Jefferson Elementary Campus Wide Interior Fencing & Gates - Addedum General Conditions
| Location: | California |
|---|---|
| Posted: | Sep 11, 2026 |
| Due: | Sep 24, 2026 |
| Agency: | Lennox School District |
| Type of Government: | State & Local |
| Category: |
|
| Publication URL: | To access bid details, please log in. |
Attachment Preview
103-25
LIST OF STRUCTURAL TESTS AND SPECIAL INSPECTIONS
☐ Project has a geotechnical report or construction documents require special inspection by a geotechnical engineer.
☑ Project does NOT have and does NOT require a geotechnical report.
S1 | SOILS - GENERAL
☐ S1a: Site Preparation
TYPE
BY
See Notes PI
C1 | CAST-IN-PLACE CONCRETE
☑ C1a: Mix Design
TYPE
Continuous
S2 | COMPACTION AND FILL
☑ C1b: Reinforcing Steel
Test
☐ S2a: Fill Materials
Test LOR* ☑ C1c: Concrete Material
Test
☐ S2b: Fill Placement
Continuous LOR*
☐ S2c: Compaction
Test LOR*
S3 | DRIVEN DEEP FOUNDATIONS (PILES)
☐ S3a: Materials and Members
Continuous GE*
☑ C1d: Strength Test
☐ C1e: Batch Plant Inspection
C2 | PRESTRESSED CONCRETE
☐ C2a: Tendons and Anchorage
Test
Test
☐ S3b: Pile Capacity
Test LOR* ☐ C2b: Tendon Placement
Periodic
☐ S3c: Driving Operations
Continuous GE* ☐ C2c: Concrete Strength
Periodic
☐ S3d: Pile Installation
Continuous GE*
☐ S3e: Specialty Piles
*
*
S4 | CAST-IN-PLACE DEEP FOUNDATIONS (PIERS)
☐ C2d: Stressing Operations
C3 | PRECAST CONCRETE
☐ C3a: General Fabrication
Continuous
Continuous
☐ S4a: Drilling Operations
☐ S4b: Pier Construction
☐ S4c: Bearing Strata
S5 | RETAINING WALLS
☐ S5a: Backfill Placement
Continuous PI
Continuous PI
Continuous GE*
Continuous GE*
☐ C3b: General Erection
☐ C3c: Diaphragm Connections
☐ C3d: Diaphragm Tolerances
C4 | SHOTCRETE
☐ C4a: Placement
Periodic
Continuous
Periodic
Continuous
☐ S5b: Soil Reinf. and Drainage
☐ S5c: Segmental Retaining Walls
S6 | OTHER SOILS
☐ S6a: Soil Improvement Test
Continuous GE*
Continuous GE*
Test
GE*
☐ C4b: Shotcrete Material
C5 | POST-INSTALLED ANCHORS
☐ C5a: Inspection
☐ C5b: Test
Test
See notes
Test
☐ S6b: Soil Improvement Inspection Continuous GE* C6 | OTHER CONCRETE
☐ S6c: Not used.
N/A
N/A ☐ C6a: Not used.
N/A
☐ S6d: Not used.
N/A
N/A ☐ C6b: Not used.
N/A
☐ S6e: Not used.
N/A
☐ S6f: Not used.
N/A
☐ S6g: Not used.
N/A
☐ S6h: Not used.
N/A
☐ S6i: Not used.
N/A
☐ S6j: Not used.
N/A
☐ S6k: Not used.
N/A
☐ S6l: Not used.
N/A
☐ S6m: Not used.
N/A
☐ S6n: Not used.
N/A
* See Appendix for additional information.
N/A ☐ C6c: Not used.
N/A
N/A ☐ C6d: Not used.
N/A
N/A ☐ C6e: Not used.
N/A
N/A ☐ C6f: Not used.
N/A
N/A ☐ C6g: Not used.
N/A
N/A ☐ C6h: Not used.
N/A
N/A ☐ C6i: Not used.
N/A
N/A ☐ C6k: Not used.
N/A
N/A ☐ C6l: Not used.
N/A
Not used.
* See Appendix for additional information.
BY
SI
LOR
LOR
LOR
SI
LOR
SI
SI
SI
SI
SI*
SI
SI
SI
LOR
SI*
LOR
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Project Name: Jefferson Elementary School
School District: Lennox School District
Application No.: 12-589500 Increment:
File No.: 19-49
DGS DSA 130(3R-e2v5is(eRdev1i2s/e0d11/223/)15/25)
DIVISION OF THE STATE ARCHITECT
DEPARTMENT OF GENERAL SERVICES
Page 1 of 4
2 of 10
STATE OF CALIFORNIA
DSA 103 - 25
LIST OF STRUCTURAL TESTS AND SPECIAL INSPECTIONS
M1 | STRUCTURAL MASONRY
f'm PSI:
TYPE
☐ M1a: Mill Certificates - Reinf.
