SpecialInspectionForm-City_of_Santa_Cruz_-141_Archer_RSW.pdf

SPECIAL INSPECTION FORMS

Published: October 19, 2020

BUILD ING & SA F E TY DIV IS ION

D E P A R T M E N T O F P L A N N I N G & C O M M U N I T Y D E V E L O P M E N T

831/420-5120 • FAX 831/420-5434

809 Center Street • Room 101 • Santa Cruz, CA 95060 • www.cityofsantacruz.com

Project Title: _______________________________________ Permit Application #: ____________________

Project Address: _______________________________________

STATEMENT OF SPECIAL INSPECTION FORM

This Statement of Special Inspections is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705.

Special Inspections and Testing will be performed in accordance with the approved plans and specifications, this statement and CBC Sections 1704, 1705, 1706, 1707, and 1708.

The attached Summary of Special Inspections summarizes the Special Inspections and tests required. Special Inspectors will refer to the approved plans and specifications for detailed special inspection requirements.

Any additional tests and inspections required by the approved plans and specifications will also be performed.

BEFORE A PERMIT CAN BE ISSUED:

The owner or their representative, on the advice of the Registered Design Professional in Responsible Charge, shall complete, sign by all parties, and submit two (2) copies of this package to this Division for review and approval. All signatures required on page 2 shall be complete prior to the acceptance of the Special Inspection Forms and approval of the permit application.

Inspection/Counter Staff and Plan Check Agencies:

Verify signatures on page 2 are complete prior to acceptance of Special Inspection forms.

831/420-5120 • FAX 831/420-5434

809 Center Street • Room 101 • Santa Cruz, CA 95060 • www.cityofsantacruz.com

Project Title: _______________________________________ Permit Application #: ____________________

Project Address: _______________________________________

The Owner and their General Contractor, where applicable, shall also acknowledge the following conditions applicable to Special Inspection and/or Testing.

1. The Owner recognizes their obligation to ensure that the construction complies with the approved permit documents and to implement this program of special inspections.

2. Contractor is responsible for proper notification to the Inspection or Testing Agency for items listed.

3. Only the authorized Special Inspection Agency shall take samples and transport them to their laboratory.

4. Copies of all laboratory reports and inspections are to be sent directly to this Division and to the Registered Design Professional in Responsible Charge by the Special Inspection Agency on a weekly basis.

5. Special Inspection Agency to submit names and qualifications of on‐site Special Inspectors to this Division for approval.

Submission of qualifications is not required when the agency utilizes the inspectors who are pre‐approved by the City. See list attached.

6. The Special Inspection Agency shall issue each Special Inspector with an identification badge that indicates the following:

a. Name of Inspector

b. Photo of Inspector

c. The specific areas in which the inspector is qualified to inspect

d. An authorization signature by the Registered Engineer who is a full‐time employee of the agency

7. The Special Inspector shall display their badge whenever performing the function of an inspector.

8. The Special Inspector is responsible to the Chief Building Official for immediate notification of any concerns and/or problems encountered.

9. It is the responsibility of the Contractor to review the Building Division approved plans for additional inspection or testing requirements that may be noted. A pre‐construction conference at the job site is recommended to review special inspection procedures.

10. The Special Inspector shall use only Building Division approved drawings.

11. BEFORE AN OCCUPANCY PERMIT CAN BE ISSUED: A Final Report of Special Inspections documenting required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy (Section 1704.2.4). The Final Report shall document:

a. Required special inspections

b. Correction of discrepancies noted in inspections

12. A Copy of final report is to be maintained at the job site for Building Inspector's review prior to final inspections.

