Form Ds-311 - Certificate Of Compliance For Off-Site Fabrication - City Of San Diego
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1City of San Diego
Certificate of
Inspection Services Division
Planning and Development Review
Compliance for
9601 Ridgehaven Court • Suite 220 • MS 1102-B
San Diego, CA 92123
Off-Site Fabrication
Information (858) 492-5070 • FAX (858) 492-5098
(MUST BE FILED WITH THIS OFFICE AND APPROVED PRIOR TO ERECTION OF FABRICATED COMPONENTS)
FABRICATION CO. NAME _____________________________________________ TELEPHONE NO. (_______) _______________
FABRICATION SHOP ADDRESS ______________________________________________ FAX NO. (_______) _______________
CITY ________________________________________________ STATE ____________________ ZIP CODE _______________
BUILDING PERMIT NO./S ______________________________ PLAN FILE NO. ________________________________________
(For projects with multiple permit numbers but with the same plan file number, you may list all permit numbers and addresses on a separate sheet.)
JOB SITE ADDRESS _________________________________________________________________________________________
DESCRIPTION OF COMPONENTS FABRICATED _________________________________________________________________
__________________________________________________________________________________________________________
FABRICATOR IS CURRENTLY CERTIFIED BY (refer to BNL 17-6):
ICBO
AISC
ACI
PCI
pti
Other ___________________________________
Certificate No. _____________________ Expiration Date ______________
SPECIAL INSPECTOR ASSIGNED
Certificate No. ___________________
(BY BUILDING OWNER) _____________________________________
(Not required for a fabricator registered and approved by the City of San Diego, unless otherwise noted on the approved permitted plans and specifications.)
FABRICATION DRAWINGS REVIEWED AND ACCEPTED BY DESIGNER OF RECORD?
YES
NO
STRUCTURAL FRAMING PLANS, DETAILS & CALCULATIONS REVIEWED AND APPROVED BY THE CITY OF SAN DIEGO
BUILDING OFFICIAL?
YES
NO
FABRICATION COMMENCEMENT DATE ____________________ FABRICATION COMPLETION DATE ____________________
We hereby certify that the components described and listed herein comply with the approved permitted plans, specifications and
workmanship provisions of the California Building Code as amended by The City of San Diego and other applicable regulations. We
further certify that each fabricated member or component has been inspected and meets all the requirements of the California Building
Code as amended by The City of San Diego and other applicable regulations. We further certify that each fabricated member or
component listed herein shipped to the project job site with an identifying mark or tag. We understand this certificate shall be submitted
to the Inspection Services Division and the architect / engineer of record prior to erection of the fabricated members and components.
NOTE: This certification is limited to fabrication of the components or members described above to be used in the structures identified
by the permit numbers shown and is not transferrable to any other fabrication work or other construction sites.
Name (Print): ____________________________________________________________ Title: ______________________________
Any person signing this application as an agent of the fabrication company declares under penalty of perjury to be an authorized agent
of record of the fabrication company having the authority to execute this document.
Executed on this __________________ day of _____________________ / _______________________ .
MONTH
YEAR
Signature: _____________________________________________________________________________
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-311 (3-00)
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Printed on Recycled Paper
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