Periodic
☐ M1b: Material Certificates
Test
☐ M1c: Strength Test
Test
☐ M1d: Mortar Proportions
Periodic
☐ M1e: Grout Proportions
Periodic
☐ M1f: Batch Plant Inspection
☐ M1g: Core Tests
Test
☐ M1h: Prisms
Continuous
☐ M1i: Dowels and Supports
Periodic
☐ M1j: Reinforcement and Members Periodic
☐ M1k: Reinforcement Placement Continuous
☐ M1l: Grout Placement
Continuous
☐ M1m: Unit Layup and Joints
Periodic
☐ M1n: Cold/Hot Weather Work
Periodic
☐ M1o: Anchors and Embeds
Continuous
☐ M1p: Grout Cavity
Continuous
M2 | VENEER OR GLASS BLOCK PARTITIONS
☐ M2a: Mortar and Grout
Periodic
☐ M2b: Unit Layup and Joints
Periodic
☐ M2c: Wires and Connector
Periodic
☐ M2d: Anchors and Embeds
Periodic
☐ M2e: Cold/Hot Weather Work
Periodic
☐ M2f: Adhered Veneer Bond
Test
M3 | POST-INSTALLED ANCHORS
☐ M3a: Inspection
Varies*
☐ M3b: Test
Test
M4 | OTHER MASONRY
☐ M4a: Not used.
N/A
☐ M4b: Not used.
N/A
☐ M4c: Not used.
N/A
☐ M4d: Not used.
N/A
☐ M4e: Not used.
N/A
☐ M4f: Not used.
N/A
☐ M4g: Not used.
N/A
☐ M4h: Not used.
N/A
☐ M4i: Not used.
N/A
☐ M4j: Not used.
N/A
☐ M4k: Not used.
☐ M4l: Not used.
☐ M4m: Not used.
Not used.
* See Appendix for additional information.
BY
SI*
LOR
LOR
SI
SI
SI
LOR
SI
SI
SI
SI
SI
SI*
SI
SI
SI
SI
SI
SI
SI
SI*
LOR
SI*
LOR
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
TYPE
BY
S/A1 | STEEL AND ALUMINUM
☐ S/A1a: Material Identification
Periodic *
☐ S/A1b: Unidentified Material
Test LOR
☐ S/A1c: Steel Fabrication
Periodic SI
☐ S/A1d: Buckling Restrained Brace
Test* LOR
S/A2 | HIGH-STRENGTH BOLTS
☐ S/A2a: Product Verification
Periodic SI
☐ S/A2b: Bolts, Nuts, and Washers
Test LOR
☐ S/A2c: Snug Tight
Periodic SI
☐ S/A2d: Pretensioned / Slip-Critical
*
SI
S/A3 | WELDING
☐ S/A3a: Weld Material
Periodic SI
☐ S/A3b: Certificate of Compliance Periodic SI
☐ S/A3c: WPS and Qualifications
Periodic SI
S/A4 | SHOP WELDING
☐ S/A4a: Weld Category A
Continuous SI
☐ S/A4b: Weld Category B
Periodic SI
☐ S/A4c: Stairs and Railing
Periodic SI
☐ S/A4d: Reinf. Steel Weldability
Periodic SI
☐ S/A4e: Reinforcing Steel
Continuous SI
S/A5 | FIELD WELDING
☐ S/A5a: Weld Category A
Continuous SI
☐ S/A5b: Weld Category B
Periodic
SI
☐ S/A5c: End Welded Studs
Periodic SI
☐ S/A5d: Deck Welds
Periodic SI
☐ S/A5e: Cold-Formed Steel
Periodic SI
☐ S/A5f: Stairs and Railing
Periodic SI
☐ S/A5g: Reinf. Steel Weldability
Periodic SI
☐ S/A5h: Reinforcing Steel
Continuous SI
S/A6 | NONDESTRUCTIVE TESTING
☐ S/A6a: Ultrasonic
Test
LOR
☐ S/A6b: Magnetic Particle
Test
LOR
☐ S/A6c:Not used.
N/A
N/A
☐ S/A6d:Not used.