ACKNOWLEDGEMENTS:

Registered Design Professional in Responsible Charge:

Print Name: ___________________________ Sign: __________________________________ Date: _________________

Owner’s Authorization:

Print Name: ___________________________ Sign: __________________________________ Date: _________________

Licensed Contractor:

Print Name: ___________________________ Sign: __________________________________ Date: _________________

Special Inspection Agency (Responsible Person):

Print Name: _________________________ Sign: __________________________________ Date: _________________

Project Geotechnical Engineer (if applicable):

Print Name: ___________________________ Sign: __________________________________ Date: _________________

831/420-5120 • FAX 831/420-5434

809 Center Street • Room 101 • Santa Cruz, CA 95060 • www.cityofsantacruz.com

Project Title: _______________________________________ Permit Application #: ____________________

Project Address: _______________________________________

SPECIAL INSPECTION AND TESTING AGENCIES

The following are the Testing Agencies and Special Inspectors that will be retained to conduct tests and inspection on this project.

If more than one special inspection agency will be performing the required special inspections, please list each below with the inspections they will be performing.

Responsibility Firm Name Address, Telephone, E‐mail

1. Special Inspection

Inspections: ___________________

2. Special Inspection

3. Special Inspection

4. Material Testing

For nondestructive testing , submit special inspector names, qualifications , and certifications for review and approval

5. Soils Inspections per Table 1705.6

The company and/or individuals performing the soils inspection must submit their qualification for review and approval

831/420-5120 • FAX 831/420-5434

809 Center Street • Room 101 • Santa Cruz, CA 95060 • www.cityofsantacruz.com

Project Title: _______________________________________ Permit Application #: ____________________

Project Address: _______________________________________

SEISMIC AND WIND RESISTANCE

Seismic Requirements (Section 1705.12) Description of seismic‐force‐resisting system and designated seismic systems subject to special inspections in accordance with Section 1705.12:

The extent of the seismic‐force‐resisting system and designated seismic systems is defined in more detail in the construction documents.

Wind Requirements (Section 1705.11) Description of main wind‐force‐resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.11.3:

The extent of the main wind‐force‐resisting system and wind resisting components is defined in more detail in the construction documents.

831/420-5120 • FAX 831/420-5434

809 Center Street • Room 101 • Santa Cruz, CA 95060 • www.cityofsantacruz.com

Project Title: _______________________________________ Permit Application #: ____________________

Project Address: _______________________________________

SUMMARY OF SPECIAL INSPECTION

Complete the following form to indicate the types of special inspection required on this project. List the required inspections from the California Building Code Chapter 17; indicate Continuous or Periodic or both as required by code. Reference CBC Chapter 17 or the schedule below for a complete list of inspections.

Construction Type Requiring Inspection List of Required Inspections C P

Steel – Sec. 1705.2

Concrete – Table 1705.3

Masonry – Sec. 1705.4

Wood – Sec. 1705.5

Soils – Table 1705.6

Pile Foundations – Table 1705.7

Pier Foundations – Table 1705.8

Helical Pile Foundations – Sec. 1705.9

Fabricated Items – Sec. 1705.10

Wind Resistance – Sec. 1705.11

Seismic Resistance – Sec. 1705.12

Testing for Seismic Resistance – Section 1705.13

Sprayed Fire‐Resistant Materials – Sec. 1705.14

Mastic and Intumescent Coatings – Sec. 1705.15

Exterior Insulation & Finish System – Sec. 1705.16

Fire‐resistant Penetrations & Joints – Sec. 1705.17

Smoke Control System – Sec. 1705.18

Alternate Materials and Systems – Sec. 1707.1

Specify other tests, inspections or special instructions as required:

831/420-5120 • FAX 831/420-5434

809 Center Street • Room 101 • Santa Cruz, CA 95060 • www.cityofsantacruz.com

Project Title: _______________________________________ Permit Application #: ____________________

Project Address: _______________________________________

CONTRACTOR 'S STATEMENT OF RESPONSIBILITY

Per Section 1704.4 of the 2016 California Building Code, the Contractor responsible for the construction of a main wind or seismic force resisting system, designated seismic system or a wind or seismic resisting component listed in the Summary of Special Inspections (structural tests and inspection schedule and as noted on the Building Division approved plans) shall submit a written statement of responsibility to the Building Official and the Owner prior to the commencement of work on the system or component.

