12372 Tri-City Medical Center S

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1 This program is prepared and submitted for an OSHPD 1 project. OSHPD 1 projects include all construction and remodel projects for general acute-care hospitals and acute psychiatric hospitals. OSHPD 1 projects also include construction and remodel of skilled nursing facilities and/or intermediate care facilities except those of single-story, Type V, wood or light steel-frame construction. SECTION A PROJECT INFORMATION Facility #: Street Address: 42 Vista Way Facility Name: Project #: City: Oceanside County: San Diego Record Name (Scope of Project): Emergency improvements to the Central Plant Mechanical equipment consisting of the installation of an emergency chiller, supporting cooling tower and pumps. Electrical and Abbreviations: CAC: California Administrative Code CBC: California Building Code RDP: Registered Design Professional Version: R2.3 OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 1 of 1

2 SECTION B DOCUMENT SUBMITTAL TESTS STRUCTURAL TESTS x11 Foundation B-F1 B-F2 B-F3 B-F4 B-F5 B-F6 Soil fill CBC 175A.6 Fill material acceptance test Soil fill CBC 175A.6 Compaction test Soil and rock anchors CBC 1811A Load test Deep foundation elements CBC 181A , 181A , 181A , 181A.3.3.2, & 181A Load test Shoring CBC 1812A Tie-Back Anchors Vibro Stone Columns (VSC) CBC 1813A Acceptance Test B-F8 B-F7 x12 B-C1 B-C9 B-C8 B-C7 B-C5 B-C4 B-C3 B-C2 B-C1 CBC 175A.3, 193A.6 & 191A.1; ACI & 26.4 Cementitious materials CBC 175A.3, 193A.5; ACI & 26.4 Aggregates/Reactive aggregates CBC 175A.3, ACI Water CBC 175A.3 & 195A.1.16; ACI Strength test CBC 175A.3 & 191A.2; & ACI , & Metal reinforcement (including welded wire fabric and headed rebar) CBC 175A.3 & ACI Headed studs and headed stud assemblies CBC Table 175A.3 Item #2a, 193A.8 Weldability of reinforcing bars CBC 175A.3 & 191A.3; ACI , 25.8 & Prestressing tendons and anchorage CBC 1911A.2; ACI 53.7 Crack repair by epoxy injection OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 1 of 7

3 SECTION B DOCUMENT SUBMITTAL TESTS B-C15 B-C14 B-C13 B-C12 B-C11 CBC 1911A.3; ICC AC178 Sec. 9 Strengthening by externally bonded FRP Shotcrete CBC 198A.5 Preconstruction test Shotcrete CBC 198A.1 Strength test Shotcrete CBC 175A.19.1 Core test Post-installed anchors CBC 191A.5 Installation verification test B-C17 B-C16 x13 B-MA8 B-MA7 B-MA6 B-MA5 B-MA4 B-MA3 B-MA2 B-MA1 CBC 215A.2; TMS B.3 Material standards tests CBC 215A.3 Mortar test CBC 215A.3 Grout test CBC 215A.2; TMS B.3 Compressive strength f'm - prism test CBC 215A.4 Core test CBC 175A.4 anchors Veneer CBC Veneer bond strength test Architectural Cast Stone CBC 213A.1 Strength of stone anchorage ASTM C1354 B-MA9 x14 B-S1 B-S2 CBC 223A.1 Identification test for structural steel and cold formed steel CBC 2213A.1 & 175A.13.1 High strength bolts, nuts, and washers OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 2 of 7

4 SECTION B DOCUMENT SUBMITTAL TESTS B-S7 B-S5 B-S4 B-S3 CBC 2213A.2 & 175A.13.1 End-welded studs CBC 175A.2.1 & 175A Nondestructive testing of welds 175A & AISC-341 K3 Buckling restrained brace load test 225A.4, 175A.12.2 & AISC-341 K2 Beam to Column Moment Connections B-S6 x15 Other Structural Materials B-OM1 B-OM2 Structural Sealant Glazing CBC Structural sealant tests - Exterior glass curtain walls Structural Sealant Glazing CBC AAMA 51.4 & 51.6 tests - Exterior glass curtain walls B-OM4 B-OM3 x16 Alternative Systems B-AS1 B-AS2 B-AS3 Seismic Isolators CBC 175A.13.4 Prototype and production test Dampers CBC 175A.13.4 Prototype and production test Structural Design Criteria CBC Tests to support alternative system B-AS5 B-AS4 x17nonstructural Components, Supports and Attachments B-N1 B-N2 Nonstructural components CBC 175A.13.2 FM 195 Seismic Bracing Special Seismic Certification CBC 175A.13.3 Shake Table test B-N4 B-N3 OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 3 of 7