N/A
N/A
☐ S/A6e:Not used.
N/A
N/A
S/A7 | STEEL JOISTS AND TRUSSES
☐ S/A7a: Fabrication
Continuous SI
S/A8 | METAL BUILDING
☐ S/A8a: Inspection
Periodic SI
S/A9 | SPRAYED FIRE-RESISTANT MATERIALS
☐ S/A9a: Surface and Installation
Periodic SI
☐ S/A9b: Density
Test LOR
☐ S/A9c: Bond: Adhesion/Cohesion
Test
* See Appendix for additional information.
LOR
Project Name: Jefferson Elementary School
School District: Lennox School District
Application No.: 12-589500 Increment:
File No.: 19-49
DGS DSA 130(3R-e2v5is(eRdev1i2s/e0d11/223/)15/25)
DIVISION OF THE STATE ARCHITECT
DEPARTMENT OF GENERAL SERVICES
Page 2 of 4
2 of 10
STATE OF CALIFORNIA
DSA 103 - 25
LIST OF STRUCTURAL TESTS AND SPECIAL INSPECTIONS
TYPE
S/A10 | ANCHOR BOLTS AND ANCHOR RODS
☐ S/A10a: Anchor Rods and Bolts
Test
☐ S/A10b: Other Threaded Rods
Test
S/A11 | STORAGE RACK SYSTEMS
☐ S/A11a: Material Verification
Periodic
BY
LOR
LOR
SI
X | OTHER
☐ X01: Product Load Test*
☐ X02: Non-HSB Installation Torque
☐ X03: Not used.
☐ X04: Not used.
TYPE
BY
Test
Continuous
N/A
N/A
LOR
SI*
N/A
N/A
☐ S/A11b: Fabrication
Periodic SI
☐ S/A11c: Anchorage
Periodic SI
☐ S/A11d: Completed System
Periodic SI*
S/A12 | OTHER STEEL AND ALUMINUM
☐ S/A12a: Not used.
N/A
N/A
☐ S/A12b: Not used.
N/A
N/A
☐ S/A12c: Not used.
N/A
N/A
☐ S/A12d: Not used.
N/A
N/A
☐ S/A12e: Not used.
N/A
N/A
☐ S/A12f: Not used.
N/A
N/A
☐ S/A12g: Not used.
N/A
N/A
☐ S/A12h: Not used.
N/A
N/A
☐ S/A12i: Not used.
N/A
N/A
☐ S/A12j: Not used.
N/A
N/A
W1 | PREFABRICATED WOOD TRUSSES
☐ W1a: Open Web Truss Fabrication Continuous SI
☐ W1b: Metal Plate Truss Fabrication Continuous SI
W2 | MANUFACTURED WOOD ELEMENTS
☐ W2a: GL Timber Fabrication
Continuous SI
☐ W2b: CLT Fabrication
Continuous SI
☐ W2c: Mass Timber Erection
Periodic SI
☐ W2d: Connections Type A
Periodic SI
☐ W2e: Connections Type B
Continuous SI
☐ W2f: Sealants
W3 | OTHER WOOD
Periodic SI
☐ W3a: Not used.
N/A
N/A
☐ W3b: Not used.
N/A
N/A
☐ W3c: Not used.
N/A
N/A
☐ W3d: Not used.
N/A
N/A
☐ W3e: Not used.
N/A
N/A
☐ W3f: Not used.
N/A
N/A
☐ X05: Not used.
N/A
N/A
☐ X06: Not used.
N/A
N/A
☐ X07: Not used.
N/A
N/A
☐ X08: Not used.
☐ X09: Not used.
N/A
N/A
N/A
N/A
☐ X10: Not used.
N/A
N/A
EXEMPTIONS
Those items identified on the DSA-approved construction
documents with a note indicating they are not part of the
DSA approval or those items checked below are exempt
from test and special inspection requirements. The project
inspector shall verify all construction complies with the
approved construction documents.
☐ Soils: Eligible shallow foundation elements**.
☐ Soils: Eligible deep foundation elements - type 1**.
☐ Soils: Eligible deep foundation elements - type 2**.
☐ Concrete/Masonry: Eligible post-installed anchors**.
☐ Concrete: Batch plant inspection for items listed in and
complying with CBC Section 1705A.3.3.2.
☐ Concrete: Epoxy shear dowels in nonstructural
slab-on-grade per CBC Section 1910A.5.4, Exception #4.
☐ Concrete/Masonry: Reinforcing bar testing for items
listed in and complying with CBC Section 1910A.2.
