08080201-SISep 17
2008
11:18HM
Hohbach-Lewin/SF
9/17/2048
11:42
FAX 408 771
3333
f
71
tar
4153188522
t'
Q 0001/0007
10300 Torre Avenue
Cupertino, California 95014
Telephone! (408) 717-3228
FAX- (408) 777-3333
COIL04UN17YDEYELOPAaMI BUILDIW DIVISION
BUILDING DEPARTMENT
SPEGIAi. INS_ PEMON AND TE MNG AGREEMM
Project Name: j&Mft'A �.��.es�+izE T W nand.. Date: -L /
Project }des; C>$QSCZO 1
To permit applicants ofprojects requiring Special Xtispection and/or Tcstiug per UBC Secdon 1701:
BEFORE A PERMR CAN BE ISSUED: no Owner. General Contractor, Project ArchitectIfEnginoer
and Special lnspeetor shall acknowledge the required special inspections, testing and conditions.
When determined by the Building Inspection Division, a pre -construction conference with the parties
involved will be held to review the special inspection requirements and procedmm .
Special inspection and testing.shall meet the minimum requirements of UBC 1701. The following
conditions are also applicable:
1. Contractor is responsible for notification to the Special Inspector or Agency regarding individual
inspections for times listed on the attached Schedule and noted on the City approved plans.
Adequate notice shall be provided so the Special Inspector bas time to become familiar with the
project and do a thorough job for all inspections.
2.. Each Special Inspector shall submit his qualifications to the City and is subject to a personal
.interview for pre-gnalihcation. Special Inspectors small display anzpproved identification badge
when pe6ouning the fuDetion of a special inspector or upon request, and must have a valid ICBO
Certification for the. type ofwork being inspected.
3. Duties and Responsibilities of the Special Inspector arc:
A- Observe the work for conformance with the CTIY APPROVED (stumped) design
drawings and specifications and applicable workmanship provisiions of the UBC.
NOTE: Shop drawings may be used Wx as an aid to inspection.
B. Bring non-confa nning itcam to tba immediate attention of the contractor and note in daily
report (Re£ tic& 4). If any ouch item is not resolved in a timely manner; or is about to be
incorporated in the work notify the Building Inspection Division and the Project_ Engineer
or Architect immediately by telephone at 408-777 3228, or in persom
r- v .
OFFICE CQPJ�
OCT 0 8 700
p.l
Received Time Sep.l1. 2008 12:03PM No-6140
Sep 17 2008 11:18RM Hohbach-Lewin/SF 4153188522
09/17/2008 11.42 FAX 408 777 3333 Z0002/0007
P.2
Special Inspection and Testing Agrc=ent
C. Fwnish reports of tests and inspections directly to the Building Iaspe ction Division,
Engineer and Architect of record and others as desigoede& These reports are to include the
following:
• Describe inspections and test made with applicable locations
■ List all non -conforming items
■ Indicate how nan-conforming items were resolved or indicate unresolved items as
applicable
■ Itemize changes authorized by Architect, Engineer, and wing Inspection
Division, if not included in non-conformance items
D. Ins= that an adequate number of pre -qualified special hmpectionpersonnel are on the job,
based on the intensity of activities, quality of work peafbruied and the various operations
occu1rh1& , , -
E. Submit a FINAL LEITER OF COMPLETION to.the Building Inspection Divinon stating
tbat, to the best of his knowlWge, all items req=' mg special inspection and testing were
acoomplishe d, approved and reported in conformance with the approved design drawings,
specifications, approved change order and the applicable workmanship provisions of the
UBC. Items not in conformance, unresolved items or any discrepancles in nns melon
coverage (i.e. missed inspections, ` periodie inspections performed when "continuous"
inspections were required, etc.) shall be specially itcmi,zod in this report-
F. FINAL LETTP.R OF COMPLETION shall be signed by the Licensed Registered Engineer
of the Special Inspection Agency of record.
4. Each Special Inspector cball complete and sign the SymW hwvgfm Ptocord of each day's
inspection and provide a daily handwritten report in a format acceptable to the Building inspection
Division (to remain at the job site with the contractor for review by the Building Department's
b apoctor). Content of the daily reports shall be per Item 3C above.
5. Work requiring a special inspection, and the performance of a special inspection, shall be
monitored by the City's building inspector. City approval is required prior to placement of
concrtm General Contractor shall notiffy 40ga777-3228, 24 hyou s in advance for each day
special inspections will be conducted.
6. Special inspections are to be pesfonned ona CONTINUOUS BASIS. meaning that. the SPECIAL.
24SPECOTR IS ON SITE IN THE GENERAL AREA AT ALL TI3M OBSERVING THE
WORIC REQUIRING SPECIAL INSPECTION. Penodia inspections may be approved by the
Building Inspection Division and, if approved. sball be noted on the SPECIAL INSPECTION
AND TESTING SCHEDULE.
