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Special Inspection FormCUPERTINO STATEMENT'OF SPECK,. IMSPECTIONS, W16 -3C AtMW ( ?1f .;FAX (8) 77'T-3333- Ibb `STA7'E-I&W OF SPEC )NSF =0W is MA�MRW in itdf rant of the is-4u remwts of CBC Suss I704.stMd 1705. Tim is sish� afW and usd by permis8ian fr m it* Struxigral lIfties (SEAONC) mode swowlt of swcw itsis tarm is 2the ,. tawissg: }� "} ZT 4Dr SPWAL WSPECT10N AGENCIES "se. 4 A list of tasting age ss and o&w specW irs,etctwa Ibat'WM ZO mtat� to eon the gets and kispectiqrts for Ods pnq e 3 ` 'bULF- OF-tPECtAL WWE;`:1 OW (page 3 --4 ' j' ._ sed--je & Specw inspo=m mra'riartres the S;�adel pa rse e>F.d faimis regd#d; 5Wjs# }rssp$cttsrs.va isft!r 10 d m Mmted ins aid sperM�0=fm da#aT ed spacipJ �. Mitt aWbond te& aM kWecfi= TK41ked by Me zp� guns and s�tWs shaft afsC be pgfe� ,qw-jal kmpectiorm Said Tes Wq wS be perforrttad In a=rdancs the app wed P*'w and spadg-da[I ths.stsiarwt and Me Sect Iris 4,704, 1705, #705, #707, �'t70& � € 4fz Hill be-satrtaitiss tc Me�Elding Of%tai a� the Regfeiarea �!� f'rafasstc=I in Respor!sbs CNvgs to awcalance wM CBC Secan 1704.4M _A fto� P4apci t of Spec, -A f2 q%s Ja* de�mmwrAuV squad Sp as lnspeCbom fisstrt;<3 end carrvcWn c any disua ami�s rr-�'n ft bspediorss. shM be mdmtb�hd PrW W muof a c4ng6a o of Use and OpmTency (Sector 1704.1 .2), The Fmei -,Repod vi dwr"t • fdegt�d epec#� �. "`frs t sr raoograizes hiscf it6r o�cn.� a tiwtthe =rtset:~r n nspus s%h trm apppm adpeunk dCdi:". is a,-3 to t is t is �-of sspes korm In pat# Mfigmer: of i.bew of Rgabun t�..G�r� wig retain and d�YT�° €nr tl�a --3per�3�peci�arss �5 rer>�d--i�t�+y,Oy�a,�. Se�tia�r,���.7.�,.,� �y� �}/� i 4i�?fFRfF� i d�%gh Hl0 undef1LE7� Vwt"80ding Z) lwl + FavUw wA 2ppvm ft q";cadM,ofSpecdat �}8 who 1,vM pmlbrm tha ert'mPeCbO7S.: + MmIrtcx spat of kLvecow ac±ivitxes ffn th ;eb mis to zamra ihm ft Sp,�6a4 trspadcrs are q€ eKed "aid ark Ong as. called w hi t Os Statemort Of Speew mspecblon- s ibrAsp ► submAUd ftpecfim jpports- a pedarrs; .as mqu#W W-ft:kxc fags' tj code.. ent REVIEWED FOR CODE COMPLIANCE Date: 04/01/19 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE INSPECTION OF WOOD 1. j7 Inspect prefabricated wood structural elements and assemblies in accordance with Section 1704.2. ___ --- 1704.6 2. ❑ Inspect site built assemblies_ --- 3. Inspect high -load diaphragms: ❑ Verify grade and thickness of sheathing. --- -- ❑ Verify nominal size of framing members at adjoining panel edges. --- 1704.6.1 ❑ Verify nail or staple diameter and length, --- --- ❑ Verify number of fastener lines, --- Verify spacing between fasteners in each line and at edge margins. 4. ❑ Metal -plate -connected wood trusses spanning 60 feet or greater: Verify temporary installation restraint/bracing and the permanent individual truss — X --- 1704.6.2 member bracing are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify materials below footings are adequate to _ X achieve the desired bearing capacity. 2. ❑ Verify excavations are extended to proper depth and -_ X have reached proper material. 3. ❑ Perform classification and testing of compacted fill X materials. --- Table 1704.7 4. ❑ Verify use of proper materials, densities and lift thicknesses during placement and compaction of X -- compacted fill. 5. ❑ Prior to placement of compacted fill, observe subgrade X and verify that site has been prepared properly. REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. ❑ Verify element materials, sizes and lengths comply X with the requirements. 2. ❑ Determine capacities of test elements and conduct X additional load tests, as required. 3. ❑ Observe driving operations and maintain complete X and accurate records for each element. 4. ❑ Verify locations of piles and their plumbness, confirm type and size of hammer, record number of blows per --- Table 1704.8 foot of penetration, determine required penetrations to X --- achieve design capacity, record tip and butt elevations and document any damage to foundation element. 5. ❑ For steel elements, perform additional inspections in accordance with Section 1704.3. 6. ❑ For concrete elements and concrete filled elements, perform additional inspections in accordance with -- -- Section 1704.4. SpecialnspectionFo»n_2012.doc revised 09106112 10