☐ Masonry: Freestanding site walls and retaining walls
per DSA IR 21-1.
Concrete: Eligible precast elements**.
☐ Welding: Eligible fences and gates**.
☐ Welding: Eligible railing and ramps**.
☐ Welding: Eligible interior cold-formed steel framing**.
☐ Welding: Eligible equipment curbs**.
☐ Welding: Eligible components supporting MEP
distribution systems**.
☐ Welding: Eligible mounts and recreational equipment**.
☐ Welding: Eligible nonstructural components**.
☐ W3g: Not used.
N/A
N/A
☐ W3h: Not used.
N/A
* See Appendix for additional information.
N/A
** See Appendix for eligibility requirements.
Project Name: Jefferson Elementary School
School District: Lennox School District
Application No.: 12-589500 Increment:
File No.: 19-49
DGS DSA 130(3R-e2v5is(eRdev1i2s/e0d11/223/)15/25)
DIVISION OF THE STATE ARCHITECT
DEPARTMENT OF GENERAL SERVICES
Page 3 of 4
2 of 10
STATE OF CALIFORNIA
DSA 103 - 25
LIST OF STRUCTURAL TESTS AND SPECIAL INSPECTIONS
IMPORTANT: This form is only a summary list of structural tests and some of the special inspections required for
the project. Any items indicated on the approved construction documents with a note stating that the items are not part of
the DSA approval are not considered in this form. Generally, the structural tests and special inspections noted on this
form are those that will be performed by the Geotechnical Engineer of Record, Laboratory of Record, or Special
Inspector. The actual complete test and inspection program must be performed as detailed on the DSA approved
documents. The exemption appendix at the end of this form identifies work NOT subject to DSA requirements for
special inspection or structural testing. The project inspector is responsible for providing inspection of all facets of
construction, including but not limited to, special inspections not listed on this form such as structural wood
framing, high-load wood diaphragms, cold-formed steel framing, anchorage of nonstructural components, etc., per
Title 24, Part 2, Chapter 17A.
Legend to TYPE and BY Columns:
Continuous - Indicates continuous special inspection is required.
Periodic - Indicates periodic special inspection is required.
Test - Indicates a test is required.
GE – Indicates special inspection shall be performed by a registered geotechnical engineer or his/her authorized
representative, usually associated with the Laboratory of Record.
LOR – Indicates test or special inspection shall be performed by a testing laboratory accepted in the DSA Laboratory
Evaluation and Acceptance (LEA) Program (i.e., the Laboratory of Record for the project). See CAC Section 4-335.
PI - Indicates special inspection may be performed by a project inspector when specifically approved by DSA.
SI - Indicates special inspection shall be performed by an appropriately qualified/approved special inspector.
Required Verified Reports:
1. Structural Testing and Inspection: Form DSA 291
Verified reports are required on
the following DSA forms:
DSA 291: Laboratory of
Record Verified Report
DSA 292: Special Inspectors
Employed Directly by the
District Verified Report
DSA 293: Geotechnical Verified
Report
AAccDDbbAAAcrDcrbcAAAlriclgiAgnlingenededdTTTeeexxxtt (t(AA(TAETTXETEX)XTT) )
AcDbArcAlignedText (ATEXT)
1111//3300//2277
AAccDDbbAArcrcAAlilgignneeddTTeexxt t(A(ATTEEXXTT) )
AAccDDbbAArrccAAlilgignneeddTTeexxtt((AATTEEXXTT))
Name of Design Professional in General Responsible Charge:
Edgar J. Paz
Name of Structural Engineer of Record (when applicable):
Gagan Bains
Signature of Architect or Structural Engineer: Date:
Gagan Bains
03-27-2026
Note: To facilitate DSA electronic
mark-ups and identification stamp
application, DSA recommends
against using secured electronic
or digital signatures.
STAMP
IDENTIFICATION STAMP
DIV. OF THE STATE ARCHITECT
DSA APP: 03-125895 INC:
REVIEWED FOR
SS
DFIVLISSION OF THE STAATECARSCHITECT
DEPARTMENT OF GENERAL SERVICES
DATE:
06/26/2026
Project Name: Jefferson Elementary School
School District: Lennox School District
Application No.: 12-589500 Increment:
File No.: 19-49
DGS DSA 130(3R-e2v5is(eRdev1i2s/e0d11/223/)15/25)
DIVISION OF THE STATE ARCHITECT
DEPARTMENT OF GENERAL SERVICES
Page 4 of 4
2 of 10
STATE OF CALIFORNIA
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