5 SECTION B DOCUMENT SUBMITTAL TESTS ELECTRICAL TESTS B-E1 B-E2 x Ground fault protection CEC 23.95(C) & (D) Performance test Emergency generator tests CEC 7.3(A) & NFPA B-E3 Wet Location 2-15 NFPA (B) B-E4 x Grounding system effectiveness 215 NFPA B-E5 Line Isolation Monitor 215 NFPA B-E6 Hospital Grade Receptacle in Anesthetizing Locations 215 NFPA B-E7 x ESS Insulation Resistance 215 NFPA B-E8 Medium Voltage Outdoor Systems CEC B-E9 x Temporary Installation Grounding CEC 59.6(b)(2)(a) MECHANICAL TESTS B-ME1 Listed hood assemblies CMC 58.2 B-ME2 B-ME3 Commercial kitchen hood ventilation CMC Performance test Refrigeration equipment CMC B-ME4 B-ME5 B-ME56 Refrigeration detection and alarm system CMC & CFC 66.8 Refrigeration flaring system CMC Safety and effectiveness Steam and hot water boilers CMC 113. B-ME7 B-ME8 B-ME9 Hydronics CMC 125.2, & Pressure test of steam and water piping Process piping CMC Pressure test Ventilation system CMC & Table 4-A Areas tested and balanced OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 4 of 7

6 SECTION B DOCUMENT SUBMITTAL TESTS B-ME1 Airborne Infection Isolation Rooms and Protective Environment Rooms CMC Alarm system test B-ME11 Airborne Infection Isolation Rooms and Protective Environment Rooms CMC 417. Mechanical system tested and balanced B-ME15 B-ME14 B-ME13 B-ME16 B-ME12 PLUMBING TESTS B-P1 B-P2 B-P3 B-P4 B-P5 B-P6 B-P7 B-P8 B-P9 B-P1 B-P11 x Disinfection of potable water systems CPC 69.9 Medical gas and vacuum NFPA Gas and vacuum system performance testing Medical gas and vacuum NFPA Gas and vacuum system verification testing Existing sewers and drains CPC , 15.3 & 712. Tested for conformance with requirements for new work Water supply system CPC 15.3 & 69.4 Pressure tested prior to covering or concealment Plumbing, drainage, and venting systems CPC 15.3 & 712. Water or air tested prior to use, covering or concealment Building sewer CPC 15.3, 712. & 723. Water or air tested prior to use, covering or concealment Storm drain piping CPC 116. Water or air tested prior to use, covering or concealment Fuel piping CPC Air, CO2 or nitrogen tested prior to use, covering or concealment Private sewer disposal system CPC 15. & H11. Tested prior to use, covering or concealment Protectively coated pipe CPC Tested for voids, damage and imperfections OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 5 of 7

7 SECTION B DOCUMENT SUBMITTAL TESTS B-P12 B-P13 B-P14 B-P15 B-P16 B-P17 B-P18 B-P19 B-P2 Defective systems CPC Air test of defective drainage and plumbing systems Moved structures CPC 12.7 All parts of plumbing systems tested Retesting CPC Retest after corrections Shower receptors CPC Backflow prevention devices and assemblies CPC 63.2 & Assembly tested Nonpotable water CPC Inspection and testing Relaimed (recycled) water systems CPC & Initial cross-connection test, inspection and testing On-site treated nonpotable gray water systems CPC & Initial cross-connection test, inspection and testing FIRE PROTECTION EQUIPMENT TESTS B-FP1 B-FP2 B-FP3 B-FP4 B-FP5 B-FP6 B-FP7 B-FP8 B-FP9 B-FP1 Joints and connections CPC , pressure tested for gas and water tightness Fire Alarm CFC 91.5 & CFC 97.7 NFPA Acceptance and Reacceptance Testing Fire and smoke dampers CFC 91.5 & CFC 97.8 Duct Detectors CFC 91.5, NFPA Differential Pressure Test Smoke control system CFC 91.5, CFC & CBC 175A.17 Fire sprinkler CFC 91.5 & NFPA Chapter 25 Aboveground piping Fire sprinkler CFC 91.5 & NFPA Chapter 25 Underground piping Standpipe system CFC 91.5 & NFPA Chapter 11 Aboveground piping Standpipe system CFC 91.5 & NFPA Chapter 11 Underground piping Private fire mains CFC 91.5 & NFPA Fire pumps CFC 91.5 & NFPA & 14.2 OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 6 of 7

