Form DSA 140: Application for Approval of Construction ... · This form shall be completed by the...

140 APPLICATION FOR APPROVAL OF CONSTRUCTION CHANGE DOCUMENT – CCD CATEGORY A/B This application is for construction changes, as defined in IR A-6, to approved contract documents. This form shall be completed by the Design Professional in General Responsible Charge of the project, in accordance with California Code of Regulations, Title 24, Part 1, Section 4-338 (c) and in compliance with DSA IR A-6.

School District/Owner: DSA File #:

-

Project Name/School: DSA App. #:

-

APPLICANT CCD Cat. A / B, #: Date Submitted: Attached Pages?: No Yes (_____pages)

For CCD Cat. B, this is a voluntary submittal, DSA required submittal (attach DSA notification requiring submission).

Firm Name: Contact Name:

Email: Phone Number: Address: City: State: Zip:

A DSA 301-N, DSA 301-P, or 90-Day Letter has been issued for this project.

For project currently under construction.

To obtain DSA approval of existing uncertified building(s).

DESIGN PROFESSIONAL IN GENERAL RESPONSIBLE CHARGE Name of Design Professional in General Responsible Charge: Professional License #: Discipline:

Design Professional in General Responsible Charge Statement: The attached Construction Change Documents have been examined by me for design intent and appear to meet the appropriate requirements of Title 24, California Code of Regulations and the project specifications. They are acceptable for incorporation into the construction of the project. Signature: _______________________________________________________________________________________ DESIGN PROFESSIONAL IN GENERAL RESPONSIBLE CHARGE

CHECK THIS BOX: To confirm that all CCD drawings and, when applicable, first sheet or index of calculations and specifications have been stamped and signed by the Responsible Design Professional listed on DSA 1 for this this project. Brief description of construction change (attach additional sheets if needed):

List of DSA approved drawings affected by this CCD:

DSA USE ONLY For business office use only

Date Sent Return By Delivery Method

DSA Stamp

SSS Date Approved / Disapproved / Not Req’d FLS Date Approved / Disapproved / Not Req’d

ACS Date Approved / Disapproved / Not Req’d Remarks

DSA 140 (rev 12-16-16) Page 1 of 1 DIVISION OF THE STATE ARCHITECT DEPARTMENT OF GENERAL SERVICES STATE OF CALIFORNIA

Tahoe Truckee Unified School District 31 H4

Truckee HS Modernization Increment #1 02 115331

09 05/11/18 17

DLR Group Kolby Harpstead

[email protected] (916) 596-4299

1050 20th Street Suite 250

Sacramento CA 95811

Jon P. Anderson

C-29998 Architecture

Resubmittal to pick up DSA comments for drinking fountain per SK-C-1, SKA-1, PSK-1-4 including chain link fencingand gates along the perimeter of the field and path of travel to playing fields.

C2.3, C4.1, C5.1, C7.2, CPS5.0, AS1.3, P0.1, P0.3, P6.3,

A

PS1.2

08/14/18 16

, C3.3

galeeDSA Approval Stamp

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IDENTIFICATION STAMPDIV. OF THE STATE ARCHITECT

OFFICE OF REGULATION SERVICES

APPL. #02-115331

AC_______FLS_______SS_______

DATE________________

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( IN FEET )

GRAPHIC SCALE0

THIS DRAWING MAY HAVE BEEN ENLARGED OR REDUCED.

NO

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1 inch = 20 feet

40'20'10'20'

GRADING NOTES

Attac

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© , DLR Group inc., SELECT STATE project is IN, ALL RIGHTS RESERVED

DLR Group

Attachment No. C2CCD-009Dated: 08/13/2018

75-15110-00

08.13.18

TRUCKEE HIGH SCHOOL MODERNIZATION

PARTIAL DRAINAGE PLANC3.3

2016

TAHOE * TRUCKEE UNIFIED SCHOOL DISTRICTArchitecture Engineering Design

NO

RT

H

1 inch = 20 feet

20'0

DRAINAGE NOTES


STOP

STOP

DOMESTIC WATER NOTES


DLR Group75-15110-00

08.13.18


DOMESTIC WATER PLANC4.1

2016


NO

RT

H

1 inch = 30 feet

30'0


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STOP

75

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C5

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30'0

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PAVING LEGEND

PAVING LEGEND



DLR Group


75-15110-00

04.04.18


DETAILS AND SECTIONSC7.2

2016


08/13/2018

DONNER PASS

ROAD

DONNER PASS

ROAD

DONNER PASS

ROAD

INTERSTATE 80

WALK

WALKDBL YEL

BIKE LANE

BIKE LANE

DBL YEL

DBL YEL

DBL YEL

DN

DN

DN

DN

DN

S2°

00'3

0"E

533.

