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15030084CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21815 LOMITA AVE CONTRACTOR: K & M DEVELOPMENT PERMIT NO: 15030084 INC OWNER'S NAME: 21815 LOMITA AVE LLC 20874 HANFORD DR DATE ISSUED: 07/02/2015 OWNER'S PHONE: 4083905127 CUPERTINO, CA 95014 PHONE NO: (408) 390-5127 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT (N) TWO STORY RESIDENCE (3889 SQ FT); License Class Lic. # 7../"/ �'l� GARAGE (454 SQ FT); COVERED PORCH (448 SQ FT). Contractor wylG0ate 2 �� I hereby affirm that I am licensed un er the provisions ofthapter 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 Sq. Ft Floor Area: Valuation: `6700000 performance of the work for which this permit is issued. ave 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 APN Number: 35716061.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Z RE -ROOFS: re Date 1 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. ❑ OW - UI DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Z �S permit is issued. Owner or authorized Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO UfNEW CONSTRUCTION / -I Z) 3 elz? � CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin cu ertinO.0r [71 ADDITION El ALTERATION r TI ❑ REVISION4E 0, ED ORIGINAL PERMIT 4 PROJECT ADDRESS 2W015- �(J /_ V15L I� e&2 Z AP— "bl 6&16 OWNER NAME ,04 A16' PHONE 4 0 . 37 o. S/ L 17 E-1LAIL 7,aa• / . ex STREET � DRESS dhl�ia' J,0N �� T� LJ CITY, STATE, ZIP /� J CONTACT NAME .},//7 or PHONE b /� E \\ ' �- aK e STREETADDRESS% 5, CII E. ZIP v 0/ FAX ❑ OWNER ❑ O%VNER-BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM LICENS NL' HF s/L� / LICENSE TYPE BUS LIC 0 GJ COMA Y N. MF �' �%NL• N' G E-MAIL ,.,1 en o f h e- s.�a. wM FAX ��IF 253 ig STR .ADDRI:S Zoe �24��' � W,?. CITY, STATE. �ZIP /,� C� '� PHONE ARCHITECT'ENGI EER NAME LICENSE \t 111if R BUS LI b COMPANYNA411- E-MAIL • FA." STREET ADDRES CITI".STATE,71P PHONE 6 • � DESCRIPTION OF WORK b v J JAPL EXISTING USE PROPOSED USE CONSTR. S TYPE • k STORIES +f fi CSE TYPE OCC. SQ.FT. VALUATION 1S1 EXISTG AREA NEW FLOOR DEMO TOTAL AREA Y:r4 AREA NET AREA C _: �)� BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA (-7A (�!.'• � V 1321 Tyj PORCH :1R[A DECK AREA TOTAL DECK PORCH AREA GARAGE ARL - A DETACHl ATTACH S 6 v G a DWELLING UNITS IS A SECOND l'Nrr F] YES SECOND STORI ❑l'ES IBEING ADDED' QI NO ADDITION? X0 PRE -APPLICATION XYES IF YES, PROVIDE COPY OF PLANNING x NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME.' NO RECEIVED TOTAL VALUATION: .APPL -;O62,6200,, By my signature below, 1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is rrect. 14Ve read the Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating to buildin on ction. I uthorize representatives of Cupertino to enter the above -identified pro for inspection purposes. Signature of Applicant/Agent: Date'. • I Z — SUPPLEMENTAL INFORMATION REQUIRE PLAN CHECK nPE ROLMNG SLIP ❑ OVER -THE COI hTER sUn DCVI 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 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 ❑ submittal of Building Permit application. SLAJOR SANITARV SEWER DISTRICT ENVIRONMENTAL HEALTH BldgApp_201 Ldoe revised 06 2111 4) CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 21815 Lomita Ave DATE: 03/12/2015 REVIEWED BY: Sean PC FEE ID APN: BP#: '5Q,3 00� 'VALUATION: $700,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: P 2nd Unit? Yes •` No�ENTAMAYTPION 1R3SFDW RMIT TE: WORKConstruct two storyresidence 3889 s ft Gara a 454 s ft ; Covered Porch 448 s ft . SCOPE Suppl. Insp. Fee -.(F) Reg. Q OT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 4,791 $3,334.84 IR3PLNCK $3,976.44 IR3INSP Permit Fee: $3,976.44 Suppl. Insp. Fee -.(F) Reg. Q OT ro.0 I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # new units $670.76 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: 4,791 $3,334.84 1'rm,el Documeniation Fees: $3,976.44 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. rianning, ruauc morns, Elf V, 0u1191uiy UGrvG .mow».. y c __ _a _ .i _ r. « , :»! ..,,ni;n» a n.blo and are only an estimate. Contact the Dept for addn 7 info. District, e[a . mese fees ure ouseu on u r rvil-1112u. FEE ITEMS (Fee Resolution 11-053 Eff.� 7%7:73) ....------ FEE Plrurrh. Plan Check Elec. Plan Check Plan Check Fee: Plumb. Permit Fe,, Elec. Perrnir Fee- 01h(21.11cch. lrrsp )Hier Plumb Inst, Other Elec. Insp. El 7- r LlecJ� -nsp. Fee. Plumb. lus. l -c_,. ]� l7�c. Inst, /, " Permit Fee: $3,976.44 NOTE: This estimate does not include fees due to other Departments (i.e. rianning, ruauc morns, Elf V, 0u1191uiy UGrvG .mow».. y c __ _a _ .i _ r. « , :»! ..,,ni;n» a n.blo and are only an estimate. Contact the Dept for addn 7 info. District, e[a . mese fees ure ouseu on u r rvil-1112u. FEE ITEMS (Fee Resolution 11-053 Eff.� 7%7:73) ....------ FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,334.84 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,976.44 Suppl. Insp. Fee -.(F) Reg. Q OT ro.0 I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # new units $670.76 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $670.74 Select a Non -Residential Building or Structure 0 1'rm,el Documeniation Fees: Strong Motion Fee: IBSEISMICR $91.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $28.00 SUBTOTALS: $8,771.781 $0.00 TOTAL FEE: 1 $8,771.78 Revised: 02/14/ZU1 b CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fac: 405-777-3333 JOB ADDRESS: Zlel— 6 PERMIT # /Spm OQtf OWNER'S NAME: /S PHONE # �&'• ©. 