APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER S CERTIFICATION (OPM)

Transcription

1 OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER S CERTIFICATION (OPM) APPLICATION #: OFFICE USE ONLY OPM OSHPD Preapproval of Manufacturer s Certification (OPM) Type: New Renewal Update to Pre-CBC 2013 OPA Number: Manufacturer Information Manufacturer: Chatsworth Products, Inc. Manufacturer s Technical Representative: Brandi Oldt Mailing Address: 3004 South Austin Ave., Georgetown, TX Telephone: (800) BOldt@chatsworth.com Product Information Product Name: Product Type: Universal & Standard d Racks Instrumentation Cabinet OPM Product Model Number: X03, 3, X05, X15, X03 5, 03 General Description: Telecommunication io on Rack / Applicant Information Applicant Company Name: EASE Co. Contact Person: Jonathan Roberson, S.E. Mailing Address: 5877 Pine Ave. Suite 210, Chino Hills, CA Telephone: (909) J.Roberson@EASECo.com I hereby agree to reimburse the Office of Statewide Health Planning and Development review fees in accordance with the California Administrative Code, Signature of Applicant: Date: 8/28/15 Title: Principal Engineer Company Name: EASE Co. Access to Safe, Quality Healthcare Environments that Meet California s Diverse and Dynamic Needs STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY OSH-FD-700 (REV 1/24/13) Page 1 of 2 OPM : Reviewed for Code Compliance by Page 1 of 17

2 OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION Registered Design Professional Preparing Engineering Recommendations Company Name: EASE Co. Name: Jonathan Roberson, S.E. California License Number: S4197 Mailing Address: 5877 Pine Ave. Suite 210, Chino Hills, CA Telephone: OSHPD Special Seismic Certification Preapproval (OSP) Special Seismic Certification is preapproved under OSP- (Separate application for OSP is required) Special Seismic Certification is not preapproved Certification Method(s) Testing in accordance with: ICC-ES C-ES AC156 FM Other* (Please Specify): *Use of test criteria other than those adopted d by the California Building Standards a ds Code, 2013 (CBSC 2013) for component supports and attachments ts are not permitted. t e For distribution i ti system, s interior partition wall, and suspended ceiling seismic bracings, test criteria ia other than those adopted d in the CBSC C 2013 may be used when approved by OSHPD prior to testing. Analysis Experience Data Combination of Testing, Analysis, s, and/or Experience e e Data a (Please e Specify): - List of Attachments Supporting the Manufacturer s u rsce r s Certification i ion Test Report Drawings Calculations Manufacturer s Catalog Other(s) (Please Specify): OFFICE USE ONLY OSHPD APPROVAL VALID FOR CBC 2013 ONLY Signature: Date: Print Name: Title: SSE Condition of Approval (if applicable): Access to Safe, Quality Healthcare Environments that Meet California s Diverse and Dynamic Needs STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY OSH-FD-700 (REV 1/24/13) Page 2 of 2 OPM : Reviewed for Code Compliance by Page 2 of 17

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