72'

UP

UP

DN

TRASH

UP

DELIVERY/SERVICE

CONTROLLEDACCESS GATE

HARDCOURTS

DN

PLAY FIELDS

ST

OP

STO

P

DROP OFF, SEE 15/C7.1

UP

PATIO

PATIO

BUILDING 5

INCREMENT 2

INCREMENT 2

INCREMENT 2

INCREMENT 2

EXISTING BUILDING

INCREMENT 1

FDC

FDC

EJEJEJEJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ EJ

EJ

EJ

EJ

EJ

EJ

EJ

EJ

(N)

(N)

(N)

(N)

(E)

(E)

MA

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- A

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MA

TC

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- A

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A 2

MATCHLINE - AREA 2MATCHLINE - AREA 4

MATCHLINE - AREA 1MATCHLINE - AREA 3

MA

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- A

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A 3

MA

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- A

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1 2

43

EJ

EJ

EJ

CONC.SEATWALL, TYP.

CONC.HARDSCAPE

(E) RAMP& STAIRS

(N) KEYPAD OPERATEDACCESS GATE W/ KNOX BOX,SEE

EXISTINGACCESS GATE

KB

MAINENTRANCE

MAINENTRANCE

MAINENTRANCE

P.O.T - PATH OF TRAVEL

ALL NEW ROUTES ARE, BARRIER FREE ACCESS ROUTE WITHOUT ANYABRUPT VERTICAL CHANGES EXCEEDING 1/2" BEVELED @ 1:2 MAXIMUMSLOPE, EXCEPT THAT LEVEL CHANGES DO NOT EXCEED 1/2" VERTICALAND IS AT LEAST 48" WIDE. LEVEL CHANGES GREATER THAN 1/2" SHALLCOMPLY W/ RAMP REQUIREMENTS. THE PATH SURFACE IS SLIPRESISTANT, STABLE, FIRM , AND SMOOTH. PASSING SPACES AT LEAST60" X 60" ARE LOCATED NOT MORE THAN 200' APART. PARTS OF P.O.T.WITH CONTINUOUS GRADIENTS HAVE 60" LEVEL AREAS NOT MORETHAN 400' APART. THE CROSS-SLOPE DOES NOT EXCEED 2% ANDSLOPE IN THE DIRECTION OF TRAVEL AND IS 5% OR LESS UNLESSOTHERWISE P.O.T. SHALL BE MAINTAINED FREE OF OVERHANGINGOBSTRUCTIONS TO 80" MINIMUM AND PROTRUDING OBJECTS GREATERTHAN 4" PROJECTION FROM WALL AND ABOVE 27" AND LESS THAN 80"

GENERAL NOTES

C7.3

4

C7.3

5

C7.3

6

C7.3

7

TOW-AWAY SIGN,SEE C5.1 & 2/A7.3


LOADING ZONE, SEE AS0.0

128' - 1 1/4" ±

TOTAL LOADING ZONEPROVIDED: 275' - 0"ACCESSIBLE LOADING ZONEPROVIDED: 60' - 9"(3 × 20' = 60' MIN)

NO STOPPINGZONE, SEE AS0.0

NOSTOPPINGZONE, SEEAS0.0

STOP

STOP

ACCESSIBLE LOADING, SEE AS0.0

60' - 9"

LOADING ZONE, SEE AS0.0

146' - 10"

49,795 S.F.

