Form Osh-Fd-303s1 - California Building Standards Code - Oshpd 1 - 2013 Page 3

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OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT
FACILITIES DEVELOPMENT DIVISION –
400 R Street, Suite 200 ~ Sacramento, California 95811
Phone (916) 440-8300
FAX (916) 324-9188
700 N. Alameda Street, Suite 2-500 ~ Los Angeles, California 90012 Phone (213) 897-0166
FAX (213) 897-0168
Testing, Inspection and Observation Program
2013 California Building Standards Code – OSHPD 1
Samples of Test and Inspection Reports are:
(NOT required for tests performed by laboratories approved through OPL Program)
E
 Attached
 To be provided following determination of the responsible firm(s) or individual(s). Samples shall be submitted to and approved by the Office,
prior to proceeding with the work that requires tests or special inspections.
 Not applicable. Project has no required tests or special inspections.
Required test and inspection reports shall be prepared and submitted to OSHPD/FDD within ____ days of the completion of all tests
and inspections. If not designated, all reports shall be submitted to the Office within 15 calendar days.
In addition to the preprinted tests and special inspections identified on this form, this program includes additional tests and special inspections as
indicated:
 Other Tests
 Other Special Inspections
 See Attachment
Verification that approved test and inspection agencies are objective, competent and independent as required by the CBC 2013 Section
1703A.1.1:
 Verification of independence and acceptance of test and inspection agencies by Registered Design Professional (RDP) in responsible charge
In accordance with the CAC Section 7-141.
 Testing agency qualification for approval or approval of testing agencies through OPL program.
 Inspection agency qualification for approval.
This program has been 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.
Submitted by:
Architect/Engineer of Record (Print Name)
Professional License #
Architect/Engineer of Record (Signature)
Date
FOR OFFICE USE ONLY
OSHPD Plan Approval:
OSHPD Field Acceptance:
Name
Date
Name
Date
A
AC
D
Architectural
Date
A
AC
D
Structural
Date
A
AC
D
Mechanical
Date
A
AC
D
Electrical
Date
A
AC
D
Fire and Life Safety
Date
OSH-FD-303S1 (Rev 08/12/14)
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
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