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11070140 - SI (2)Address: Work i �` ,' - P Work as Requested bi of: Reported to: of: DSA File.# IPL DSA Appl. # DSA LEA #.33 OSHPD # [XC EPDXIED DOWELS -125 ❑ EPDXIED ANCHORS - 126 ❑ EXPANSION ANCHORS - 127 F1 Witnessed the drilling of holes of proper diameter and depth. or [�7f Inspected predrilled holes fo'r proper diameter and depth. Expiration Date of Epoxy Observed the cleaning of holes and the injection of i a b S epoxy. or Witnessed the proper insertion a1: the insertion of epoxy capsules. Remarks/: It 1 rS 0.j P PJ — "j7 §-'S V Notes: ❑Type ❑ Do not type( The as was not The Work Inspected Inspected in Accordance with the Requirements of the Build! i The Requirements of the met did not meet Documents Documents Ylaterial Sampling LJ was ❑was not ❑ N/A i >arinrm art in 4ne,..d—,• -41. o.dui_- ----- _ -- �c: Project Architect General Contractor r Structural Engineer Building Jurisdiction Signature ol9 ecial lnspo r Project Inspector - Date DSA Regional Office Pdnt Name CCertiticat(on Noi Corporate Office —2811 Teagarden Street —San Leandro, California 94577— (510) 835 -3142— FAX (510) 8343777 www.Testina- Engineers com ' 'EI FILES \TEIWms4Speaal Wpec4on FortnslEpoxyJ�nchor40a0t07ado. 'r C DSA CMU Masonry (108) and CMU Grout Inspection (168) Report Inspected the placement of NLconcrete. masonry [gZiRt units for performedbY 9 g placed: masons. Totals square footage ❑ Cas[ specimens (Sample # ) forjobsite mix Type (specified strength psi) representing mortar placement ❑ for the above ❑ for the following 'Inspected the placement of reinforcing steel (180) for �'xl flit7 si e4`" Performed ❑ continuous ❑ periodic inspection,of batch plant (123) operations at: ❑ Inspected the ❑ high ❑ low lift grout placement for ❑ Cast (4 min.) specimens (Sample # from (batch plant supplier) representing gout placement ❑ for the above ❑ for. _ slump ins.) for Grout Mix # (specified strength psi, slump ins.) ❑ Total cubic yards placed: ❑ Inspected placement of diameter ledger bolts. ❑ Final acceptance is pending written approval or corrective action as noted. ❑ See attached RFI. ❑ All non - compliance items were brought to the attention of at the job site. Notes: L9 j C A r C 7t `� �/ i 6� ' L r .r :l C' t_. r_'. .v Oe>T ! '�'F TY 1 != C L- :W trT 01F r s ❑ Showup; ❑ Stand -by time; ❑ Job Cancelled; ❑ Re- inspection; Hours: The.work;U'was ❑ was not inspected in accordance with the Building Department or DSA or OSHPD approved documents. The work inspected 2 met ❑ did not meet the requirements of the Building Department or DSA, or OSHPD approved documents, ❑ ercept as noted above. ' Material sampling ❑ was ❑ was not ❑ N/A performed in accordance with the Building Department or DSA or OSHPD approved documents. Drawings V iP -G (' r C 4 �,� _� Dated - �- j l f. City ❑ County ❑Shop V, P Inspector: :/ ]c'L x Certification # �� y��%i! -G� Date: Received by: J Date: Corporate Office - 2811 Teagarden Street - San Leandro, California 94577 - (510) 835 -3142 - FAX (510) 834 -3777 www.Testi na -Enc ineers.eom TESTING GINEERS, INC _,_ Date: C-D - I L DSA File #: Project #: / 2_ ^, OSHPD #: Project Name: cJ��rT7: J O Permit / SF App. #: Address: J O / /off; Al D • 7>Z- 4V Z-A Tow Code: . City:. C V ffi? r-i'o O Start Time: Requested by: Hours: 'y Reported to: hn ; rcr- t 11ni' Tz- "1=T of (Company Name DSA CMU Masonry (108) and CMU Grout Inspection (168) Report Inspected the placement of NLconcrete. masonry [gZiRt units for performedbY 9 g placed: masons. Totals square footage ❑ Cas[ specimens (Sample # ) forjobsite mix Type (specified strength psi) representing mortar placement ❑ for the above ❑ for the following 'Inspected the placement of reinforcing steel (180) for �'xl flit7 si e4`" Performed ❑ continuous ❑ periodic inspection,of batch plant (123) operations at: ❑ Inspected the ❑ high ❑ low lift grout placement for ❑ Cast (4 min.) specimens (Sample # from (batch plant supplier) representing gout placement ❑ for the above ❑ for. _ slump ins.) for Grout Mix # (specified strength psi, slump ins.) ❑ Total cubic yards placed: ❑ Inspected placement of diameter ledger bolts. ❑ Final acceptance is pending written approval or corrective action as noted. ❑ See attached RFI. ❑ All non - compliance items were brought to the attention of at the job site. Notes: L9 j C A r C 7t `� �/ i 6� ' L r .r :l C' t_. r_'. .v Oe>T ! '�'F TY 1 != C L- :W trT 01F r s ❑ Showup; ❑ Stand -by time; ❑ Job Cancelled; ❑ Re- inspection; Hours: The.work;U'was ❑ was not inspected in accordance with the Building Department or DSA or OSHPD approved documents. The work inspected 2 met ❑ did not meet the requirements of the Building Department or DSA, or OSHPD approved documents, ❑ ercept as noted above. ' Material sampling ❑ was ❑ was not ❑ N/A performed in accordance with the Building Department or DSA or OSHPD approved documents. Drawings V iP -G (' r C 4 �,� _� Dated - �- j l f. City ❑ County ❑Shop V, P Inspector: :/ ]c'L x Certification # �� y��%i! -G� Date: Received by: J Date: Corporate Office - 2811 Teagarden Street - San Leandro, California 94577 - (510) 835 -3142 - FAX (510) 834 -3777 www.Testi na -Enc ineers.eom TESTING ENGINEERS, INC. Date: 6 -- ,Y -�� DSA File N: Project #: ,j s/ .Z #: Project Name: �^ Permi SF App. #: Address: 0' �_ r� o -e Code: City: ��ji . Start Tirite: Requested by: ` Hours: Reported to: r (/ o of (Company Name' CMU Masonry (108) and CMU Grout Inspection (168) Report ® Inspected the placement of © concrete masonry,❑ brick units for li 11 1 7Y Ir -b ccvyst- cE performed by L-` masons. Total square footage placed: Cast _3 specimens (Sample # i > > ) forjobsite mix Type __(specified strength psi) representing mortar placement ® for the above ❑ for the following M Inspected the placement of reinforcing steel (180) for ❑ continuous ❑ periodic inspection of batch plant (123) operations at: ❑ Inspected the ❑ high ❑ low lift grout placement for ❑ Gas[ (4 min.) specimens (Sample # from (batch plant supplier) representing grout placement ❑ for the above ❑ Total cubic yards placed: i ❑ for. slump ins.) for Grout Mix # (specified strength psi, slump ins.) ❑ Inspected placement of diameter ledger bolts. ❑ Final acceptance is pendinggwritten approval or corrective action as noted. ❑ See attached RFI. -• ❑ All non - compliance items were brought to the attention of at the job site. /J Notes: 'k F-rI ❑ Showup; ❑ Stand -by time; ❑ Job Cancelled; ❑ Re- inspection; Hours 77te work wns ❑ tras not inspected in accordmice with the Building Department or DSA or OSHPD approved documents. -K `- The work inspected 10 met did not meet the requirements o the Building Department or DSA or OSHPD approved documents, ' '`- ❑ except as noted above. Material sampling 0 was'❑ was nm ❑ N/A performed in accordance with the Building Department or DSA or OSHPD approved documents. Inspector: Received by: Dated I � - / ? - ) I O City ❑ Cowry ❑ Shop Certification N / 'G7 Date: Date: Office - 2811 Teagarden Street - San Leandro, California 94577 - (510) 835 -3142 - FAX (510) 834 -3777 www.Testina -Ena i neers. corn r Testing Engineers, Inc. Quality Assurance Services Materials Consulting Since 1954 Regular Concrete Compression Test Report Project No.: 55123 Client: INF000 RECEIVE ample No.: 239074 Project Name: Report Date : 01/08/13 10165 N. De Anza Blvd. - LOC 12/21/12 MAR 18 2013 Sample Date: 12/11/12 Cupertino Hotel for Infinite Loop Hotel, LLC Time Sampled: 11 20A Cupertino, CA Name: ate Received : 12/12/12 Inspector: M. Ardizzone, TEI Supplier: Central Concrete Mix:14H135RA Ticket No.: 18556284 Location: Permit # 1107 -0140. Footing for CMU retaining wall at north and west side of structure. Specimens Cast (ASTM C -31) : 5 Air Temperature (ASTM C -1064) : 60 deg F Mixture Temperature (ASTM C -1064) : 68 deg F Slump (ASTM C -143) : 4 -1/2 inches Date Tested 12/18/12 01/08/13 01/08/13 01/08/13 HOLD ID Number 54A 54B 54C 54D 54E Mark Sample Dimension, inches Diameter 4 4 4 4 Length 8 8 8 8 Area, sq. inches 12.57 12.57 12.57 12.57 Ultimate Load, Ibs 23000 50000 51000 49000 Ultimate Str., psi 1830 3980 4060 3900 Average, Str., psi 3980 Age Tested, Days 7 28 28 28 HOLD Fracture Type 1 1 1 1 Dry Unit Weight, pcf Specified Strength, psi 3000 3000 3000 SPECIMENS NOT SCHEDULED FOR TESTING WILL BE DISCARDED AFTER 28 DAYS OLD The Material Y WAS WAS NOT The Material Tested X MET DID NOT MEET THE SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. Remarks: Samples Tested in General Conformance with ASTM C -39 1 cc. City of Cupertino 1 cc. SD Deacon Reviewed By: 1 cc. SD Deacon 1 cc. Loorz Construction Management, LLC 1 cc. RYS Architects Robert Green 1 cc. Infinite Loop Hotel LLC Concrete Lab Supervisor Corporate Office - X811 Teagarden Street, San Leandro, California 94577 - (510) 835 -3142 - Fax (510) 834 -3777