Form Osh-Fd-125 Post Approval Document
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4RECEIVED
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT
FACILITIES DEVELOPMENT DIVISION
OFFICE USE ONLY
Project#
Increment #
Post Approval Document
PAD-
Facility
Project #
Facility #
Facility Name
OSHPD Building # BLD -
Building Name
Type of Facility
Acute Psychiatric Hospital
General Acute Care Hospital
Skilled Nursing or Intermediate Care Facility
Correctional Treatment Center
Licensed Clinic
Record Detail
Record/Project Name
Detailed Description
Application Specific Information – Post Approval Document
Submittal Type
Amended Construction Document
Deferred Item (Include Project Information form OSH-FD-100.)
Applicant Tracking Number
Reason for Change
Scope of Change
PROFESSIONAL
By my signature below, I acknowledge that the documents for the submittal type above have been reviewed and have been found to be in
general conformance with the design of the project.
Signature of Architect or Engineer in Responsible Charge
Date
Signature of Structural Engineer
Date
(Required on projects that include primary gravity and/or lateral load elements/systems)
Application Specific Information – Critical Path Expedite Review
Critical Path Expedite Review Requested
Justification
OFFICE USE ONLY - OSHPD APPROVAL
Printed Name
Title
Signature
Date
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
OSH-FD-125 (Rev 11/11/11)
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Parent category: Legal