Brumley X X Jared Byers X X Richard Collin X X X X Robert Cortez X X X X X X Robert Criswell X X X X Mark Doman X X X X X Tom Edwards X X X X X X Tim Farley X X X X X X X Gary Fechner X X X X Mike Gaunt X X- Ron Harr X X X X X Neal Hoellwarth X Richard Jones X X X X X Rick Mann X X X Kevin McCurdyX X Kevin Meyers X X Kevin Moore X X Craig Nagle David Puskarich X X X X William Radulovich Brian Ragan X X X X X X John Rink X X George Rockenstein X X Larry Rothey X X Erin Salazar X X Robert Schulze X Donald ShirleyX X X Tom Shuster X X X X X X Larry Slater X X Daryl S ieker X X Gary Stapleton X X X X Matt Swope X X Travis Taylor X X X Vinny Vinavong X X Shawn Vucenic X X John White X X X X X X Isidoro Za ien X X X X RC = Reinforced Concrete SS = Structural Steel Welding(Bolting S = Soils PC = Pre-stressed/Post-tensioned Concrete FP = Spray -Applied Fireproofing W = Mood SM = Structural Masonry SW = Structural Welding CG = CalGreen Code SpeciallnspectionList.doc revised 07106112 Agent;y Name, Address and expiration date �(peC9S9 ierspeCtoP`S Special] Inspection FWd RC PC SM SS SYd . FP S vu CC Earth Systems Pacific 446 S. Hillview Dr. Milpitas, CA 95035 Tel: (408) 934-9302 Fax: (831) 637-0510 Exp: 6/28/2014 George Barnett X X Jeff Bryan X X Norman En en X X X X X Cal Hicks X X X X X X Dennis HurleyX X rus Me'ia ENGEO Incorporated 2010 Crow Canyon PI., Suite 250 San Ramon, CA 94583 Tel: (925) 866-9000 Fax: (888) 279-2698 Exp: 7/06/2014 Tim Benton Greg Hudson X Mike Huener ardt X X X X X Kevin Lecce James "Chip" Moore X X X Randy Mues X Jonathan Parker X X X X Rich Rose X X X FHP Inspections, Inc. 690 Sunol St., Bldg. H San Jose, CA 95126 Tel: (408) 288-8460 Fax: (408) 271-0902 Expires: 3/22/2012 Tony Cotta X X Chuck Pinkham X X X X David Pinkham X X X X P. Scott Pinkham X X X Joel Sorenson X X X X Gary Stafford X X X X X Jason Waugh X X X X X KC Engineering Co. 865 Cotting Lane, Suite A Vacaville, CA 95688 Tel: (707) 447-4025 Fax: (707) 447-4143 Exp: 3/18/2012 Dennis Brown X X Art Crawford Jr. X X X X X Maurice Mathews X X X X X Ted Scibek X X X RC = Reinforced Concrete SS = Structural Steel Welding/Bolting S = Soils PC = Pre-stressedlPost-tensioned Concrete FP = Spray-Applled Fireprooring W = Wood SMI = Structural Mason SW = Structural Welding CG = CalGreen Code SpeciallnspeclionList.doc revised 07106112 Agency Name, Address dateRC Special Inspectors Speciall Inspection Fieldandexpiration PC SWI SS SUV FP S W CO. Krazan & Associates, Inc. 6711 Sierra Court, Ste B Dublin, CA 94568 Tel: (925) 307-1160 Fax: (925) 307-1161 Exp: 2/6/2014 James Allen X X X James Benefeito X X X X Larry Borges X X X X X Ron Chandler X X Van DeMent X X X Gregory Fernald Matthew Fernald Lewis Franklin X X X X X X Ken Hafeli X X X X Andy Morris X X X X X Sidney Moss X X X X X Matt Romero X Gregory Ruf MatriScope Engineering Laboratories, Inc. 436 14th Street, Suite 1429 Oakland, CA 94612 Tel: (510) 763-3601 Fax: (510) 763-1388 Expires: 3/19/2012 Kevin Muser X X X X X Steven W. Russell X X X X Jack Sta ner X X X X X X Joe Varella X X X X Neil O. Anderson and Associates 50 Goldenland Ct., #100 Sacramento, CA 95834 Tel: (916) 928-4690 Fax: (916) 928-4697 Exp: 4/19/2012 Michael A. Cozad, ASc X X X X X Katie L. Demuth X X X X David C. Gray X X X X X Rollin Hall X X X X Jason Kort X X X Donald X George O as X X Colin Stock X X Roger T. Williams X X X X PacificlnterWest Bldg Consultants, Inc. 1600 South Main St, Suite 380 Walnut Creek, CA 94596 Tel: (925) 939-5500 Fax: (925) 939-9561 Expires: 9/6/2013 Doug Coe X PSI, Inc. 365 Victor Street, Suite C Salinas, CA 93907 Tel: (831) 757-3536 Fax: (831) 757-6265 Expires: 12/31/2010 Albert George X X X RC = Reinforced Concrete SS = Structural Steel WNeldingl8olting S = Soils PC = Pre-stressed/Post-tensioned Concrete FP = Spray -Applied Fireproofing WR/ = Wood SM = Structural Mason SNW1= Structural Weldinq CG = CalGreen Code SpeciallnspectionGist.doc revised 07106112 Agency Name, Address and expiration date Special [Inspectors Special