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City of Bakersfield FORM Development Services CITY OF BAKERSFIELD 1715 Chester Avenue STRUCTURAL TESTS AND INSPECTIONS Bakersfield, CA 93301 SCHEDULE (661) 326-3733 Prior to issuance
on a Building Permit, the Owner, on the advice of the Architect or Engineer, shall complete, sign, and submit this form to the Building Official. ____________________________________
______________________________ ________________ Project Address Permit Number Date ____________________________________ ______________________________ ________________ Project Engineer/Architect
Name (print) Project Engineer/Architect Signature Engineers Phone ____________________________________ ______________________________ ________________ Testing/Inspection Agency's Name
Testing/Inspection Agency's Signature Agency's Phone ____________________________________ ______________________________ ________________ Contractors Name (print) Contractors Signature
Contractors Phone ____________________________________ ______________________________ ________________ Owners Name (print) Owners Signature Owners Phone All the above hereby certifies
that the Testing/Inspection Agency named above has been engaged to perform structural tests and inspection during construction, as checked below, to satisfy all applicable portions of
the Building Code. Notice: All required test reports and inspections must be submitted to the Building Department on a weekly basis. Prior to issuance of final inspection, the Testing/Inspection
Agency shall submit a statement that all items of designated work items on this list are ready for sampling, testing, or inspection, so that the required services may be performed. CONCRETE,
GROUT, AND MORTAR REINFORCING STEEL: Conc. Grout Mortar ____ Tensile & Bend, one set per heat per _____ tons ____ _____ _____ Aggregate Tests for Design ____ Inspection of Placement
____ _____ _____ Suitability of Aggregate ____ Inspection of Welding ____ _____ _____ Mix Designs ____ _____ _____ Test Panels STRUCTURAL STEEL: ____ _____ _____ Batch Plan Inspection
____ Sample & Test (List Specific Members Below) ____ _____ _____ Compression Tests ____ Shop Identification & Welding Inspection ____ _____ _____ Cast Specimens ____ Shop Ultrasonic
Inspection ____ _____ _____ Shrinkage Bars ____ Shop Radiography ____ _____ _____ Yield Check ____ Field Welding Inspection ____ _____ _____ Air Check ____ Field Bolting Inspection ____
_____ _____ Dry Unit Weight ____ Field Ultrasonic Inspection ____ Field Radiology PRECAST CONCRETE: ____ Field Deck Welding Inspection ____ Reinforcement Test ____ Inspection of Reinforcing
Placement FIREPROOFING: ____ Tendon Tests ____ Inspection of Placement ____ Inspection of Concrete Placement ____ Density Tests ____ Inspection of Concrete Batching ____ Thickness Tests
____ Inspection of Panel Attenuation & Inserts ____ Inspection of Panel Installation STRUCTURAL WOOD: ____ Compression Tests ____ Inspection of Fabrication ____ Inspection of Placement
& Grouting ____ Inspection of Truss Joint Fabrication ____ Sample & Test Component MASONRY: ____ Preliminary Acceptance Tests (Masonry Units, Wall Prisms) OTHER TESTS, INSPECTIONS, OR
____ Subsequent Tests (Mortar, Grout, Prisms) INSTRUCTIONS: ____ Inspection of Grouting ____ Inspection of Placement of Grouting ____ _____________________________________ GRADING, SOILS,
FILL MATERIAL: ____ _____________________________________ ____ _____________________________________ ____ ____________________________________________ structural_tests_inspections FORM
11/26/2008. AM