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07120237 Plan Check Divisibn _ 10300 ygrrq Avenue Cupertino CA 95014 CITY OF Telephone(408)777.3228 CUTE__ IN® Fax(408)777-3333 Building Department tot35s tJ. smut ec. 4PS P&L*.A Project Address Praje ETitle SPECIAL INSPECTION AND TESTING To owner of projects requiring Special Inspection or Testing per Chapter 17 of the 1996 CaIifnmia.Building Code,please acknowledge and return to the City. BEFORE A PERMrl'CAN BE ISSUED:The Owner or his reQresentative,on the advice of the responsible Project Engineer or Architect,shall complete,sign and submit the attached form"Structural Tests and Inspection Schedule"to this Department for review and approval. The owner and his general contractor,where applicable,sball also acknowledge the following conditions applicable to Special Inspection and/or testing. 1. Contractor is responsible for proper notification to the Inspecting or Testing agency for items listed. 2. Testing laboratory only should take samples and transport them to their laboratory. 3. Copies of all laboratory reports and inspections are to be sent directly to the City by the Testing agency. 4. Inspection agency to submit names and qualifications of on-site special inspectors to the Building Department for approval 5. The Special Inspector is under.the authdrity and is responmble to the Building Official All inspection concerns and/or problems encountered are to be brought to his attention immediately. 6. Specialinspectars may be required,as a minimum,to provide weekly reports to this department of all inspection activity. 7. It is the responability of the contractor to review City approved plans for additional inspeciion or testing requirements that may be noted. 13. BEFORE AN OCCUPANCY PERMIT CAN BE ISSUED.The inspection agency shall submit a statement thattutting all items requiring and inspection were fulfilled and reported.Those items not tested and/or inspected shall be note in this statement Copy of statement to be maimed at the job site for Citys Building Inspector's review prior to final inspections. pp ACKNOWLEDGMENT BY ALL PARTIES CONCERNED .Y�-iUiY,f I✓lh/ off' Cya,K.p� s« i tore A- STRVCiV4&L, ojectEngineer Signature Tes ' g/ eciion f fuse �ON11QZjG- Contractor's Si tore OCit'Plan Cherkh 'e-er Signature 113 Revised 12/17101 Plan Check Division AL 10300 ToneAvenue Cupmtino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 STRUCTURAL TESTS AND INSPECTIONS SCHEDULE Prior to issuance of a bruldinly pemvt,the Owner,on the advice of the•Architect or Engineer,shall complete, sign and submit this form to the Building OffidaL Lks ppst,N,AS ProjecWame Z (e Date tofys5 N. sstz�tauw moo. %j Project Address Testing/Inspection ry 1frM rA& aw »ea rp Owner's Name Signature&, itle hereby certifies that the Testing/Inspection Agency named above has been engaged to'perfonn structural tests and inspection during construction,as checked below,to satisfy all applicable portions of Elie 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 checked.butnot tested or inspected will be noted and explained. Whenever any designated iWno on this list are ready for sampling,testing,or inspection,it shall be the responsibility of the Contractor to give timely notice to the Inspection Agency so that the required services may be performed. REINFORCING STEEL; STRUCTURAL STEEL: Tensile&Bond,one set per heat par---tons Sample&Test(list spedfic members below) Inspection of Placement -Shop Identification&Welding Inspection Inspection of Welding _Shop Mt asonic Inspection Shop Radiography MASONRY. v Field Welding Inspection _Preliminary Acceptance Tests(MaconryUnits,WoUprisms) _Field Bolting Inspection _SubsequentTests(Mortar,Grout,Fivid WaB Prisms) Inspection of Grouting _Field Ultrasonic Inspection _Field Mhmsomphy � _Inspection of Placement&Grouting _Metol Deck Welding Inspection CONCRETE,SHOTCRIM GROUT&MORTAR• ASPHALTIC CONCRETE: Conc. I Shot Groat Mortar —�&x Designs _Impaction of Batch Plant Aggregate Tests for Designs _•Core/Test SuitabiytyofAggregetes _Field&tspection MixDesigas _Suitability Tests Test Papal _Specific Gravity BatchPlatttInspectim —Aspladtcmitent Cement Grab Sampla —Sieve Analysis Inspe�Placing _K Pastors _Stabilometer Value Com mssion.Tests _Swell Cast specimens Pick-up Samples LNSULAnNG CONC r: Shdnhge Bats _Sample&Test Yield Check __Unit Weights j Air Check Dry Unit Weight 2)3 Revised 12/17/01 Plan Check Division 1030 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 PRECAST/POSLTFNSIONED CONCRETE FIIZEPROOI,'NG: _.Reinforcing Tests _Inspection of Placement _Inspection ofReinforcing PIE Ment _Density Tests _Tendon Tests . _ThicknesTests _Inspi!dtitm of Tendon Plamment _Inspect Batching Inspection of Concrete Placement Inspection of Cur=ate Baiehing FILL MATERIAL _In:pe=tion of Panel Attachments&Inserts ^Acceptance Tests _Iacpection of Penal Installation _Moisture-De city Determination _Compression Test, _Field Density Inspection of Stressing/Transfer PILING,CAISSONS,CAP3,TTfFq ROOFING: _Inspeclion of Reinforcing Placement _Inspection ofPlacemmt _Inspection of Concrete Placement _Sample&-Test _Inspection of Concrete Batching UNDERPINNIING: STRUCTURAL WOOD: Inspection of Steel Fabrimfion _Inspection of Pabriration _Inspection of Reinforcing&Forms _Inspection of Truss jolst Nbrimtion _Inspection of Concrete Placement _Sample&Test Components —Inspection of Tieback _Inspection of Glu Lam Fabrication _Shear D'•aphragms ADDITIONAL INSTRUCTIONS OR OTIM TESTS&INS'ECTIONS: tsPox4 tessT�•RON ot= t�wcttoe. 6otTs/}Iot,paaN F,on� i 1 3/3 Revised 12/17/01