7. Only the City approved Testing Agency of re cord sball sampleti trm elt and test materials.
8. Only the City -approved Special Inspection Agency of record shall provide special inspectors.
Independent inspectors may be prc-approved by the Building Inspection Division per Item 2
above,
V3
Revised NI1/04
Received Time Sep. 17, 2008 12:03PM No. 6140
Sep 17 20o8 11:18AM Hohbach-Lewin/SF
09/17/2008 11:42 FAX 408 777 3333
4153188522
p.3
(A0003/0007
10300 Torre Avenge
Crpa lino, California 95014
relepbom (408) r"--3228
,Z U PERT INO Am. (408) 777-3333
COMMUNIIYDBVELOPMBNT/BV DM DIVWON
STRUCTURAL TESTS AND INSPECTIONS SCHEDULE
Prior to isstw= of a budding permit, the Owner, as the advice of the Architect or Enginem, shall complete,
sign and submit this form to the building OfficiaL
'CRA6441 A'ric.t..o -er- RE "ra'os. L. 9 /i C. /c %
Project Name Date '
Prof ect Addtess Te on Agency
Owner's Name
& Title
Owner hereby certifies that the Testing/Inspection Agency named above bas been engaged to perform stmctural
tests and inspections during constmctioq as cbecked below, io satisfy all applicable portions of the Building
Code. Prior to issuance of an occupancy permit, the Inspection Agency shall submit a statement that all items
of designated work performed were reported. Any items chec end, but not test or inspected, will be noted and
explained.
Whcnaver any designated items on this lin am ready for sampling, testing or inspotdioA it shall be the
responsibility of to Contractor to give timely notice to the Inspection Agency so that the required suvices may
be perfoaned.
REneORCING SZ EEX-
Tensile & Bond, age set par brat per tans
In gmcdoo of Piwernem
Iaspocd= of'Veining
MASONRY:
Pnlimoary Acceptance Tcala (Mammy Liming, Wall Prisms)
Sbbacq=w Test (Momr, Greut, Field wall Prism)
Inspmdpn of (routing
bispoWan of Plac=ew do Groroting
ASPRAL17C CONCRETE:
Mac Dcsigs
Inpe96010 of Batch Pbuit
Caae/Tedt
Feld inspectim
Scift n7ity Tests
speeifte Cavity
Aspbab Cement
Sieve Analysis
x pack=
stabilomerss value
swell
STRUCIV1lAI SMEL:
Semple 8t Test (llet specific nwmbera below)
Shop Idadficat ion dt Welding Inspccdou
ShW
Ridiogmpby
Field Welding Inspection
Field Rotting b3spechm
Field Ultrasonic Inspection
-_ Metal Deck Welding Inspection
DMLTLA71NO OONCRVM-
Sa=ple & Tat
L% t Weian
P*W an PAq cue P*w
Received Time Sep, 11, 2008 12:03PM No•6140
Sep 17 200e 11:18HM Hohbach-Lewin/SF
09/17/2008 11:42 FA.1 408 777 3333
4153188522
p.4
Q0004/0007
nwtaW Tests nd Inspections Schedule
)N SHOTCREi'E
GROVI & MORTAR
)nr-
ShLot
Grout
Mortar
Teats for Desism
S 0f Agwegailes
lvf ac Desi
Testpanel
Batch Plaint Ingpection
Camant Crab SwnpLe
Place
'= Tests
Cast SpeCiMCUS
Pick-up Smples
Sbrinkagc Bars
Yield Check
Air Check
Unit wcdgbt
ECAST&M TESSIONED OONCREIP-
_ RCb&rri g-TCsts
_ Iaspocbion of Remfacmg Placement
_ Tendon Tesp .
_ inspection of Teadoa PbKcn=t
Impecdon of t:on=W Plac=cnt
_ bup=tion of Concrete Batrhh,g
_ Inspwdon of Panel Attad mzmb & I neres
_ b*eetion of Panel Insmuaticm
_ Coep moo ion Tests
_ULTectim Of
JNGI CAISSONS. CAPS. TIES: '
_ iaspecdw of Roiafoccing Ph=ncat
_ Inspecton of Concrete Phoemeza
_ hupectiom of Concrete Batebiag
00 "V 7,7—�e
_ Iapootion of Stud Fabrication
_ Ingwtkm ofRan.fOrMg & Forms
_ Inspection of C Cr to Plaoament
_ Inspection of Tisbadw
x PROOFING:
hupoction of P4cnixiis
Density Teat
Tlaclmmt Tests
Inspect Bat ung
FUX MAT'SRiAL:
Acaepb ►ee Test:
Moistae-Densty Detrinstion
Field Density
ROOPW(k
b>apetion of Placement
Sa wle k Tat
STRVCCUML WOOD:
Inspection of Fabdcaden
Iaspecdon of truce Joist Fabrication
Sample d: Test Composes
Inspection of file Ism Fabacation
Shm Diaphragms
212
Revised &11/04
Received Time Sep.11. 2008 12:03PM Nc.6140
S'ep 17 2008 11:18nM Flohbach-Lewin/SF
09/17/2.008 11:43 FAa 408 777 3333
4153188522 p.5
Z 0005/0007
!'