5/Z GENERAL CONTRACTOR BUSINESS LICENSE # Z ZZ ADDRESS: Za o - G C ,e 4 ,49 Z2 CITY/ZIPCODE: So/ *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date wner actor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork33 Cement Finishing ElectricalZ 2 ZOO - Excavation I/�✓/d?1LaC �� �'1y��� Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating /--W IVV4C SZ;;e ✓ _ '?-tee:5 Insulation J0344 -z5. Landscaping 244,30 Lathing Masonry Painting/ Wallpaper �r �/L Z 6 /!� Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rockl &Z-Z� pZJ Tile wner actor Signature Date CUPERTINO PURPOSE UTILITY RELEASE REQUEST FORM 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 • bulldinaAgypertino.org For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building, INSTRUCTIONS 1. Download this format: http://www.cupertino.org/index.aspx?pa eg X97. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 buildin�,na,,cupertino,org 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (##404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN BLDG I RMS DATE: 4 r SITE �1 ADDFZESS: e?I IS Z-40 "Y /� 14ye_2/411r OWNER'S NAME: PHONE #: 390 S/Z1 Z/e'l.S LL_G FAX MAILING ADDRESS (if different from site address): �a� . f ia� �..,o 609 CONTRACTOR: PHONE #; FAX #: CONTACT: PHONE #: �j 2 FAX M I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move Into the residence until they receive all of the required final sign -offs and the City has issued a certificate of occupancy for the building. Owner:... /........... Date:...... .... .................Print:...../,.t.�.�......�..J.�...................... ... ..�. Contractor...............�..�-� ......_.....................Print:......'�i�.........................Dete:.�I...;l...�. UtilityReleaseForm_2011.doc revised 08/09111 CUPERTINO 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 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCr-cuoertino.org SITE ADDRESS SE 2672 04/07/15 APN o 5 2 - /6 - 016 BP# Owner.r?!'U ...... Z.4 .................I... Contractor................................................................., ..................................... Address ..Zr.. .................. Address ................................................ /!y ....................... Zi � 3�tI S/Z; hone........:......... City/St ................................................. Zip ................... Phone ........................ Applicant..���.....:.. ...................................................... Signature ............ .......................................... Lic.# ........:...:. s............. .. Date:... `... .... Engineer/Architect .... Y YU-.Jar-0.1en ................................................... Address !'c !;�' `l....�. .................... Address.. 40660- Robin. Stret................................................................. City/StC/y Zip.. .....Phone �.... ......./City/St ... Fremont........................ Zi .X43.... Phone 51.06870939 PROJECT DESCRIPTION: New Single Family House 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 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 will perform the inspections. • Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties as called for in this Statement of Special Inspection. • Review submitted inspection reports. • Perform inspections as required by the local building code. l have read and agree to comply with the terms and conditions of this statement Prepared By: Project R Engineer O Architect-- SE 2672 04/07/15 Registered Design Professional in Charge Signature ......'.......................................................... Lic.#....................................... Date:.......................... Owner Name: Owner's Authorization Signature ..... - ......................................................I.................. Date:........................ Inspection Agency / Inspector Name: .. — �vi�G' C Y�ir %✓+1L' 1=�G L`7� �J Signature ............ .......................................... Lic.# ........:...:. s............. .. Date:... `... .... Building Official or designee: Signature.................................................................................................................... Date:.......................... 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 s ecial inspection agencies that will be retained to conduct tests and inspection on thisproject: EXPERTISE FIRM / INSPECTOR INFORMATION 1. Special Inspection (except for Firm ........ C.C' �.�... 2° • f � • ;,�,..4.........Addy.......'.........,... �_ �� � �. • ........ .�.�...... ....�& geotechnical) Ci ...... city ................................................. �z �zt............................. ... State ..�:...� �.. ...........Zi ? p ... ,�,5... Telephone...................................... Fax ............................................ Email......................................................... 2. Material Testing Firm............................................... . Addr...........f ....,.. -........................................ CS&I.....................Zip . City................................................. r1 ................................ 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: Inspect structural shear walls and SIMPSON strong walls. The extent of the seismic -force -resisting system is defined in more detail in the construction documents. WIND REQUIREMENTS i5ection 1705.4.1 Description of main wind -force -resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: The extent of the main wind -force -resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm_2012.doc revised 09/06/12 SCHEDULE OF SPECIAL INSPECTION SITE APN BP# ADDRESS 21815 Lomita Ave. Cupertino 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 STANDl IBC REFERENCE ARD I 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. 