pnspection Field RC PC SM SS SW I FP I S I ti#I I CO RES Engineers, Inc. 150 North Wiget Lane, Suite 204 Walnut Creek, CA 94598 Tel: (925) 932-4600 Fax: (925) 9324625 Exp: 3/19/2012 Michael A. Cozad, ASc X X X X X Katie L. Demuth X X X X David C. Gray X X X X X Rollin Hall X X X X Jason Kort X X X RMA Group of Northern California 6296 San Ignacio Ave., Suite A San Jose, CA 95119 Tel: (408) 362-4920 Fax: (408) 362-4926 Expires: 04/01 /2012 Maurice Alley X X Jeff Bosque X X X Greg Carr Joe Cecconi X Gordon Chinn X X X X Chris Francis X X Rich Geraghty X X X John Gillespie X X X X X Al Gundersen X X X Tiffany Haff Dottie Hughes X X X Jeff Sondrol X X X X Jacob Stocke X Pat Swain X Mike Tellesen X X Bill Tonkovich X X X X Chris Walters X X X X X X Adam Zeiher X Signet Testing Labs, Inc. 3121 Diablo Avenue Hayward, CA 94545 Tel: (510) 887-8484 Fax: (510) 783-4295 Expires: 8/4/2012 Garrett Baccus X X Robert Bigford X Paul Colby X X Bob Haynes Sr. X Willis Hughes X X X Fred Mangrum X X X Jeffery McPeek X X John Pagliero X X Rodger Patterson X X X X Robert Stalf X X X X X Doug Stark X X X X Pat Toschi X X X X X RC = Reinforced Concrete SS = Structural Steel Welding/Bolting S = Soils PC = Pre-stressed/Post-tensioned Concrete FP = Spray -Applied Fireproofing W= Wood SM = Structural Mason SW = Structural Welding CG = CalGreen Code SpeciallnspectionList.doc revised 07106112 Agency Name, Address and expiration date ��BeCiaO OP9S�DeC1�®PS Special lnspeCtion Meld RC PC SM SS SW FP S W CG Stevens Ferrone & Bailey 1470 Enea Circle, Suite 1551 Concord, CA 94520 Tel: (925) 688-1001 Fax: (925) 688-1005 Expires: 3/18/2012 Marty Babione X X X Scott Conner X X X X X X X Breit Fletcher X X X X X X X Richard Fletcher X X X X Matthew Minor X X X Tom Quinn X X X X Jay T. Wolfe X X X X X X X X George Yamaichi X Testing Engineers, Inc. 2811 Teagarden Street San Leandro, CA 94577 Tel: (510) 835-3142 Fax: (510) 834-3777 Expires: 11/02/2012 Mike Ardizonne X Eric Dixon X John Dougherty X X X X Jim Ganly Frank Hernandez X X X Jeff Messinger X X Bruce Muzika X X Rich Rose X X X Jason Souza X X Tom Speger X X X X X X Howard Stephenson X X X X X X Mike Tellesen X X Dennis Wertz X X X Brian Williams X Tim Woodbeck X X Tony Woodbeck X John Yoka X X X Valley Inspection, Inc. 326 Woodrow Ave. Vallejo, CA 94591-7302 Tel: (707) 552-7037 Fax: (707) 552-7022 Expires: 7/16/2012 Carroll Strickland X X RC = Reinforced Concrete SS = Structural Steel Welding/Bolting S = Soils PC = Pre-stressed/Post-tensioned Concrete FP = Spray -Applied Fireproofing W = Wood SM = Structural Wason SW = Structural Welding CG = Ca/Green Code revised 07106112 Saw dose 140 company F eel? 110 W. Taylor Street San Jose, CA 95110-2131 April 9, 2013 3 Karpakam Rajagopalan 21869 Gardenview Lane Cupertino, CA 95014 Reference: 21869 Gardenview Lane, Cupertino Dear Ms. Rajagopalan: San Jose Water Company Water Services Administration 1265 S. Bascom Ave., San Jose, CA 95128 Facsimile: 1 408 279-7889 Writer's Direct Dial: 1 408 279-7879 am," IE 1L V MTO-- APR 11 .-1-3 /1� 61(000& / The purpose of this letter is to inform you of the procedures you need to follow to finalize the installation of a new water service for this project, and to retire and abandon the existing service at this site. Basically, you will need to hire a contractor to perform the work to our standards and under our inspection. It is suggested, but not required, that you contact one of our general contractors to have the work performed. They are West Valley Construction at 408-371- 5510, and Lewis & Tibbitts at 408-925-0220. In any case, your contractor must possess a valid license for this type of work, and must obtain a permit from the City of Cupertino to do the job. Based on the data you supplied on our water service questionnaire, our Engineering Department has determined that a 1'/2" copper service with a check valve needs to be installed for this residence. The piping from the check valve/meter to the house should be 2" in size. By copy of this