Special Inspection and Testing Agreement
9. BEFORE AN OCCUPANCY PERMIT CAN BE ISSUED: The Special Inspector or Agency shall
submit a FINAL LETTER OF COMPLETION, per item 3E above, directly to the Building
lnspection Division.
10. Copy of SPECIAL INSPECTION AMID TESTING SCHEDULE, SPECIAL INSPECTION AND
TESTING AGREEMENT, SPECIAL INSPECTION RECORD, and SPECIAL INSPECTION
DAILY REPORT, SHALL BE AT THE JOB SITE-
ACICNOWLEDG
i a -•
owner.
General Contractor.
Special Inspector or Agency.,
Project Engin=/Architoct:
Building Inspection Division:
3/3
Revised 6/11104
K► r%C-o
dl• V�•r O �
SEAT Te.s n csfor y
Neceived Time: Soo. 17, 2008 1.2:03PM No. 611.0
Sep 17 2009 11:19AM Hohbach-Lewin/SF
09/17/2008 11:43 PAX 408 777 3333
4153188522 p.g
00008/0007
1.
10300 Torre Avg mw
Ctg wlinv, CdY n is 95014
Telephhow. (408) 777-3228
FAX (409) 777-3333
COhOdUMTYDEPEWPhiSNTI BUILDING DrMON
BUILDING DEPARTMMNT
WCX F 8 1 9-P& kit e- NGL oS V Q qt Sin' t" we c L.
ProjectAddms Project'%tle
owner ofproje requiting Special Inspeetim or to rung per Chapter 17 of the 1999 Cilffbmia Building Code, please
mowk dp and return to the City.
TORE A PERMIT CAN BE ISSUED: The Owner, or his representative, on the advice of The responsible Project
ginew or Architect, Thal] complete, sip and submit the attached ftwm "Structual Tests and Iaspoctiom Schedule" t,o the
d1dmg Dcp&Mmw t for review and approval.
it owner andhis general contractor, wbere applicable, shall also admowledge.the following conditions applicable to
ceW Inspection aad/ar testing.
1. Gantractar is responsible for props notification to the Inspecting or Testing agency for items listed
2. Only the tftg Ubma ry should take samples and hmsport them to &air laboratory.
3. Copies of all laboratory repots and inspections are to be sent .directly to the City by the Testing agmwy,
4. bspectiol agency to submit names and qualification of on -site special ms;wtors to the Building Department far
approval-
S. The Special Inspector is under the authority and is ttspowible to the Building Official. Allinspection concerns
and/or problems encountcrcd are to be brought to his attention immediately.
6. Special inpecon may be required, as a miainsim to provide weekly report to this dap®rtraent of all inspection
activity.
7.. It is the respo rwibility of the connactor to review City appcoved plans for additional inspection or testing
nequfivw nts that may be noted .
S. BEFORE AN OCCUPANCY PERMIT CAN BE ISSUED: The bWecdpa ag®cy shall submit a
statemau Chad all itelrla requiring testing and inspection have baser fulfilled and rcportoti Those itenns
not vestal and/or inspeciod shall be noted in this statement. 'Copy of statement is to be maintained at the
job site for City's Building Inspector's review prior to final inspoetiona.
ProjectEagineer or Architect 5ipature
Teatiag/Iru i
t^,,ontracboe Sure City Plan Cheek Eaginees Signature
P~ an PW~ pow
Received Time Sep.11, 2006 12:03PM No.6140
S'ep 17 2008 11:18AM Hohbach—Lewin/SF 4153188522 p.7
09/17/2008 11:43 FAX 408 777 3333 a0007/0007
RECOGNIZED SPECIAL INSPECTION & nSM NC AGENCIES
E r f e c r i r X 3/ I/ 0 S- 1 2/ 3 0/ 0 S
:l1PE TINO ray: RC->� C
s� �►-AypMedo�wL UR14 •UMabrt+tcad llsa�y Pabl[aa�ae
Tab ody
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BawUW C.eeteelmtnt
SS87 Swot Boulevard
(925) 48+40220
x
X
3/31/2009
Caawairaats
Pleasaoeon. CA 94566
846A64S
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SIM C"M AsawclIkI6
1871 The Ala noda Saitw 200
(4 M 29&MS
x
X
X
X
x
3/31/1006
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Sao Jaw. G1. 951
29"114
X3JL Associates
1181 QMTY IAM 03W
(92S) 4624NO
x
x
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2/2812906
Ptaaaanwn, CA 94366
925 462-OM
C+P� BaptOwariag
74 Slr°ico Coww=
(510)668-1815
X
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11/301r10DS
CA 94539
10 49D4&6
CrsNidat°d
7060 Rail Cotter Patim". 03DD
(910 4e0"000
X
X
X
X
X
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2/1[/2006
ZmAjacarint labs
CA•94%&3108
925 4BS.Mlt
Cowalrodlwn IKdiaials
2271-11 Pilae Cant
(925) 825-wo
x
X
X
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X
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6/30/1006
TwWaLisve.