1704.3.3 Section M2.5 ❑ 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 09106112 CUPERTINO 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 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building0cupertino.org P Pr, T17Vn SIZE SITEADDRESS APN / � 17 - / , ` c / �.� CJ Owner... i / f Gar: i%' �yF ��t ......�J �. ............... Contractor.....i....................................... ......................... . �.%.�./......'.........�...'.. ...o......... Address..�......................... dress .......a ............................................................................................. City/.../St...b......Zip.iL . Z)City/St.......... .................................. . Zip...................Phone......................... •i� �° f-` Applicant .... / ..... ....................... Eng ineer/Architect .... Y.u:J ar..Ghen................................................... Address ....... ...... .' 7`r' ... 't,��Lc . ....``:................................. Address ..40f60 Robin. Street........................................................ city/St.................. .................... Zip ............... ........... Phone ....... ............ Ci5106870939 ty/St...Fr•®rraor�t ........................Zip �45�$.... Phone .................... PR®,76�CT ®(eSCRIP`t°M: New Single Family House 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: 0 Required special inspections. m Correction of discrepancies noted in inspections. 49% rM 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 will perform the inspections. a Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties as called for in this Statement of Special Inspection. • Review submitted inspection reports. ® Perform inspections as required by the local building code. / have read and agree to comoly with the terms and conditions of this statement Prepared By: Project Engineer ❑ Architect p Registered Design Professional in Charge Signature ......'..:........................................................... SE 2672 04/07/15 Lic.#....................................... Date:.......................... Owner Name: — �... Owner's Authorization Signature ...............<' S ...................................... Date:...... Inspection Agency / Inspector Name: C'�'►�-'l`� �%I(��221?i.,fL-' �+�G / Signature ..............:... .....� ....... .......Lic.#....�:...7..:�./..C.,..........Date:..�f.�.�1./. ..... Building Official or designee: sinature ..... . .............................................................................. Date:. T..5...... SpeeialnspectionForm_2012.doe revised 09/06112 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 vroiect: EXPERTISE FIRM I INSPECTOR INFORMATION • 1. Special Inspection (except for geotechnical) Firm......................Addr....y�.,r..{.......1,. v ................................. F.T.II Slate �/ �........Z...iPTelephone ...................................... Fax ............................................ Email.......... ....... 2. Material Testing Firm .....................................................................Addr......................................................................................... Cltr.................................... I........... t.t......... ....../.. :.s.L!.$tate .......................Zip ...................... Telephone.......................................Fax............................................ Email......................................................... 3. Geotechnical Inspections Fhm......................................................................Wr......................................................................................... city.......................................................................................................... State ......................Zip ..................... Telephone...................................... Fax ........................... ................. Email ......................................................... 4. Other: Firm .....................................................................Addr......................................................................................... City.......................................................................................................... state .......................Zip ...................... Telephone................ ...................... Fax ............................................ Emall......................................................... *AEI 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: Inspect structural shear walls and SIMPSON strong walls. The extent of the seismic -force -resisting system is defined in more detail in the construction documents. WIND REQUIREMENTS fSection 9705.4.1 Description of main wind -force -resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: The extent of the main wind -force -resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm_2012.doc revised 09/06/12 SATE ADDRESS 21815 Lorr 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. Dox 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. VERIFICAT(1OW AND USPECTI®HC I P REFERENCEDDARD I IraC REFER MCE I IHSPECTION OF FABRICATORS I 1. ❑ Inspect fabricator's fabrication and quality controlI I w 1704.3 procedures. IHSPECTIOM 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 procedures. --- X — _- 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. 