TOW-AWAYSIGN, SEE C5.1& 2/A7.3

/53 AS8.2

TOW-AWAYSIGN, SEE C5.1& 2/A7.3

/53 AS8.2

ST

OP

ST

OP

/55 AS9.3

(E) RAMP & STAIR

TOW-AWAYSIGN, SEEC5.1 & 2/A7.3

/53 AS8.2

LIGHT POLE - SEE ELECTRICAL DWGS

EJ

PROPERTY LINE

NEW BUILDING LINE

EXISTING/NEW CURB, SEE CIVIL DWGS

PAVING CONTRACTION JOINT - SEE CIVIL

PAVING EXPANSION JOINT - SEE CIVIL

FENCE

SITE SYMBOLS

ACCESSIBLE PATH-OF-TRAVELTO PUBLIC RIGHT-OF-WAY ANDSAFE DISPERSAL AREA. FIRE TRUCK ACCESS

150'-0" MAX. FIRE HOSE PULL RADIUS COVERAGE

150'-0" MAX. FIRE HOSE PULL PATH

KNOX BOX LOCATION, SEE SITE GENERALNOTES A & B ON AS0.0KB

FIRE LANE CURB

EXISTING BUILDING

NEW BUILDING - INCREMENT 1

NEW WORK - INCREMENT 2

EXISTING FIRE HYDRANT TO REMAIN

TURF/ PLANTING AREA , SEE LANDSCAPE DWG

(E)

NEW FIRE HYDRANT(N)

FDC/PIV FIRE DEPARTMENT CONNECTION & POSTINDICATOR VALVE, SEE FIRE PROTECTION DWG

BFP BACK FLOW PREVENTER, SEE CIVIL DWG

SNOW MELT AREA

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LEGEND NOTES ARE COMMON TO ALLSOME NOTES MAY NOT APPLY TO THIS SHEET

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IDENTIFICATION STAMPDIV. OF THE STATE ARCHITECT

OFFICE OF REGULATION SERVICES

APPL. #02-115331INCREMENT 1

AC_______FLS_______SS_______

DATE________________

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NORTHSCALE: 1" = 30'-0"

OVERALL SITE ACCESSIBILITY PLAN

PLAY FIELDS

EJ


/53 AS8.2 ST

OP

ST

OP

EJ

EJ

EJ

SKA- 2

1

5' - 0"

6' -

0"

5' -

0"

5' -

0"

6' -

0"

R 7

4' - 1

1"

R 22' - 6"

UTILITY PAVING; MAINTAIN 1:50 MAX. SLOPE INALL DIRECTIONS. GATES WILL REMAIN CLOSEDTO EQUIPMENT DURING FIELD USE.

6' CHAIN LINKFENCE

40' GATEFOR SNOWREMOVAL

2SKA-1

1SKA-1

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CCD-09


6' HIGH CHAINLINK FENCE,SEE DETL.

4' GATE w/ADA HARDWARE

DRINKING FOUNTAIN PER PSK-3

TRUNCATEDDOMES PER 5/C7.1

ADA FORWARD APPROACHDRY WELL

ANTI-SIPHON FREEZELESSYARD HYDRANT12" x 12" x 18" HIGH PEDESTAL

SKA-1

4

SKA-1

3

/2 SKA-1

2 ' - 2 "3 ' - 1 1"

1 ' - 1 "5 ' - 0 "

5' - 0"2' - 0"3' - 0"

10' - 0"

1' - 10"

2 ' - 3 "

4 ' - 7 "

8 1/2"

5 ' - 0 "

1 2' - 2"

NOTE:ADD ALUMINUM SLATS FORWHERE SHOWN IN PLANS

SHALL BE PVC-COATED

40' - 0"

20' - 0"

GREATER THAN 8'-0"

6'-0

"4'

-0"

MAX.2"

10' MAX.

18" O.D. CONC. FTG. (TYP.)

AND CORNER POSTS3" O.D. END PULL

EACH POST 1/4" WIRETENSION WIRE ANCHOR AT

WHEN LOCATED IN ASPHALT PAVING6" Ø BY 18" DEEP CONC. FTG.FULLY OPEN POSITION. SET INGRADE AT BOTH CLOSED AND2" GAP FOR LEAFSPIPE SLEEVE DOWN 6" BELOWCANE BOLT WITH SLEEVE; STEEL

MIN. GAP REQ.:

LESS THAN 8'-0";1" GAP FOR LEAFS

GATES WHERESHOWN

FORK LATCH

POST CAP

LINE POST2.875" O.D.