CA %520-1252
682-7953
cmab°dioa
2142 RhwmDrive. Such E
(925) 41MSI
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X
X
X
X
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10/3ll1006
T Swrvleea
Plwwtaa CA 94M
462-3183
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Coas6sadab 7wsdn8 di
242 West Lamb Road, Suito F
(9N) 576.2271
X
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x
X
X
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1Worm
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Trs , CA 95304
09 339-289S
Dyaamic
1300 Space Pak Way
(6.50) 9674082
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Consuha°tsLa.
Mwuot4* cw'CA 94043
630 967-695S
soft Slaw°a
47953 Warm Spr(np Boulevard
MO) 353-0320
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121Wr"S
Cwaatlbnb
Frwmoa CA %539 7400
510 353-0344
BNGEO
MI Oi w Cw Ww Rd., Suite 2DO
8-1600
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X
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1201/2006
loco ratd
Sao Rasnoo, CA 94583-1545
925 38-7425
Iversy*6 P.adneertme
1760 Induttrial Way. Suite I
(707)231-1212
X
X
X
12130/200S
CAmwatomw
Nam CA %558
9MIS9.1393
Yattptetlwaa
690 Surwl Street Bldg. i1
(408)us-8460
X
X
X
X
X
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3l31l2006
Sao Jobe CA 95126
408 271.0902
fupsatiaa
Her 26 Tba 8 obm:=4M
(41S) 2433-3263
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SeavkM Iau
Stm Frmc(st m CA 94105
415 243-3266
its ��°a�°t Co.Yas
865 Cotmtg Lwc, Sk A
(70'f) 4474035
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17/3012005
CA 956N
70 7-4143
Kki°fddwrlitc
7133 RiA Coda Parkwty, 0100
(9:4) 494-17D0
X
X
X
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l/31f2006
P'.camroa CA94S66
4W-2977
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43DPtsatooCan%Suite B
(9,M 4S4jjOn
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lac-
live more, CA 94551
4544S64
Krssac and
543 Parted Sued
(408) 271-2200
X
X
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X
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1214317A05
Associates Ina-
Sao late. CA 95112
271-2201
Matrri ood. Inc
3102 Industtial BoOeftrd
x
X
X
X
X
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12r30i100S
We" Saa� CA 95691
7S4i701t
PDcldasEathwaln8
6743Dublb►Boulawxr* sl3
(92S)829-w90
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Du CA 94S6t
829"5
MgoisMoorw
t956WebtterStteel.Stite400
(SIO)633-5640
X
X
X
X
X
10/31r2006
OWdand CA 94612
510 633-5646
PSI
365 Victor Surat. Suite C
(833) 757-ffi16
X
X
X
x
X
X
12/JOMM
S&UUZICA93907
l 757.6265
M Ebf°aar% Ibc.
150 Nash W1ge UMA SWte M4
(925) 933 4600
X
X
X
X
X
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08r3IrAw
Walnut Crodk CA 94SW2434
92 932-462S
SlpetTesting
3121 Diablo Avenue
(510)187-6484
X
X
X
X
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Laboratawies
Hn CA 94S45
510 783.4295
Sa ti-Etury
P_O. B" 880550, R mws Paint
(415) 330.38D0
ampamw
Shipyard, 8u11ding 114
(413) 330-MO
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zalka 06
San Francisco. CA 941813
Tarr°seswslt leK
6640 VIA Del ono, 0110
(400) 3624M
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1213N2005
San kok CA 95119
408 3624926
Testing Ugiawars Ine_
2311 Teaprden Street
(510) M3142
X
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1213fYm
Sao Louudto, CA 94577
510 634-3777
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a95aaw in fw ww 1h a awe iwutbL Bwtld(a[ O�oiak uwy add aed/ar cerwova a[encia Arm Ws Cut
know 51�aoaaacs waSom" SaMon
Received Time Sep.17. 2008 12:03?M No•6140