To comply with the requirements of Section 1704.4, the Contractor acknowledges the following:

1. The Contractor is aware of the special requirements contained in the Summary of Special Inspections (structural tests and inspection schedule and as noted on the Building Division approved plans) prepared by the Engineer of Record or the Registered Design Professional per the requirements of Section 1704 of the 2016 CBC.

2. Control will be exercised to obtain conformance with the construction documents approved by the Building Official.

3. The Contractor has procedures for exercising control within the contractor's organization, the method and frequency of reporting, and the distribution of the reports.

Provide a brief description of the procedure:

4. The Contractor has the qualified personnel to exercise such control.

Specify the name (s) of the person(s) exercising such control and a brief description of their qualifications:

ACKNOWLEDGEMENT:

Licensed Contractor:

Print Name: ___________________________ Sign: __________________________________ Date: _________________

831/420-5120 • FAX 831/420-5434

809 Center Street • Room 101 • Santa Cruz, CA 95060 • www.cityofsantacruz.com

RECOGNIZED SPECIAL INSPECTION & TESTING AGENCIES

pg 1 of 3 ‐ Updated: September 2020

KEY:

RC = Reinforced Concrete PC = Prestressed Concrete SM = Structural Masonry SW = Steel Welding

HSB = High‐Strength Bolting NDT = Non‐destructive Testing SWC = Structural Wood Construction FP = Fireproofing

AGENCY NAME ADDRESS PHONE/FAX RC PC SM SW HSB NDT SWC FP EXPIRATION DATE

A 1 Inspection Services 1754 Mission Street San Francisco, CA 94109

(415) 621‐8001

(415) 358‐4409

X X X X X X X X 10/6/2018

ACE Quality Control 1830 Vernon St, Suite #7 Roseville, CA 95678

(916) 742‐5096

(530) 241‐5935 X X X X X X 9/4/2021

Achievement Engineering Corp.

2455 Autumnvale Drive, Unit E San Jose, CA 95131

(408) 217‐9174

(408) 217‐9632

X X X X X X X X 3/6/2022

Advanced Testing & Inspection, LLC

540 Brunken Avenue, Suite B Salinas, CA 93901

(831) 422‐2272

(831) 597‐2004

X X X X X X 10/1/2022

Apex Testing Labs, Inc.

1790 Yosemite Ave San Francisco, CA 94124

(415) 550‐9800

(415) 550‐9880

X X X X X X X 10/11/2021

Applied Materials & Engineering, Inc.

980 41st Street Oakland, CA 94608

(510) 420‐8190

(510) 420‐8186

X X X X X X X X 8/2/2022

Aries Engineering 5357 Persimmon Grove Ct San Jose, CA 95123

(408) 634‐0087 X X 1/14/2022

Baez Geotechnical Group (BGG) 1686 Second St, Ste. 205 Livermore, CA 94550

(925) 766‐1616 X X X 4/22/2022

BAGG Engineers 138 Charcot Avenue San Jose, CA 95131

(650) 852‐9133

(650) 852‐9138

X X X X X X X X 7/6/2023

Berlogar, Stevens and Associates

5587 Sunol Boulevard Pleasanton, CA 94566

(925) 484‐0220

(925) 846‐9645

X X X X X X 9/4/2021

Biggs Cardosa Associates, Inc.

1871 The Alameda, Suite 200 San Jose, CA 95126

(408) 296‐5515

(408) 296‐8114

X X X X X 11/7/2020

B.S.K. Associates 399 Lindbergh Ave Livermore, CA 94551

(925) 315‐3151

(925) 315‐3152

X X X X X X X 2/14/2021

Consolidated Engineering Labs 2001 Crow Canyon Rd, Suite 100 San Ramon, CA 94583

(925) 314‐7100

(925) 855‐7140

X X X X X X X X 10/18/2021

Construction Testing Services 2174 Rheem Drive, Suite A Pleasanton, CA 94588

(925) 462‐5151

(925) 462‐5183

X X X X X X X X 12/15/2022

CTE Cal, Inc.