letter, we are informing the City of Cupertino of our determination, and I have enclosed our standard service drawing that details an approved installation. You also need to retire and abandon the existing service by disconnecting it at the water main in the street. The meter/check valve (service con section) defines the point at which you receive service, and the point where the owner's piping begins. The owner of the property is responsible for all piping and equipment past the check valve. Please note that in addition to the check valve in the meter box, you must also install a rubber seated single check valve (property of the owner) on the internal plumbing of the house. The location of the check valve must be where the fire sprinkler piping tees off from the domestic piping. Also, the water pressure in this area is over 80 PSI (approximate range at the meter will be 118 127 PSI). San Jose Water Company recommends that a pressure regulator be installed on private service lines that will prevent pressure in excess of 80 PSI from entering the structure. Please contact your plumberregarding this matter. Karpakam Rajagopalan April 9, 2013 Page Two If you would like to proceed with the work, please sign, date, and return this letter with a construction deposit as discussed below. Also include the address where the monthly billings should be sent. Monthly billings start when the meter is installed, and a copy of our rate schedule is enclosed for your information. You must also submit a deposit in the amount of $829 to cover the cost of our reviews, inspection, and the purchase and installation of the new meter and check valve. Please make your check payable to San Jose Water Company. At the appropriate time, you will need to provide our Construction Department at least one week notice for inspection services. Your contact is Nick Bernhardt, who can be reached at 1-408-279-7830. A San Jose Water Company inspector must witness the actual tap of the water main. Once the service lateral and meter box have been installed and approved, we can install the meter and check valve at your request. If you have any questions or require further information, please contact me at 1-408-279- 7879. WEF:dmk Enclosures gardenview.doc cc;,Wflding Department, City of Cupertino ACKNOWLEDGED AND AGREED Responsible Party Signature Print Name Date Sincerely, ORRIN& NEED o V Wanda E. Folk Water Services Representative MONTHLY LY BILLINGS TO. Name Address City Phone Number CUPERTINO PURPOSE: 2010 CALGREEN RESIDENTIAL CHECKLIST MANDATORY D EMS COMMUNITY DEVELOPMENT DEPARTMENT ^BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 o building6d�cupertinc.orq The 2010 CalGreen Code applies to all newly constructed hotels, motels, lodging houses, dwellings, dormitories, condominiums, shelters, congregate residences, employee housing, factory -built housing and other types of swellings with sleeping accommodations and new accessory buildings associated with such uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Project Address: s o-'04,` Poj e.�; —jcr 113 (� '2160q Cqarden+ti o ,fin. Cz4 oer-Ilno V Project Description: 4ai' Z Sow' hoL,ze J� �� C E C (0,1 � Instructions: i' 1. The Owner or the Owner's agent shall employ a,licensed• professional experienced with the 2010 California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design !Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 e Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements A4.1 PLANNING AND DESIGN Planning aridtiDesigrn '^ Situ Preservation Y t - 4.104.1 A site plan and inventory of the site is developed and used to minimize site disturbance in order preserve desirable existing natural resources and ®I J9 minimize future adverse effects on the proposed structure. Planning and Design Safe Development 4.106.2 A plan is developed and implemented to manage storm water XI 9 drainage during construction. 