12372 Tri-City Medical Center S
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1 ThisprogramispreparedandsubmittedforanOSHPD1project.OSHPD1projectsincludeallconstructionandremodelprojectsforgeneralacutecarehospitalsand acutepsychiatrichospitals.oshpd1projectsalsoincludeconstructionandremodelofskillednursingfacilitiesand/orintermediatecarefacilitieseceptthoseofsingle story,typev,woodorlightsteelframeconstruction. SECTION A PROJECT INFORMATION Facility #: Facility Name: Project #: Sub #: Tri-City Medical Center S Street Address: City: 4002 Vista Way Oceanside Record Name (Scope of Project): County: San Diego Tri-City Medical Center OR3 light Replacement Abbreviations: CAC: California Administrative Code CBC: California Building Code RDP: Registered Design Professional Version:R02.1 OSHFD303A(Rev03/12/2015) STATEOFCALIFORNIAHEALTHANDHUMANSERVICESAGENCY Page1of6
2 SECTION B NOTE: Approved agencies, individuals, and all changes to the TIO program shall be identified, evaluated by the DPOR and approved by OSHPD prior to proceeding with the related work. Facility #: Faclity Name: Project #: Sub #: Tri-City Medical Center S DURING CONSTRUCTION DOCUMENT SUBMITTAL DURING CONSTRUCTION In nde # REQ QUIRED (S Select) TESTS FORMED F-SITE PER OF RESPONSIBLE APPROVED AGENCY AND/OR INDIVIDUAL COM MPLIANCE VERI FICATION BY IOR OSH HPD/FDD USE STRUCTURALTESTS 12 Concrete B-C15 Post-installed anchors CBC 1910A.5 Installation verification test 14 B-S2 ELECTRICALTESTS B-E7 CBC 2213A.1 & 1705A.13.1 High strength bolts, nuts, and washers ESS Insulation Resistance 2015 NFPA CO: OTHERTESTS B-OT1 Receptacal Polarity Test 2012 NFPA OSHFD303A(Rev03/12/2015) STATEOFCALIFORNIAHEALTHANDHUMANSERVICESAGENCY Page2of6
3 SECTION C Facility #: Faclity Name: Project #: Sub #: Tri-City Medical Center S DURING CONSTRUCTION DOCUMENT SUBMITTAL In nde # REQ QUIRED (S Select) STRUCTURALSPECIALINSPECTIONS 12 Concrete C-C5 14 C-S1 C-S3 C-S4 C-S5 SPECIAL INSPECTIONS Concrete CBC 1705A.3 CIP & Post-installed anchors CBC 1705A.2 & 1705A.12.1 shop fabrication CBC 1705A.2.5 & 1705A.12.1 Shop and field welding AWS D1.1 3 & 4 and AWS D Shop and field welding - WPS / WPQR CBC 1705A.2 & 1705A.12.1 High strength bolt installation FIREPROTECTIONSPECIALINSPECTIONS C-FP3 Penetration firestops CBC 1705A.17.1 Penetration firestop systems that are tested and listed NOTE: Approved agencies, individuals, and all changes to the TIO program shall be identified, evaluated by the DPOR and approved by OSHPD prior to proceeding with the related work. FORMED F-SITE PER OF DURING CONSTRUCTION RESPONSIBLE APPROVED AGENCY AND/OR INDIVIDUAL COM MPLIANCE VERI FICATION BY IOR OSH HPD/FDD USE FLSO: OSHFD303A(Rev03/12/2015) STATEOFCALIFORNIAHEALTHANDHUMANSERVICESAGENCY Page3of6
4 SECTION D Facility #: Faclity Name: Project #: Sub #: Reference VERIFIED CONSTRUCTION INSPECTION AND OBSERVATION REPORTING PROJECT MILESTONE OR INTERVAL Tri-City Medical Center CONSTRUCTION VERIFICATION S VERIFIED COMPLIANCE REPORT REQUIRED AS INDICATED (Form OSH-FD-123) (See PERSONAL KNOWLEDGE as defined in California Administrative Code, Section 7-151) FOR OSHPD USE ONLY GEOR AOR SEOR MEOR EEOR CONT IOR SP INSP TEST LAB OSHPD FDD PROJECT COMPLETION X X X OSHFD303A(Rev03/12/2015) STATEOFCALIFORNIAHEALTHANDHUMANSERVICESAGENCY Page4of6
5 SECTION F PLAN REVIEW APPROVAL Facility #: Faclity Name: Project #: Sub #: Tri-City Medical Center S NOTE: For testing, Inspection and Observation Program Instructions, visit our website: Submitted by: I have reviewed the approved construction documents for this project and all tests and special inspections required by Code are marked as required on this form. Changhua Sun Architect/Engineer of Record (Print Name) Architect/Engineer of Record (Signature) Structural Engineer of Record (Print Name) OSHPD Plan Approval: FOR OSHPD USE ONLY Structural Engineer of Record (Signature) Name Comments: Laura Baldrati, Senior Architect May 01, 2017 OSHFD303A(Rev03/12/2015) STATEOFCALIFORNIAHEALTHANDHUMANSERVICESAGENCY Page5of6
6 SECTION G BUILDING PERMIT APPROVAL Facility #: Faclity Name: Project #: Sub #: Tri-City Medical Center S NOTE: For testing, Inspection and Observation Program Instructions, visit our website: Changhua Sun S Architect/Engineer of Record (Print Name) Professional License # Architect/Engineer of Record (Signature) OSHPD TI&O Program Approval: FOR OSHPD USE ONLY Name Comments: OSHFD303A(Rev03/12/2015) STATEOFCALIFORNIAHEALTHANDHUMANSERVICESAGENCY Page6of6
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