8 SECTION B DOCUMENT SUBMITTAL TESTS B-FP14 B-FP13 B-FP12 B-FP11 Fire protection water tank CFC 91.5 & NFPA Chapter 17 Wet chemical extinguishing system CFC 91.5 & NFPA 17A Clean agent extinguishing system CFC 91.5 & NFPA CO2 extinguishing system CFC 91.5 & NFPA & B-FP18 B-FP17 B-FP16 B-FP15 Dry chemical extinguishing system CFC 91.5 & NFPA Halon 131 extinguishing system CFC 91.5 & NFPA 12A Underground fuel storage tank CFC & NFPA Initial testing Underground fuel storage tank CFC & NFPA Tightness testing B-FP19 Flammable and combustible liquid fuel piping CFC Pressure testing B-FP2 OTHER TESTS B-OT6 B-OT5 B-OT4 B-OT3 B-OT2 B-OT1 OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 7 of 7

9 SECTION C DOCUMENT SUBMITTAL SPECIAL INSPECTIONS STRUCTURAL SPECIAL INSPECTIONS x11 Foundation C-F1 C-F2 C-F3 C-F4 C-F5 C-F6 C-F7 Soils CBC 175A.6 Soil fill Foundation CBC 175A.7 Driven deep foundations Foundation CBC 175A.8 Cast-in-place deep foundations Foundation CBC 175A.9 Helical pile foundations Shoring CBC 1812A Shoring Vibro Stone Columns (VSC) CBC 1813A Vibro Stone Columns Prestressed soil and rock anchors CBC 175A.3, 1811A & 1812A Installation and testing C-F9 C-F8 x12 C-C8 C-C7 C-C6 C-C5 C-C4 C-C3 C-C2 C-C1 CBC 175A.3; ACI & Placement of concrete CBC 175A.3; ACI Admixtures CBC 175A.3; ACI Mix Design CBC 175A.3; ACI Reinforcing steel & prestressing steel CBC 175A.3 CIP & Post-installed anchors CBC Table 175A.3 Adhesive anchors in horizontal and upwardly inclined positions CBC 175A.3; ACI Specialty inserts, Stud rails, Rebar mechanical conn., Headed rebar CBC 175A.3.3 Batch plant inspection OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 1 of 5

10 SECTION C DOCUMENT SUBMITTAL SPECIAL INSPECTIONS C-C17 C-C16 C-C15 C-C14 C-C13 C-C12 C-C11 C-C1 C-C9 CBC 175A.3.5; ACI Prestressed concrete CBC 175A.3 & 175A.12.5 Precast concrete fabrication & precast panels CBC 175A.3 Precast concrete erection Shotcrete CBC 175A.19 & 198A Installation CBC 175A.3 Insulating concrete CBC 175A.3, 175A.3.1 & 193A.8 Welding of reinforcing bars CBC 175A.12.5 GFRC panels CBC 1911A.2; ACI 53.7 Crack repair by epoxy injection CBC 1911A.3, ICC AC178 Sec. 3 to 8 Strengthening by externally bonded FRP C-C19 C-C18 x13 C-MA4 C-MA3 C-MA2 C-MA1 CBC 175A.4 Laying and grouting CBC 214A.1.3 Low lift grout CBC 214A.1.3 High lift grout CBC 175A.4 anchors C-MA6 C-MA5 x14 C-S1 CBC 175A.2 & 175A.12.1 shop fabrication OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 2 of 5

11 SECTION C DOCUMENT SUBMITTAL SPECIAL INSPECTIONS C-S6 C-S5 C-S4 C-S3 C-S2 x CBC 175A.2.5 & 175A.12.1 Automatic end-welded studs CBC 175A.2.5 & 175A.12.1 Shop and field welding AWS D1.1 3 & 4 and AWS D Shop and field welding - WPS / WPQR CBC 175A.2 & 175A.12.1 High strength bolt installation CBC 175A.2, 175A.11.2 & 175A.12.3 Cold-formed steel light frame construction C-S8 C-S7 x15 Wood C-W4 C-W3 C-W2 C-W1 Wood CBC 175A.5, 175A.5.4, 175A.11.1 & 175A.12.2 Glue laminated timber Wood CBC 175A.5.6, 175A.11.1 & 175A.12.2 Installation of timber connectors Wood CBC 175A.5 & 175A.5.5 Manufactured trusses Wood CBC 175A.11.1 & 175A.12.2 Nailing, screw attachment, bolting, anchoring, field gluing operations and other fastening C-W6 C-W5 x16 Other Structural Materials C-OM1 C-OM2 Aluminum CBC 23.1 Inspection Structural Sealant Glazing CBC Structural sealants for exterior glass curtain walls C-OM3 x17 Alternative Systems C-AS1 C-AS2 Alternative system CBC 175A.1.1 Construction materials and methods for alternative system Seismic isolation and damping system CBC 175A.12.8 Fabrication, installation, prototype, and production testing OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 3 of 5