4.106.3 The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. Page 1 of 5 CalGreen_2010.doc revised 08127111 A4.5 ENVIRONMENTAL -:--- - Fireplaces 4.503.1 Install only a direct -vent sealed -combustion gas or sealed wood- ® n burning fireplace, or a sealed woodstove. hl'oflutant�Control ;- 4.504.1 Duct openings and other related air distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks shall be compliant with VOC and X� 1� Ill other toxic compound limits. 4.504.2.2 Paints, stains and other coatings shall be compliant with VOC limits. ® �I 4.504.2.3 Aerosol paints and other coatings shall be compliant with product FS weighted MIR Limits for ROC and other toxic compounds. 4.504.2.4 Documentation shall be provided to verify that compliant VOC limit finish materials have been used. 4.504.3 Carpet and carpet systems shall be compliant with VOC limits. 4.504.4 Fifty (50) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools (CHPS) Low -emitting Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Particleboard, medium density fiberboard (NIDF), and hardwood plywood used in interior finish systems shall comply with low formaldehyde FF emission standards. Interior Moisture Control 4.505.2 Vapor retarder and capillary break is installed at slab on grade foundations. 4.505.3 Moisture content of building materials used in wall and floor framing is checked before enclosure. Page 3 of 5 CalGreen_2010.doc revised 08127111 Project Name: Srr n�aj eLf// 3 Project Address: v,ew Lee Cu�or�/ 9SU��r Project Description: SEcnoN i - DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2010 California Green Building Standards Code as adopted by the q4kof Cupertino. Owner's Owner's Name (Please Print) Design P essional's Signature 5(A5?,e h C,4 64 Design Pro�.ssionai's Name (Please Print) --- - - Signat of License Professional responsible for CalGreen compliance ltik -c4eh Name of License Professional respo� ible for CalGreen compliance (Please Print) Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Date O`d Zo / Z Date O-o(Zb/IZ Date Phone Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2010 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen 2010.doc revised 08127111 rN STMEMEN u OF SPECIALS IIHS C mril0o ms26 9 COMMUNITY DEVELOPMENT DEPARTMEN ILDIING DIVISION ALBERT SALVADOR, P.E.,.C.B.O., BUILD , CUPERTINO 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-325 , - _>� (408) 777-3228 ^ FAX (408) 777-3333 - butilldin Iiger'U'no.or f1 .iY �,'r SITE I�6 ADDRESS 1 f i PG-Zn/N1�=t./ �/ Uft*-TtAlo 1 0� �� C�� BP# CC* Owner..$. .�!�.h.!!Pz",tam...mW....................... Contractor...................... \.J Address.-?-. LN1....... cl.fAA-1 1!>`mIt ✓............................................ Address........................................................................................................... City/St........ ..eo `�M.®......... Zip.... �.�. .......Phone.�.t0..-..iyly y�City/St....... ........ ......... ......................... Zip ................... Phone ................... ..... Applicant..... ............................. ................. Engineer/Architect.,,O; !�,e Address........................................................................................................... Address-72-4jl .-- RAI-PAyoy....'� ..0....................... City/St............................................. Zip ..... ...................... Phone ..................... City/St..��. . ....PR.;... ..............Zlp. Phonell7...:i0.7.. PROJECT DESCRIPTION: �o�c�, 4 04(34 -z- Sri lam` ( V�rf�� ca.A-co G-,C1 This "STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 ark 1705. This form is structured after and used by permission from the Structural Engineer Association of Northern California's (SEAON bilk statement of Special Inspections. Also, included with this form is the following: I ❑ "LIST OF SPECIAL INSPECTION AGENCIES (page 2). A list of testing agencies and other special inspectorglt� be retained to conduct the tests and inspections for this project �• ❑ "SCHEDULE OF SPECIAL INSPECTION" (page 3 - 6). The Schedule of Special Inspections summarizes th S Inspections and tests required. Special Inspectors will refer to the approved plans and specifications for Ii .gp coal -. inspection requirements. Any additional tests and inspections required by the approved plans and specif a10-shaC�alsd be performed. Special Inspections and Testing will be performed in accordance with the approved plans and specifications, this sta�& an�£BG� Sections 1704, 1705, 1706, 1707, and 1708. Interim reports will be submitted to the Building Official and the Registen._:+% Professional in Responsible Charge in accordance with CBC Section 1704.1.2. 