Form Ds-310 - Special Inspection Agency - Construction Materials Testing Laboratory Final Report - 2006
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1City of San Diego
Special Inspection Agency/
Inspection Services Division
Planning and Development Review
Construction Materials Testing
9601 Ridgehaven Court • Suite 220 • MS 1102-B
San Diego, CA 92123
Laboratory Final Report
Information (858) 492-5070 • FAX (858) 492-5098
DATE: ____________ / ____________ / ___________
TO: Building Official, City of San Diego
Inspection Services, Planning and Development Review
9601 Ridgehaven Court, Suite 220
San Diego, CA 92123
SUBJECT: SATISFACTORY COMPLETION OF WORK REQUIRING:
(PLEASE CHECK AS APPLICABLE)
SPECIAL INSPECTION
CONSTRUCTION MATERIALS TESTING
PERMIT NO.: ________________________________________ PLAN FILE NO.: ________________________________________
PROJECT ADDRESS: ______________________________________________________________________ San Diego, California
The special inspection services were provided by:
SPECIAL INSPECTION AGENCY: ______________________________________________________________________________
ADDRESS: _________________________________________________________________________________________________
SPECIAL INSPECTOR’S NAME:
(TYPE OR PRINT) _______________________________________________________________________________________
(each special inspector is required to complete and submit this Final Report form)
SPECIAL INSPECTOR’S CERTIFICATION NUMBER: _______________________ EXPIRATION DATE: ____________________
The construction materials testing were performed by:
TESTING LABORATORY: _____________________________________________________________________________________
ADDRESS: _________________________________________________________________________________________________
RESPONSIBLE MANAGING CIVIL ENGINEER OF THE TESTING LABORATORY:
(MR./MS.) __________________________________________
STATE OF CALIFORNIA REGISTRATION NUMBER: _____________________________ EXPIRATION DATE: _______________
COMMENTS: _______________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
I declare under penalty of perjury that, to the best of my knowledge, all the work requiring special inspection and/or material sampling
and testing for the structure/s constructed under the subject permit is in conformance with the approved plans and construction docu
ments, the approved inspection and testing program and the applicable workmanship provisions of the California Building Code as
amended by The City of San Diego.
Executed on this __________________ day of _____________________ / _______________________ .
MONTH
YEAR
Signature: _____________________________________________________________________________
(SPECIAL INSPECTOR OR RESPONSIBLE MANAGING CIVIL ENGINEER, AS APPLICABLE)
NOTE: At your option this form may be stored electronically and reproduced on your company’s letterhead.
This information is available in alternative formats for persons with disabilities.
To request this information in alternative format, call (619) 236-7703 or (800) 735-2929 (TT)
DS-310 (8-06)
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Printed on Recycled Paper
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