AND CORNER POSTS(TYP.) AT GATE, END, PULL

3/8" O.C. TENSION ROD

1.66" O.D. TOP &BOTTOM RAIL

KNUCKLED FABRICTOP AND BOTTOM

LINK FABRIC

9 GA. CHAIN-

3. ALL CHAIN-LINK FENCE

GATE AS SHOWN ON PLAN2. PROVIDE A DOUBLE OR SINGLE

FENCING GREATER THAN 8' TALL.1. PROVIDE MID RAIL AT ALLNOTES:

4 5/16" 4' - 9 15/16"

"MAINTENANCE VEHICLEACCESS ONLY"

4. INCLUDE SIGN INDICATING

6'-0

"

12"

3"

MA

X.

12" H. x 18 GA. GALV.,SMOOTHFACED, STEEL PLATEON BOTHSIDES OF GATE FORPANICHARDWAREMOUNTING

HORIZONTAL PIPEINGFRAME ATTOP OF KICKPLATES

12"H. x 18 GA. GALV.,SMOOTH FACED,STEELKICK PLATE ON BOTHSIDES OF GATE.PER CBC 11B-404.2.10.

CONCRETE WALK

LEVER STYLE LATCH W/ PANICHARDWARE ON PUSH SIDE OF GATE.

FOR CHAIN LINK FENCE POSTFOOTINGS, SEE 2/SKA-1

5 LBS. MAX. PRESSURE TOOPERATE GATE. SEE 2013 C.B.C.,CHAPTER 11B FOR ADDITIONALINFORMATION

8 1/

2"3'

- 2

"

SEE PLAN

KICK PLATE MOUNTEDTO PIPE FRAMEWITHOUT JOINTSEXCEEDING 1/16" OFTHE SAME PLANE

2' -

10"

1' -

6"

4"

CONCRETEPEDESTAL

1' - 0"

FREEZELESSYARDHYDRANT

1' -

0"

CONCRETEWALK

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AS

1.3

SCALE: 1/4" = 1'-0"SKA-1

1 DRINKING FOUNTAIN AT ES PLAYFIELDSCALE: 1/2" = 1'-0"SKA-1

2 CHAIN LINK FENCE - GATE

SCALE: 1/2" = 1'-0"SKA-1

3 CHAIN LINK FENCE - MAN GATESCALE: 1" = 1'-0"SKA-1

4 WATER HYDRANT PEDESTAL

NTS .


6' HIGH CHAINLINK FENCE,

SEE DETL.

4' GATE w/ADA HARDWARE

TRUNCATED

DOMES PER 5/C7.1

SKA-1

3/2 SKA-1

5' - 0

"

5' - 0

"

8' - 0"

3' - 0

"

Architecture Engineering Planning Interiors

© , DLR Group inc. , a California corporation, ALL RIGHTS RESERVED

DLR Group

Attachment No.

to

Dated:

8/3/2018 1:56:54 PM

75-15111-00

05.09.18


PARTIAL SITE PLANSKA- 2

2015

TAHOE * TRUCKEE UNIFIED SCHOOL DISTRICT

SKA-2

CCD 09

08/03/2018

SCALE: 1/4" = 1'-0"SKA- 2

1 GATE AT ES PLAYFIELDCCD09

#02-115331

09/14/2017

PSK-1


UP

#02-115331

08/03/2017

PSK-2

#02-115331

06/30/2017

PSK-3


#02-115331

08/03/2017

PSK-4

GENERALPedestal steel fountain with textured powder coat finish andE-Coat immersion for year-round beauty with minimum main-tenance. The E-Coat immersion process coats the outsideand inside of the fountain for the ultimate in corrosion protec-tion. Contour-formed stainless steel bi-level basins withrounded corners and edges reduces splatter, insures properdrainage and prevents standing waste water. Designed to beeasily accessible to both physically challenged and able-bodied individuals. Ideally suited for installation in publicareas. Model meets state and federal requirements as definedby the Americans with Disabilities Act.

NO LEAD DESIGNTHIS DRINKING FOUNTAIN COMPLIES WITH THE LEAD-FREEDEFINITION IN THE SAFE DRINKING WATER ACT OF 1986AND LEAD CONTAMINATION CONTROL ACT OF 1988.Elkay Drinking Fountains are manufactured with a waterwaysystem utilizing copper components and completely lead-freematerial. These waterways have no lead because all leadedmaterials, such as leaded brass, have been removed.