5177 A Final Report of Special Inspections documenting required Special Inspections, testing and correction of any discre io�io in`/%- the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy (Section 1704.1.2). The F� document: � P • Required special inspections. Fri ` • Correction of discrepancies noted in inspections. 00{ The Owner recognizes his or her obligation to ensure that the construction complies with the approved permit docu4�1'dta%; implement this program of special inspections. In partial fulfillment of these obligations, the Owner will retain and directly pifot°t Special Inspections as required in CBC Section 1704.1.,E �= This plan has been developed with the understanding that the Building Official will: • Review and approve the qualifications of the Special Inspectors who will perform the inspections. • Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are perPlfrr ing hheir duties as called for in this Statement of Special Inspection. • Review submitted inspection reports. • Perform inspections as required by the local building code. I have read and a ree to comply with the terms and conditions of this statement Prepared By: Project J Engineer ❑ Architect gl Registered Design Professional in Charge Si nature ................... ................. Lic.# .. .lP��? 1.. ........... Date:. Y/.. �.."...... Owner S' %11+8� ✓ tWW8AMhWt Owner's Authorization Si nature ...........:.. ............................................... Lic.#....................................... Date:. .. (.... Inspection Agency // Inspector Name: Signature '--- �p Buil 'R fficial or designe Signature ...... .. ...................Lic.# ....C:7�..C.�9 .... r,cc�� Date:....... �V..!..�. Aa-04oL�;, SpecialnspectionForm_2012.doe revised 07109112 LIST OO F SPECIAL NSPEC OO AGE C ES 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 agencies that will be retained to conduct tests and inspection on this project: EXPERTISE FIRM I INSPECTOR INFORMATION 1. Special Inspection (except for geotechnical) Firm.........GV.......................................Addr..tj. 4�� $g �6�....� ..... C1 ��.:................ City��...................................................................... State.."............. ....... Zip ..�5193 ... Telephone..'Y. -TkX f ... Fax.'Y0.W3 'X.-.8.�......... Emai1611W .. 1 .a3`r'! q..CO 2. Material Testing Firm......... V.......................................................... Addr........... P........................................................................... City............. ��.......................................................................................... State ..... '................Zip ....................... Telephone......................................Fax............................................ Email ..........'.I.............................................. 3. Geotechnical Inspections Firm................................................Addr..*?0 ...... f��......K.1............................................ city.................................................................................. State ... C4............ Zip .9i!� 11$ . Telephone.6091 .`11�6 Fax .... C��'� �. 