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14040181CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10411 BUBB RD CONTRACTOR: SC BUILDERS INC PERMIT NO: 14040181 OWNER'S NAME: M WEST PROPCO It LLC 910 THOMPSON PL DATE ISSUED: 04/30/2014 OWNER'S PHONE: 4084503854 SUNNYVALE, CA 94085 PHONE NO: (408)328 -0688 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class_ Lic. # _7160 APPLE T.I. - VOLUNTARY SEISMIC UPGRADE Contractor ��(�v(// S GNC. Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 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: $120000 erformance of the work for which this permit is issued. ve and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 35720010.10411 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 �R1VI UANCE 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 F LAST C INSPECTION. indemnify and keep harmless the City of Cupertino ag st liabilities, judgments, costs, and expenses which may accrue against said in consequence of the Y� granting of this pe it. Additionally applica nderstands and will comply Is y: Date: with all non -p 'nt oorce regulatio r the C rtino Code, Section 9.18. ROOFS: Signature Date 30 14 All roofs shall be inspected prior to any roofing material being installed. If a roof is any r installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER- BUILDER 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 carder penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self- insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the B Area Air Quality nagement District I performance of the work for which this permit is issued. will maintain compliance with the C pertino at e, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sect' n 5505,25 , and 4. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: ate: 4/3a 1 permit is issued. 1 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, 1 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 I certify that l 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 [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 CUPIERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 e FAX (408) 777 -3333 • buildingQcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS AIN # / Q q 1 ) OWNER NAME sl� �1 e�S-P �cp - Z t_c.c PHONE its 3$54 7&CQZ MAIL v2 t' e1.1W_ F- ¢o STREET ADDRESS CITY, STATE, ZIP FAX 3351 OLLM C "IET CA Go V CONTACT NAME PHONE E -MAIL ^ Qe-g uQ� 6TO.l069 S4$1b 11.SiFK$)IIG GOf1 STREET ADDRESS CITY, STATE, ZIP FAX Cf1PS01A Lti Sula -A V Le CA 9y ❑ OwiTR ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # -I Vi kal S 0� 4 O COMPANY NAME EMAIL (41EotZA , FAX . Ou GIB STREET ADDRESS Tito n1oAf) k CITY, STATE, ZIP ,AA ,J nLe- CA, qA0 PHONTEu65' ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # S� sya,a COMPANY NAME E -MAIL FAX 1=5MfE: Ld AVE SuADE 7t °tiJSTQ�ICIV R!'IL . C4(1 STREET ADDRESS CITY, STATE, ZIP PHONE x'15 %2 SA.� 4��'.� 4, Mo — S[fL�11� r 3°t`i .W0 3 DESCRIPTION OF WORK 0♦i.>JPAIA a��S�l C U 9� Tc� 1�0 1LL� N G I � EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA RFN40DEL AREA PORCH AREA DECK AREA TOTAL DECK /PORCH AREA GARAGE AREA: DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT [] YES SECOND STORY []YES BEING ADDED? []NO ADDITION." []NO PRE - APPLICATION YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES E3G TOTAL VALUATION: PLANNTNGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLERHOME4 [3 NO By my signature below, I certify to each of the following: 1 am the property owme orized a ct roperty owner's behalf. I have read application and the information I have provided is correct. I have read the Description of Work and ver it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ilding c uthorize representatives of Cupertino to enter the above- identified property for inspection purposes. Signature of Applicant/Agent: Date: a99- L P& � �7d 14 SUPPLEMENTALINF ATI QUIRED M0ocx cs �,yUu.ROpTn TrGw;, , New SFD or Multifamily dwellings: Apply for demolition ennit for Y g PP Y p I�'OVERTHECOUNTERr ° z ' L' �€' � � BUII -DING existing building(s). Demolition permit is required prior to issuance of building r k PLAN RED IEw t, - Penn it for new building. '; ,EXPRESS, -,5+ Commercial Bldgs: Provide Hazardous Materials Disclosure cT '�� _ � w � -: * a completed Lv ST-XND Rn Y° eflI PUBLlc�voxrzs � form if any Hazardous Materials are being used as part of this project. ? K rt 3 mow -1 al v _ Copy of Planning Approval Letter or Meeting With Planning prior to'r4Aa X�i sn�rTR�S�xY sE i DisTiucr submittal of Building Permit application. • B1dgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING ]DIVISION .. ADDRESS: 10411 BUBB RD DATE: 04128120/4 REVIEWED BY: MELISSA � . r APN: 357 20 010.10411 BP #: I Q VQl ''VALUATION: $120,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building PME Plan Check: PENTAMATION PERMIT TYPE: 1GENC0 WORK APPLE T.I. - VOLUNTARY SEISMIC UPGRADES SCOPE Suppl. Insp. Fee:t) Reg. Q OT 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 nrelintinary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eli 7,-1!13) FEE P1 Ib. PlrM Chrc A Elec. Man Chcck Plan Check Fee: Hourly Only? 0 Yes (D No $0.00 i:lc( Permit Fee, Suppl. PC Fee: E) Reg. Q OT LLJ Other• El. t. My. $0.00 PME Plan Check: Insp. Fec- 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 nrelintinary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eli 7,-1!13) FEE QTY/FEE 1M[ISC ITI'E1M[S Plan Check Fee: Hourly Only? 0 Yes (D No $0.00 0 hours Plan Check, Hourly $278.00 1STPLNCK Suppl. PC Fee: E) Reg. Q OT LLJ hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ® Yes (E) No $0.00 Suppl. Insp. Fee:t) Reg. Q OT LO ,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Fec Work Without Permit? C) Yes C) No $0.00 Advanced Plannin& Fee: $0.00 Select a Non - Residential Building or Structure Strong Motion Fee: 1BSEISMICO $25.20 2.0 hrs Inspections $278.00 1STINSP Inspection, Hourly Bldg Stds Commission Fee: 1BCBSC $5.00 SUBTOTALS: $30.20 $556.00 TOTAL ]FEE: 1 $586.20 Revised: 04/01/2014 C� �SS.1ys< rjqK.f T INOO CONTRACTOR / SUBCONTRACTOR OR ILIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408-777-3333 •i /1' j I 1 • 1' 1 : of GENERAL CONTRACTOR: c �� ' US1NESS LICENSE # - V3 1101 IN *Our municipal] code requires aIDl businesses working in the City to have a City of Cupertino business license. NO BUILDING ]FINAL OR FINAL OCCUPANCY INSPECT (S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND AL S BCONT TO AVE OBTAINED A CITY OF CUPIERTI NO BUSINESS LICENSE. II am not using any subcontractors. Signature Date Mease check appfficabRe subcontractors and complete the following information: c� Owner / Contractor Signature Date SUBCONTRACTOR BUSJ NESS NAME BUSINESS INESS LIICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date STATEMENT OF SPECIAL. INSPECTIONS, 20-13 CSC COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 550143255 CUPEFtTfhtfl (408) 777.3228 • FAX (408) 777 -3333 • building- 2cupertino.ora \1014.) AJTAA-Y S q5w1c uP /0s¢" o SITE 10411 Bubb Road APN 33,15 ADDRESS Signature .... .................................... ....... Owner.....t�1...�!.�.5�.. P-4, °....�..,. LLB ................ ............................... Contractor......G.. ? �tpi2.9..�.Z!k,................ Address ... 33.57.t D�Co ',S �¢ tE: ...................... ............................... Address....C11o? a .PS41?... . ............................... ........................ Zip.. S f a �....... Phone .1. .50: '1 .... ............... Zip! S ... Phone . ,,� �, Applicant.... G.. �...... t? �.... ....�t........................................................... SW Structural, Inc. Engineer / Architect..............................................- ... ...... ..................... Address.....�ito. Mon pSo�.... C- ...................... ............................... . ................ Addres07582 San Benito WaY... ............................... City /St...` ....... Zivo,. `.0.55......... PhoneSs;04!4�er.... Monte Sereno, CA 95Q3Q 408.3°9.0623 City /St....., Zip...... Phone �%� "' ... .......................... . .................... PROJECT DESCRIPTION: Tenant Improvement Of existing Single story tijt-up building. 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 Associalion of Northern Califcmia's (SEAONC) mode statement of Special Ins included with this form is the following: ` ❑ "L I . TION AGENCIES (page 2). A list of testing agencies and other special in pe ors that will be i re t t nd inspections for this project J ❑ "S _ SPECTIOtJ" (page 3 — 6). The Schedule of Specia{ Inspections sum �c the i I l Inspe SlYrf %d& wired. Special Inspectors will refer to the approved plans and specifications for de l d spe )) inspecf Any additional tests and inspections required by the approved plans and specificatr� s st%at afse be perfl U �j Special Inspectionfl if ng will be performed in accordance with the approved plans and specifications, this statement and C G Sections 1704, 171017 E t 704 -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 r edd Special Inspectionstesti n t y discrepancies noted in the inspections shall be submitted prior to issuance o� iii VW The Final Report will document: Required special inspections. J Correction of discrepancies noted in inspecti - The Owner recognizes his or her obligation to ensure that the constfuctioti'complies with the approved permit d . d implement this program of special inspections. In partial fulfillment of these obligations, the Owner will reta' r the Special Inspections as required in CBC Section 1704, 1. (t,� 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 inspectior4 • Monitor special inspection activities on the job site to assure that the Special Inspectors are quaTi ed and are 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 earee to cortwly with the terms and conditions of thi.a statement eir 0� Prepared By: Architect Project Id Engineer ❑ Architect /........... Registered Design professional in Charge Signature .... .................................... ....... , Exp 6130114 Lic.4 _._ ....... .. ..... ..... Cate : ............................ Owner Name- �wner s Au hanzation // Signature ,....... ,. / ............ ! ` .............- '.......�........ t . lJ r� L O Y G ��jj Date:.'"1.......... �• �. .. Inspection Agency/ Inspector Name: Srr.rk�,- Cry -+C (Z JF �%� "' (% h.� /l'/C. ✓rcAi «Gldl= Si nature..... Building Official or designee:/ ',' l� l Signature .............. 11""3- .......... ........... ............................... Date:. ..�.. Spec-MInspectiunFa"rn_20l2.doc revised 09106-72 L S OF SF"ECIA�_ J"PFc T � 7N AGE JCIES 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 agencies that will be retained to conduct tests and inspection on this project: *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) Descriptions of seismic-force-resisting system and designated s�+eismic systems subject to special inspections as per Section 1705.3: — 'Pef I to k P W 411 -he's / — C.-OA n w,'/y Hes — M- e .1 e.'au-'na4. The extent of the seismic - force - resisting system is defined in more detail in the construction documents. WIND REQUIREMENTS Section 1705.4.1 Description of main wind- force - resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: The extent of the main wind - force - resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm_1011.doc remised 09106111 EXPERTISE FIRM / INSPECTOR INFORMATION * 1. Special Inspection (except for geotechnical) Firm, 64...... q��, ....................... City..,. �� ? Addr...RA. ....0.��A17-bJ4-- ............................... .....�E.� State ..C-, .............Zip ,........................ .. ...0 .. ....................... Telephone.C1k9Y ...3� Fax .................. ..........................Email b !�.0? ....... 2. Material Testing Firm ..................................................................... Addr.......................................................... ............................... City........................................................................... ............................... State .......................Zip ...................... Telephone........ ............................... Fax............. ............................... Email. ............................... 3. Geotechnical Inspections Firm ..................................................................... Addr.......................................................... ............................... City........................................................................... ............................... State .......................Zip ............... I...... Telephone ....... ............................... Fax............. ............................... Email ............................ ............................. 4. Other: Firm ..................................................................... Addr .............................. ............................. ............................... City........................................................................... ............................... State .......................Zip ...... I............... 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) Descriptions of seismic-force-resisting system and designated s�+eismic systems subject to special inspections as per Section 1705.3: — 'Pef I to k P W 411 -he's / — C.-OA n w,'/y Hes — M- e .1 e.'au-'na4. The extent of the seismic - force - resisting system is defined in more detail in the construction documents. WIND REQUIREMENTS Section 1705.4.1 Description of main wind- force - resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: The extent of the main wind - force - resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm_1011.doc remised 09106111 SCHEDULE OF SPECIAL INSPECTION SITE ADDRESS (��(l 5,66 �. APN BP #t�p� PROJECT DESCRIPTION: J Notation Used in Table: Column headers: C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and /or contract documents should clarify. Box entries: X Is placed in the appropriate column to denote either "C" continuous or "P" periodic inspections. - -- Denotes an activity that is either a one -time activity or one whose frequency is defined in some other manner. Additional detail regarding inspections and tests are provided in the project specifications or notes on the drawings. VERIFICATION AND INSPECTION C p REFERENCED IBC REFERENCE STANDARD INSPECTION OF FABRICATORS 1. )6 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 AU 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_20)2.doc remised 09106112 VERIFICATION ARID INSPECTION C P REFERENCED STANDARD IBC REFERENCE 4. Material verification of weld filler materials: W 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: D. 