CONSTRUCTIONSanitary Freeze-Resistant Valve System: Fully sealedassembly minimizes chance of ground water contamination,and prevents drain water from mixing with fresh water.Freeze-resistant valve designed for ground installation 18"below the frost line.

Bubbler: Vandal-resistant, bubblers are one-piece, chrome-plated with integral hood guard design to prevent contamina-tion from other users, airborne deposits and tampering.

Pushbutton Actuation Mechanism: Self-closing, vandal-resistant pushbuttons do not require grasping or twisting.

Automatic Stream Height Regulator: Dual stream heightregulator is located inside sanitary freeze-resistant valvesystem to prevent tampering. Unit resists corrosion andliming. A constant stream height is automatically maintainedunder line pressures that vary from 20 to 105 psi.

Water Inlet: 1/2" male NPT fitting.

Drain Outlet: Drain requirements are detailed in the owner’smanual.

Access Panel: Manufactured of heavy-gauge steel with vandal-resistant screws. Provides access for easy hook-up ofall plumbing connections.

SUGGESTED SPECIFICATIONSFountain shall include pushbuttons on the front and side.Shall include contoured-formed basins to eliminate splashingand standing water, and shall have rounded corners andedges. Projectors shall be chrome-plated vandal-resistanttype with integral hood guard and anti-squirt feature. Fountainshall comply with ANSI 117:1 and ADA for visual and motiondisabilities. The manufacturer shall certify the unit to meet therequirements of NSF/ANSI 61/372, and the Safe Drinking WaterAct.

Shipping Weight: 185 lbs.

In keeping with our policy of continuing product improvement, Elkay reserves the right to changeproduct specifications without notice.

This specification describes an Elkay product with design, quality and functional benefits to theuser. When making a comparison of other producers’ offerings, be certain these features are notoverlooked.

Bi-Level, Tubular PedestalSanitary Freeze-Resistant,

Barrier-Free FountainModel LK4420SFRK

®

SPECIFICATIONS

Elkay 2222 Camden CourtOak Brook, IL 60523Printed in U.S.A.©2012 Elkay

(2/12) 19-12Belkayusa.com

Model LK4420SFRK

This fountain is ADA compliant.

This fountain is certified by WQA to lead-free complianceincluding NSF/ANSI 61 and 372.

DF-2

Bi-Level, Tubular PedestalSanitary Freeze-Resistant,Barrier-Free FountainModel LK4420SFRK

®

ROUGH-IN DIMENSIONS

Elkay 2222 Camden CourtOak Brook, IL 60523elkayusa.com

Printed in U.S.A.©2012 Elkay

19-12B (2/12)

B

( 6 ) 1/2" ( 13mm ) DIA. HOLES EQUALLY SPACED ON A 12" ( 305mm )BOLT CENTER

WATER INLET LINE( BY INSTALLER )

VALVE WATER LINE SUPPLIED WITH A 1/4 x 1/2 NPT CONNECTOR

DRAIN LINE BY INSTALLER( AS REQUIRED BY LOCAL CODES )

A

SEE DETAIL A

A

LEGENDA = ACCESS PANEL (8" X 10")B = REMOVABLE BOTTOM COVER

Ø10"(254mm)

29"(737mm)

27"*(686mm)

33-5/16"(847mm)19"

(483mm)

4"(102mm)

8"(203mm)

30"(762mm)

35-3/16"(894mm)

2-7/8"(73mm)

42-3/16"(1071mm)

Ø 14"(356mm)

TOP VIEW

SIDE VIEW

*ADA Requirement

1-14" DRAIN TUBESUPPIED W/ FTN.

AIR GAP ASSY.SUPPLIED WITH VALVE

1-12" DRAIN TUBESUPPLIED BY INSTALLER

DETAIL A�AIR GAP / VACUUM BREAKER

MOUNTING INSTRUCTIONS andPLUMBING INSTRUCTIONSSite and drainage excavation is required for fountain installa-tion. Provide solid, well-drained site and drainage surface to mount pedestal fountain (concrete pad recommended). (6) 1/2" anchor bolts (not included) should be attached firmlyto mounting surface in order to secure fountain. Refer torough-in diagram and be sure to allow an opening for thefreeze-resistant valve in the ground as shown in the installa-tion instructions that accompany the fountain. Refer to localcodes for any additional requirements.