46716 Fremont Boulevard Fremont, CA 94538

(510) 573‐6362

(510) 573‐6684

X X X X X X X X 10/27/2019

Earth System Pacific 48511 Warm Springs Blvd, Suite 210 Fremont, CA 94539

(510) 353‐3833

(888) 567‐4292

X X X X X X X 10/25/2020

ENGEO Incorporated 2010 Crow Canyon Pl., Suite 250 San Ramon, CA 94583‐1545

(925) 866‐9000

(888) 279‐2698

X X X X X X X X 8/7/2022

Geissler Engineering 83e Beach Road Belvedere, CA 9420

(415) 992‐9393 X X 2/27/2020

Pending Review2

Geocon Consultants, Inc.

6671 Brisa Street Livermore, CA 94550

(925) 371‐5900

(925) 371‐5915

X X X X X 8/1/2019

Pending Review2

HP Inspections 690 Sunol Street, Bldg. H San Jose, CA 95126

(408) 288‐8460

(408) 271‐0902

X X X X X X X 1/8/2021

Inspection Consultants, Inc.

1515 North C Street Sacramento, CA 95814

(916) 321‐5580

(916) 321‐5590

X X X X X X 1/20/2020

Inspection Services Inc.

1798 University Avenue Berkeley, CA 94703

(415) 243‐3265

(415) 243‐3266

X X X X X X X X 6/25/2022

831/420-5120 • FAX 831/420-5434

809 Center Street • Room 101 • Santa Cruz, CA 95060 • www.cityofsantacruz.com

RECOGNIZED SPECIAL INSPECTION & TESTING AGENCIES

(continued) pg 2 of 3 ‐ Updated: September 2020

KEY:

HSB = High‐Strength Bolting NDT = Non‐destructive Testing SWC = Structural Wood Construction FP = Fireproofing

KC Engineering Co.

865 Cotting Lane, Suite A Vacaville, CA 95688

(707) 447‐4025

(707) 447‐4143

X X X X X X 11/7/20

Kleinfelder Inc.

2601 Barrington Ct.

Hayward, CA 94545

(925) 484‐1700 X X X X X X X 7/30/2022

Korbmacher Engineering Inc.

480 Preston Court, Suite B Livermore, CA 94551

(925) 454‐9033

(925) 454‐9564

X X X X X X X 4/11/2020

Krazan and Associates Inc.

1061 Serpentine Lane, Suite F Pleasanton, CA 94566

(925) 307‐1160

(925) 307‐1161

X X X X X X X X 1/5/2021

MatriScope Engineering Laboratories, Inc

6244 Preston Av Livermore, CA 94551 601 Bercut Dr. Sacramento, CA 95811

(510) 763‐3601

(916) 375‐6700

X X X X X X X X 1/1/2022

Mid Pacific Engineering, Inc MPE 4200 N. Freeway Blvd., Suite 5 Sacramento, CA 95834

(916) 927‐7000 X X X X X X X 3/12/2023

Moore Twining Associates, Inc.

2527 Fresno Street Fresno, CA 93721

(559) 268‐7021

(559) 268‐0740

X X X X X X 8/8/2021

Nicholas Engineering Consultants 6743 Dublin Boulevard, #15 Dublin, CA 94568

(925) 829‐8090

(925) 829‐0235

X X X X X X X 5/7/2022

Ninyo & Moore 1956 Webster Street, Suite 400 Oakland, CA 94612

(510) 633‐5640

(510) 633‐5646

X X X X X X X X 12/8/2019

NORCON LLC

1661 Tennessee St. Suite 201 San Francisco, CA 94107

(415) 710‐1155 X X X X X X X X 5/18/2020

Pacific Crest Engineering, Inc.

444 Airport Blvd, Ste. 106 Watsonville, CA 95076

(831) 722‐9446

(831) 722‐9158

X X 1/7/2022

Picot Inspection 2162 62th Ave.