12 SECTION C DOCUMENT SUBMITTAL SPECIAL INSPECTIONS C-AS4 C-AS3 x18nonstructural components, supports and attachments C-N1 C-N2 C-N3 C-N4 C-N5 C-N6 Architectural components CBC 175A.12.5 & 175A.16 Cladding, nonbearing walls and veneer Ceiling CBC 175A.12.5 Suspended ceiling systems and their anchorage Access floors CBC 175A Anchorage of access floor systems Storage racks 8 or taller CBC 175A.12.7 Anchorage Plumbing, mechanical and electrical components CBC 175A.12.6 Anchorage, bracing, and vibration isolators Special Seismic Certification CBC 175A.12.4 Special Seismic Certification label, anchorage and mounting C-N8 C-N7 MECHANICAL SPECIAL INSPECTIONS C-M6 C-M5 C-M4 C-M3 C-M2 C-M1 PLUMBING SPECIAL INSPECTIONS C-P4 C-P3 C-P2 C-P1 OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 4 of 5

13 SECTION C DOCUMENT SUBMITTAL SPECIAL INSPECTIONS C-P5 FIRE PROTECTION SPECIAL INSPECTIONS C-FP1 C-FP2 C-FP3 C-FP4 C-FP5 C-FP6 C-FP7 C-FP8 x Sprayed fire-resistant materials CBC 175A.14 Spray-applied fireproofing Mastic and intumescent fire-resistant coatings CBC 175A.15 In accordance with AWCI 12-B Penetration firestops CBC 175A.17.1 Penetration firestop systems that are tested and listed Fire-resistant joint systems CBC 175A.17.2 Fire-resistant joint systems that are tested and listed Smoke control systems CFC & CBC 175A.18 Ductwork and operation Sprinkler system piping NFPA Welded pipe and fittings Standpipe system piping NFPA Welded pipe and fittings OTHER SPECIAL INSPECTIONS C-OT1 Exterior insulation and finish systems (EIFS). CBC 175A.16 EIFS applications C-OT2 Water-resistive barrier coating CBC 175A.16.1 ASTM E257 Barrier coating when installed over a sheathing substrate. C-OT3 Medical Gas, NFPA chapter 5MC, Brazing and Labeling. C-OT6 C-OT5 C-OT4 OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 5 of 5

14 SECTION D Facility #: Faclity Name: Project #: Reference PROJECT MILESTONE OR INTERVAL Tri-City Medical Center VERIFIED CONSTRUCTION INSPECTION AND OBSERVATION REPORTING CONSTRUCTION S VERIFIED REPORT AS INDICATED (Form OSH-FD-123) (See PERSONAL KNOWLEDGE as defined in California Administrative Code, Section 7-151) FOR OSHPD ONLY GEOR AOR SEOR MEOR EEOR CONT IOR SP INSP TEST LAB OSHPD FDD PROJECT COMPLETION x ABBREVIATIONS: GEOR - Geotechnical Engineer of Record AOR - Architect of Record SEOR - Structural Engineer of Record MEOR - Mechanical Engineer of Record EEOR - Electrical Engineer of Record CONT O/B - Contractor or Owner/Builder SP. INSP - Special Inspector IOR - Inspector of Record Test Lab Engr. For the approved agency OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 1 of 1

15 SECTION F PLAN REVIEW APPROVAL 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. Gerald Wayne Hunter 11/8/217 Architect/Engineer of Record (Print Name) Architect/Engineer of Record (Signature) Date Alvaro Celestino 11/28/217 11/8/217 Structural Engineer of Record (Print Name) Structural Engineer of Record (Signature) Date FOR OSHPD ONLY OSHPD Plan Approval: Name Date Comments: OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 1 of 1

16 SECTION G BUILDING PERMIT APPROVAL NOTE: For testing, Inspection and Observation Program Instructions, visit our website: Gerald Wayne Hunter C /8/217 Architect/Engineer of Record (Print Name) Professional License # Architect/Engineer of Record (Signature) Date OSHPD TI&O Program Approval: FOR OSHPD ONLY Name Date Comments: OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 1 of 1

17 SECTION H SUMMARY OF CHANGES TO THE TIO PROGRAM NOTE: Note all changes shall be approved as amended construction documents per CAC 7-153, or concurred with as non-material alterations per CAC 7-153(b), by OSHPD prior to proceeding with the related work. Facility #: Faclity Name: Project #: Tri-City Medical Center S TESTING, INSPECTION, OBSERVATION PROGRAM NON-MATERIALLY ALTER CHANGES BY THE ARCHITECT OF RECORD / ENGINEER OF RECORD IN RESPONSIBLE CHARGE An in column F or G indicates the indicated DPOR has reviewed the changes made and the acceptance statement in Section I of this Form is applicable to any approved agencies/testing laboratories and special inspectors added. OSHPD FDD CONCURRENCE REVISION # SYNOPSIS OF CHANGE Architect/Engineer of Record Signature Structural Engineer of Record Signature DATE OSH-FD-33A (Rev 3/12/215) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY Page 1 of 1