NOTE: Fountain is not furnished with service valve. Assemblemounting brackets to pedestal base with bolts provided.

Position pedestal over plumbing and secure base to anchorbolts. Remove access panels and connect supply and waterlines. Turn on water supply and check for leaks. Refer toowner’s manual for detailed instructions.

Service stop not included.

Operating Pressures: Supply water - 105 psi maximum.

When ordering, specify model number, inlet and finish.©2010 WOODFORD Mfg. 0473 Rev. 08/10 Form No. Y95.106

Backflow Preventer replacement is recommended every 3-5 years.

SPECIFICATIONS:MODEL 50HF BACKFLOW PREVENTER - Patent Pending • ASSE 1052 Approved • Listed by IAPMO • Field Testable • Two Independent Check Valves • Drains automatically when hose is removed • No spray back

FEATURES:TAMPER PROOF - The hinged door lock uses the same tee key that operates hydrant to prevent unauthorized use.ONE PIECE VARIABLE FLOW PLUNGER - Large cush-ion type seal for longer life - is not easily damaged and assures shut-off even when foreign particles are present. Automatic drain feature - plunger opens drain to prevent freezing when hose is removed.VALVE SEAT – Permanent type brass valve body with hemispherical seating surface.PACKING – EPDM rubber with adjustable packing nut.BOX – Deep box, brass casting.FINISH – Brass box, door and head casting.FEMALE INLET – 3/4” N.P.TDRAIN HOLE – 1/8” N.P.T. CASING – 1” galvanized steel pipe Optional - 1” brass pipeOPERATING ROD – 3/8” galvanized steel pipe Optional - 3/8” brass pipeMAX PRESSURE – 125 p.s.i.MAX TEMPERATURE - 120° F

SHIPPING WEIGHT –

Anti-SiphonFreezeless Yard Hydrants

Model Y95

Woodford Model Y95 lawn hydrants are installed flush with surrounding surfaces. This brass box enclosed hy-drant is intended for irrigation purposes on golf courses, in parks and recreation areas, shopping center malls, and landscaped areas around buildings.

Rough-In Dimensions

Bury Depth (ft) 1 2 3 4 5 6 7

Weight (lbs) 14 16 18 21 23 26 28

For Installation / Troubleshooting Instructions go to www.woodfordmfg.com or call 1-800-621-6032

For more information contact...

2121 Waynoka Road, Colorado Springs, Colorado 80915 • Phone: (800) 621-6032 • Fax: (800) 765-4115To view our complete product line visit: www.woodfordmfg.com or email: [email protected]

A Division Of WCM Industries, Inc.

WOODFORD MANUFACTURING COMPANY

MODEL Y95 PARTS LISTITEM PART# DESCRIPTION

1 50010 Tee Key

2 30107 Packing Nut

3 30247 EPDM Packing

4 55176 Head Nut Assembly

5 10109 Yoke Nut

6 10105 Plunger

7 10018 Valve Body

8 50HF-BR 50HF Vacuum Breaker-Brass

9 55020 Box Assembly

10 3/8” OPERATING PIPE (Bury Depth & Length)

10031 1’ Bury (4-1/8” long)

10032 2’ Bury (16-1/8” long)

10033 3’ Bury (28-1/8” long)

10034 4’ Bury (40-1/8” long)

10035 5’ Bury (52-1/8” long)

10036 6’ Bury (64-1/8” long)

10037 7’ Bury (76-1/8” long)

RK-Y95 Repair Kit (Includes Items 1-6)

Excellence

Woodford

Since 1929

Proudly Made In The U.S.A.

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CCD09-C2.1CCD09-C4.175-15110-00_CCD-009 CPS5-0 EDITCCD009-C2.3-C2CCD009-C7.2-C475-15110-00_CCD-009 SKA-2SheetsSKA- 2 - PARTIAL SITE PLAN

301-Issued#1: OffObtainDSAApproval#1: OffB-RequiredSubmittal#1: Off

Form DSA 140: Application for Approval of Construction ... · This form shall be completed by the...

Documents

Transcript of Form DSA 140: Application for Approval of Construction ... · This form shall be completed by the...