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 - -- IA 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 SpecinlnspectionForm_2012.doe revised 09106112 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE INSPECTION OF CONCRETE 1. ❑ Inspection of reinforcing steel, including prestressing - -- X ACI 318: 3.5, 7.1 -7.7 1913.4 tendons and placement. 2. ❑ Inspection of reinforcing steel welding in accordance AWS D1.4 ACI 318: with Table 1704.3 Item 5b. 3.5.2 3. ❑ Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowable X -- ACI 318: 8.1.3, 1911.5, 1912.1 loads have been increased or where strength design 21.2.8 is used. 4. ❑ Inspection of anchors installed in hardened concrete. - -- X ACI 318: 1912.1 5. ❑ Verifying use of required design mix. 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: 5 510 .9, . 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. 9f 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 anchors. _ -_ X 14. ❑ Other: Spec ialnspectionForm_2012.doc revised 09106112 0 2012.doc revised 09106112 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C F IBC TMS 402 1ACI TMS 402 /ACI SECTION 530 /ASCE 5 530 /ASCE 6 INSPECTION OF LEVEL 1 MASONRY ❑ Compliance with required inspection provisions of the construction documents and the approved - -- X - -- - -- Art. 1.5 submittals shall be verified. 2. ❑ Nifica-ti on of f m and fAAc prior to construction X _ -- ___ Art. 1.48 where specifically exempted by this code. 3. ❑ Verificat n of slump flow and VSI as delivered to X - -- ___ ___ Art. 1.513.11.b.3 the site for elf consolidating grout. 4. As masonry constr tion begins, the following shall be verified to ensure compliance: • Proportions of site- repared mortar. - -- X - -- - -- Art. 2.6A • Construction of mortar' ints. - -- X - -- - -- Art.3.313 • Location of reinforcemenNahorages. nectors, __- X - -- - -- Art. 3.4, 3.6A prestressing tendons, an • Prestressing technique. - -- X - -- - -- Art. 3.613 • Grade and size of prestressing ten ns and - -- X - -- - -- Art. 2.413, 2.4H anchorages. 5. During construction the inspection programs all 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 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 Se .2104.3, - -_ Art. 1.8C, 1.8131 40 degrees F) or hot weather (temperature above 2 04.4 90 degrees F). ❑ Application and measurement of prestressing X � \ I force. - -- � - -- - -- Art. 3.6B 6. Prior to grouting the following shall be verified to ensure compliance: ❑ Grout space is clean. - -- X - -- - -- Art. 3.21D ❑ Placement of reinforcement and connectors and - -- X --- -9x. 1.3 Art. 3.4 prestressing tendons and anchorages. ❑ Proportions of site - prepared grout and - -- X - -- - -- Art. 2.6B prestressing grout for bonded tendons. ❑ Construction of mortar joints. - -- X - -- - -- Art. 3.313 7. Grout placement: • Grout placement shall be verified ensure X - -- ___ ___ rt. 3.5 compliance. • Observe grouting of prestressing bonded X - -- - -- - -- Art 6C tendons. 0 2012.doc revised 09106112 03 Specia117specfi017Form_2012.doc revised 09 106112 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 4021AC1 TMS 4021AC1 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. ❑ Co Hance with required inspection provisions of the onstruction documents and the approved - -- X -- - -- Art. 1.5 submitt 2. ❑ Verification f fm and fAAc prior to construction and for every ,000 square feet during - -- X - -- - -- Art. 1.413 construction. 3. ❑ Verification of pro rtions of materials in premixed or preblen ed mortar and grout as - -- X - -- - -- Art. 1.51 . delivered to the site. 4. ❑ Verification of slump flo and VSI as delivered to X - -- - -- - -- Art. 1.513.1.b.3 the site for self consolidate grout. 5. The following shall be verified to sure compliance: r, grout, and • Proportions of site - prepared m!nrns. __- X - -- - -- Art. 2.6A prestressing grout for bonded • Placement of masonry units and cons uction of X - -- - -- Art. 3.36 mortar joints. • Placement of reinforcement, connectors a - -- 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. - -- - -- - -- Art. 3.6C • Size and location of structural elements. - -- - -- - -- Art. 3.31' • 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, 1.81D 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 03 Specia117specfi017Form_2012.doc revised 09 106112 VERIFICATION AND INSPECTION C p REFERENCED STANDARD IBC REFERENCE INSPECTION OF WOOD 1. NO Inspect prefabricated wood structural elements and assemblies in accordance with Section 1704.2. - -- 1704.6 2. ❑ spect site built assemblies. - -- - -- 3. Inspec igh -load diaphragms: ❑ Verify de and thickness of sheathing. - -- --- ❑ Verify nom al size of framing members at adjoining panel edges. _ ___ - -- 1704.6.1 ❑ Verify nail or stap diameter and length, - -- - -- ❑ Verify number of fast er lines, - -- - -- ❑ Verify spacing between f teners in each line and at edge margins. 