Oakland, CA 94621

(510) 847‐8990 X X X X X X 3/10/2023

PJC & Associates, Inc.

600 Martin Ave, Ste 210 Rohnert Park, CA 94928

(707) 584‐4804 X X X 8/5/2019

Professional Service Industries, Inc.

380 Tennant Ave, Ste. 3 Morgan Hill, CA 95037

(408) 669‐5500 X X X X X 3/26/2022

Quantum Geotechnical 6288 San Ignacio Ave. Suite D San Jose, CA 95119

(408) 629‐3822

(408) 629‐3825

X X X X 8/10/2019

RES Engineers, Inc.

1250 Missouri Street, Suite 207 San Francisco, CA 94107

(415) 822‐4625

(415) 822‐8925

X X X X X X X X 6/3/2022

RMA Group 130 Archer Street San Jose, CA 95112

(408) 362‐4920

(408) 362‐4926

X X X X X X X X 4/2/2022

Salem Engineering Group, Inc.

4055 W. Shaw Ave, Suite 110 Fresno, CA 93722

(559) 271‐9700

(559) 275‐0827

X X X X X X X X 7/25/2021

Signet Testing Laboratories 3526 Breakwater Court Hayward, CA 94545

(510) 887‐8484

(510) 783‐4295

X X X X X X X X 12/19/2020

Smith‐Emery Company P.O. Box 880550, Hunters Point Shipyard, Building 114, San Francisco, CA 94188

(415) 642‐7326

(415) 642‐7055

X X X X X X X X 1/2/2020 Pending Review2

Stevens Ferrone & Bailey 1600 Willow Pass Court Concord, CA 94520

(925) 688‐1001

(925) 688‐1005

X X X X X X X 3/6/2022

Structure Group 2352 Research Drive Livermore, CA 94550

(925) 447‐9900

(925) 447‐9901

X X X X X X X 2/2/2021

Summit Associates 2300 Clayton Road, Suite 1380 Concord, CA 94520

(925) 363‐5560

(925) 363‐5511

X X X X X X X X 12/12/2022

831/420-5120 • FAX 831/420-5434

809 Center Street • Room 101 • Santa Cruz, CA 95060 • www.cityofsantacruz.com

RECOGNIZED SPECIAL INSPECTION & TESTING AGENCIES

(continued) pg 3 of 3 ‐ Updated: September 2020

KEY:

HSB = High‐Strength Bolting NDT = Non‐destructive Testing SWC = Structural Wood Construction FP = Fireproofing

Terracon Consultants, Inc.

5075 Commercial Circle, Suite E Concord, CA 94520

(925) 348‐9057 X X X X X X X 10/31/2021

Testing Engineers Inc.

2811 Teagarden Street San Leandro, CA 94577

(510) 835‐3142

(510) 834‐3777

X X X X X X X X 3/9/2021

Twining 1572 Santa Ana Avenue Sacramento, CA 95838

(916) 649‐9000

(916) 921‐8532

X X X X X X 2/6/2021

Valley Inspection 326 Woodrow Avenue Vallejo, CA 94591

(707) 552‐7037

(707) 552‐7022

X X X 3/9/2021

Wallace‐Kuhl & Associates, Inc.

3050 Industrial Boulevard West Sacramento, CA 95691

(916) 372‐1434

(916) 372‐2565

X X X X X X X 5/10/2019 Pending Review2

Notes:

1. Agencies may have offices in more than one location.

2. Agencies with a “Pending Review” status are recognized.

3. Other agencies may be approved by local jurisdictions.

Agencies have not been evaluated for geotechnical special inspection or nondestructive testing. Agencies may not be qualified to perform all aspects of special inspection. Agencies may have offices in more than one location. Other agencies may be approved by local jurisdictions. Building Officials may add and/or remove agencies from this list. * Agency Subcontracts Laboratory Services.

(Agencies may contact the City of Santa Cruz Building & Safety Division directly by email: bcounter@cityofsantacruz.com)