1704.3.3 Section M2.5 ❑ 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 09/06/12 VERIFICATION AND INSPECT110K C P GREFERENCED STANDARD IBC REFERENCE 4. Material verification of weld filler materials: ❑ Identification marking to conform to AWS specification in the approved construction documents. -- X AISC 360, Section A3.5 and applicable AWS A5 documents 1704.3 ❑ Manufacturer's certificate of compliance required. --- X --- --- 5. Inspection of welding: a. Structural steel and cold -formed steel deck: ❑ 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: ❑ 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 09/06/12 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 products ❑ Direct tension testing of new bolts. --- X ❑ Torque testing of new bolts. ___ X ❑ Prequalification test for bolts and other types of - X anchors. 14. ❑ Other: SpecialnspectionForm_2012.doe revised 09/06112 SpecialnspectionForm 2012.doc revised 09/06/12 REFERENCE FOR CRITERIA --- VERIFICATION AND INSPECTION C P IBC TICS 4021ACI TRnS 4021ACI SECTION 5301ASCIE 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 fn, and f AAc prior to construction -__ X __ ___ Art. 1.48 except where specifically exempted by this code. 3. ❑ Verification of slump flow and VSI as delivered to X --_ ___ __ Art. 1.58.1.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 prestressing tendons, and anchorages. --- __ __ Art. 3.4, 3.6A ❑ Prestressing technique. --- X -- -- Art. 3.68 ❑ Grade and size of prestressing tendons and anchorages. --_ X _ __- Art. 2.413, 2.4H 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 other details of anchorage of masonry to -- X Sec. 1.2.2(e), _ structural members, frames or other construction. 1.16.1 ❑ 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 force. --_ __ __ Art. 3.613 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 prestressing tendons and anchorages. --_ ___ Sec. 1.3 Art. 3.4 ❑ Proportions of site -prepared grout and prestressing grout for bonded tendons. _-- X ___ __ Art. 2.613 ❑ Construction of mortar joints. --- X --- -- Art. 3.313 7. Grout placement: ❑ Grout placement shall be verified ensure compliance. X --- __ __ Art. 3.5 ❑ Observe grouting of prestressing bonded tendons. X --- ___ ___ Art 3.6C SpecialnspectionForm 2012.doc revised 09/06/12 - - REFEREKPCE FOR CR7ERA----- VERIFICATI®N AND UiSPECTION C P Bc TI`S 402/ACI THS402/ACI SECTION 630/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 fm and f„Ac prior to construction and for every 5,000 square feet during --- x --- --- Art. 1.48 construction. 3. ❑ Verification of proportions of materials in premixed or preblended mortar and grout as --- x --- --- Art. 1.51B delivered to the site. 4. ❑ Verification of slump flow and VSI as delivered to the site for self consolidating rout. X --- __- __ Art. 1.5B.1.b.3 5. The following shall be verified to ensure compliance: ❑ Proportions of site -prepared mortar, grout, and X prestressing grout for bonded tendons. -_- __ _-_ Art. 2.6A ❑ Placement of masonry units and construction of mortar joints. --- -- --- Art. 3.3B ❑ Placement of reinforcement, connectors and prestressing tendons and anchorages. --- X __ Sec. 1.15 Art. 3.4, 3.6A ❑ Grout space prior to grouting. X --- --- --- Art. 3.2D ❑ Placement of grout. x --- — -- Art. 3.5 ❑ 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 force. --_ _ ___ Art. 3.6B 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 09106111 VEMFICATMN AMD INSPECTION, C P RE�EC I_t�CE© ICAC STb�NDACD IEFERENCE INSPECTION OF WOOD 1. P 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, --- El 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 achieve the desired bearing capacity. -"" X 2. ❑ Verify excavations are extended to proper depth and have reached proper material. X 3. ❑ Perform classification and testing of compacted fill materials. --- X -- 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 additional load tests, as required. X "- 3. ❑ Observe driving operations and maintain complete and accurate records for each element. X "- 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. SpecialnspectionFonn 2012.doc revised 09/06/12 VERIFICATION AND 1NSIPECTi COR C p REFERENCED STANDARD 119C REFERENCE 7. ❑ For specialty piles, perform additional inspections as determined by the registered design professional in --- -- --- Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTON 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 Lconcrete 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, TXT__ __ 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 09/06/12 VERIFICATION AND INSPECTIONC P REFER�.C�Cfo® IEC SiAND R® 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 WIN® 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. --- 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. 7 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 _T ❑ Welding of elements of the seismic -force -resisting _ 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 equipment. X ❑ 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 hazardous materials. X ❑ 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 qualified. _ 1708.4 12. ❑ Obtain system tests as required by ASCE 7 Section 17.8. --- -- --- 1708.5 SpecialnspectionForm_2012.doc revised 09/06/12