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: 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: 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 07109112 SCHEDULE OF SPEML NSPECTMH SITE ADDRESS Z(� (� PROJECT DESCRIPTION: Notation Used 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 ASTIM 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 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 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 07109112 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 --- ❑ 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 --- ❑ 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 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. --- X 6. Inspection of steel frame joints details for compliance.- 0 Details such as bracing and stiffening. --- X --- 1704.3.2 ❑ Member locations. --- X ❑ Application of joint details at each connection. -- X VERIFICATION AND INSPECTION C 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 SpecialnspectionForm_2012.doc revised 07109112 VERIFICATION AND INSPECTION C P REFERENCED IBC STANDARD IREFERENCE 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. 1904.2.2,1913.2, --- X ACI 318: 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. ❑ Bolts Installed in Existing Masonry or Concrete ❑ Direct tension testing of existing anchors. --- X See ICC ES Reports form special inspection requirements for proprietary ❑ Direct tension testing of new bolts. -- X ❑ Torque testing of new bolts. ___ X products ❑ Prequalification test for bolts and other types of X anchors. _- 14. ❑ Other: SpecialnspectionForm 2012.doc revised 07109112 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 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 FAAc 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.3.36 ❑ Location of reinforcement, connectors, x ___ ___ Art. 3.4, 3.6A prestressing tendons, and anchorages. ❑ Prestressing technique. --- x --- -- Art. 3.68 ❑ Grade and size of prestressing tendons and --- x "- --- Art. 2.4B, 2.4Fi anchorages. 5. During construction the inspection program shall verify: ❑ Size and location of structural elements. --- x --- --- Art. 3.31F ❑ 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. 3.66 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. SpecialnspecdonForm_2012.doc revised 07109112 REFERENCE FOR CRITERIA VERIFICATION ARID 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 f m and f nac prior to construction and for every 5,000 square feet during --- x --- --- Art. 1 AB 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. 3.21D ❑ 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, 1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing x _ _ ___ ___ Art. 3.613 force. 6. ❑ 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 07109112 VERIFICATION ARID INSPECTION C p REFERENCED IBC STANDARD IREFERENCE 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 ARID 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 ARID INSPECTION OF DEEP DRIVEL 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 07109112 VERIFICATION AND INSPECTION C P REFERENCED IBC STANDARD 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 application. --- X ❑ Verify ventilation of area during and after application. --- X 2. ❑ Measure average thickness per ASTM E605 and Section 1704.12.4. --- --- --- 1704.12.1 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] SpecialnspeclionForm_2012.doc revised 07109112 VERIFICATION AND INSPECTION C p REFERENCED IBC STANDARD IREFERENCE 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. ❑ Inspection of screw attachments, bolting, anchoring, and other fastening of components within the main --- 1706.3 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. --- K SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE 1. ❑ Special inspection for welding in accordance with the _ _ 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 of components within the seismic -force -resisting 1707.3 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 1707A system. SpecialnspectionForm_2011.doc revised 07109112 ❑ 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.E ❑ 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 07109112