4. ❑ Metal- plate- connected wood tru es spanning 60 feet or greater: Verify temporary install ion restraint/bracing and the permanent dividual truss --- X --- 1704.6.2 member bracing are installed in accor nce with the approved truss submittal package. REQUIRED VERIFI TION 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 X materials. - -- Table 1704.7 4. ❑ Verify use of proper materials, densities and lift thicknesses during placement and compaction of X - compacted fill. 5. ❑ Prior to placement of compacted fill, observe subgrade _ X and verify that site has been prepared properly. REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN F UNDATION 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. 012.doc revised 09106112 VERIFICATION ARID INSPECTION C P REFERENCED STANDARD IBC REFERENCE 7. ❑ For specialty piles, perform additional inspections as determined by the registered design professional in - -- - -- - -- Table 1704.8 responsible charge. RE4YIRED VERIFICATION AND INSPECTION OF CAST -IN -PLACE DEEP FOUNDATION ELEMENTS 1 ❑ Obse rve drilling operations and maintain complete and X accurate ecords for each element. 2. ❑ Verify place ent locations and plumbness, confirm element diam ters, bell diameters (if applicable), lengths, embe ent into bedrock (if applicable), and X - -- - -- Table 1704.9 adequate end -be ing strata capacity. Record concrete or grout v umes. 3. ❑ For concrete elements, perform additional inspections in accordance with Sect n 1704.4. ___ ___ HELICAL PILE FOUNDATIONS 1. ❑ Record installation equipmen sed, pile dimensions, X - -_ 1704.10 tip elevations, final depth, final 1 stallation torque. SP YED FIRE - RESISTANT MATERIALS Physical and visual tests 1. Condition of substrates. ❑ Inspect surface for accordance with the a roved fire - resistance design and the approved man uf turer's - -- - -- written instructions. ❑ Verify minimum ambient temperature before an after - -- X application. ❑ Verify ventilation of area during and after applicatio - -- X 2. ❑ Measure average thickness per ASTM E605 and Section 1704.12.4. S ' -- - -' - -- 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] SpecinlnspectionForm_2012.doc revised 09106112 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE 6. Wind Resistance • of cladding and roof framing connections. - -- - -- - -- ❑ Wall co�tfions roof and floor diaphragms and _ -_ - -- framing ___ • Roof and floor diaphrag stems, including ___ collectors, drag struts and bou elements. ___ ___ • Vertical wind - force - resisting systems, inc 'ng 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. tructural Wood ❑ ect field gluing operations of elements of the main X win rce- resisting system. - -- 1706.2 ❑ Inspect nai ' bolting, anchoring, and other fastening of components ' in the main windforce- resisting _ X system, including wo shear walls, wood diaphragms, drag struts, es and hold- downs. 2. Cold- Formed Steel Framing ❑ Welding of elements of the main wind - force- 'sting - 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 X - -- 1707.2 quality assurance plan requirements ofAISC 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 X 1707.4 system. SpeciabrspectianFor•m_2012.doc remised 09 106112 ❑ Inspection of screw attachments, bolting, anchoring, and other fastening of components within the seismic- _ - X force- resisting system including shear walls, braces, dia ragms, collectors (drag struts) and hold- downs. 4. Storage ra s and access floors ❑ Anchorag of storage racks 8 feet or greater in height X 1707.5 and access ors. 5. Architectural compo ents ❑ Inspect erection an fastening of exterior cladding weighing more than sf and higher than 30 feet - -- X above grade or walking urface. ❑ Inspect erection and faste\gof veneer we ighing more than 5 psf.and highe30 feet above grade - -- X or walking surface. - -- 1707.6 ❑ Inspect erection and fastening of a exterior non- bearing walls higher than 30 feet ab ve grade or - -- X walking surface. ❑ Inspect erection and fastening of all inten r non- bearing walls weighing more than 15 psf a higher - -- X than 30 feet above grade or walking surface. 6. Mechanical and Electrical Components ❑ Inspect anchorage of electrical equipment for emergency or stand -by power systems. -- X ❑ . 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 hazardous materials. ❑ Inspect installation of vibration isolation systems where required by Section 1707.7. - -- X 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 - -- - -- - -- 1 08.5 17.8. SpecialiispectiaiForm_2012.doc revised 09106112