OSHPD PREAPPROVAL OF MANUFACTURER'S …06/16/2015 OPM-0209-13: Reviewed for Code Compliance by...
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OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION “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 APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER’S CERTIFICATION (OPM) OFFICE USE ONLY APPLICATION #: OPM-0209-13 OSHPD Preapproval of Manufacturer’s Certification (OPM) Type: New Renewal Update to Pre-CBC 2013 OPA Number: Manufacturer Information Manufacturer: CareFusion Manufacturer’s Technical Representative: Jared Zamaloff Mailing Address: 10020 Pacific Mesa Blvd., San Diego, CA. 92121 Telephone: (818) 876-4287 Email: [email protected] Product Information Product Name: Double Storage Cabinet Product Type: Other Electrical and Mechanical Components Product Model Number: Pyxis Supply Station General Description: The Pyxis Supply Station – system provides easy access to needed supplies on nursing floors and throughout your healthcare facility. This secure storage device provides your staff with the ability to document supply usage, in real-time. Applicant Information Applicant Company Name: EASE Co. Contact Person: Jonathan Roberson, S.E. Mailing Address: 5877 Pine Ave. Suite 210, Chino Hills, CA. 91709 Telephone: (909) 606-7622 Email: [email protected] I hereby agree to reimburse the Office of Statewide Health Planning and Development review fees in accordance with the California Administrative Code, 2013. Signature of Applicant: Date: 3/30/15 Title: Principal Engineer Company Name: EASE Co. 06/16/2015 OPM-0209-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 1 of 12 y y h h y S S u e e S S u u e S S t t h s s a S S a a h s s a a S S a a a a a a t t t a a l l a a t n a t t a a n h t h a o h t h t i i o S o h St n a ta y a a y n a a S h n t S he n ti St e o St ea u o ta a u a al s f a lt s f s f t th a s a y i h a y o s o s n t n t t e t e t e m m s f m s f m y T y p T ys p T s r h t i r h t l o i e i o e t v m v m m d d d d p T d p T e r h e r h s o s o v e v e v e d a d a d s e s e y s y t s y t s a e a e c c a c a c s c s e y e e e e y t e e s e s s s d s d a s d s d a s d e c e t e c t e t e c o c e e e e e s s d s d s e t e to cal Components c on tion system provides easy acc o tion – system provides easy acce hcare facility. This secure storag ge, in real - e, i hcare facility. This secure storag g e in n re a Emai Jared.zam binet d Mech pply S Supply o nee your healthcare facility. This secure storage device p upply u p pl il: d.zam bi d u S d your healthcare facility. This secure storage device p u h S y o healthcare facility. This secure storage dev u upp ne ply Mec net ma il: Jar our ppl ce Jeffrey Jeffre Y. Y Kikumoto Kik moto OPM-0209-13 al Components al Components 06/16/2015 - - time. time.
Transcript of OSHPD PREAPPROVAL OF MANUFACTURER'S …06/16/2015 OPM-0209-13: Reviewed for Code Compliance by...
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-700 (REV 1/24/13) Page 1 of 2
APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER’S CERTIFICATION (OPM)
OFFICE USE ONLY
APPLICATION #: OPM-0209-13
OSHPD Preapproval of Manufacturer’s Certification (OPM)
Type: New Renewal Update to Pre-CBC 2013 OPA Number:
Manufacturer Information
Manufacturer: CareFusion
Manufacturer’s Technical Representative: Jared Zamaloff
Mailing Address: 10020 Pacific Mesa Blvd., San Diego, CA. 92121
Telephone: (818) 876-4287 Email: [email protected]
Product Information
Product Name: Double Storage Cabinet
Product Type: Other Electrical and Mechanical Components
Product Model Number: Pyxis Supply Station
General Description:
The Pyxis Supply Station – system provides easy access to needed supplies on nursing floors and throughout your healthcare facility. This secure storage device provides your staff with the ability to document supply usage, in real-time.
Applicant Information
Applicant Company Name: EASE Co.
Contact Person: Jonathan Roberson, S.E.
Mailing Address: 5877 Pine Ave. Suite 210, Chino Hills, CA. 91709
Telephone: (909) 606-7622 Email: [email protected] hereby agree to reimburse the Office of Statewide Health Planning and Development review fees in accordance with the California Administrative Code, 2013.Signature of Applicant: Date: 3/30/15
Title: Principal Engineer Company Name: EASE Co.
06/16/2015 OPM-0209-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 1 of 12
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OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
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. 91709
Telephone: 909-606-7667 Email: [email protected]
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 AC156 FM 1950-10
Other* (Please Specify):
*Use of test criteria other than those adopted by the California Building Standards Code, 2013 (CBSC 2013) for component supports and attachments are not permitted. For distribution system, interior partition wall, and suspended ceiling seismic bracings, test criteria other than those adopted in the CBSC 2013 may be used when approved by OSHPD prior to testing.
Analysis
Experience Data
Combination of Testing, Analysis, and/or Experience Data (Please Specify):
List of Attachments Supporting the Manufacturer’s Certification
Test Report Drawings Calculations Manufacturer’s Catalog
Other(s) (Please Specify):
OFFICE USE ONLY – OSHPD APPROVAL VALID FOR CBC 2013 ONLY
Signature: Date: 06/16/2015
Print Name: Jeffrey Kikumoto
Title: SSE
Condition of Approval (if applicable):
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-700 (REV 1/24/13) Page 2 of 2
06/16/2015 OPM-0209-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 2 of 12
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