OSHPD PREAPPROVAL OF MANUFACTURER'S CERTIFICATION (OPM) · PDF fileJeffrey EnzlerJeefffrreeyy...
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“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs” OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY OSH-FD-700 (REV 12/16/15) Page 1 of 2 APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER’S CERTIFICATION (OPM) OFFICE USE ONLY APPLICATION #: OPM-0165-13 OSHPD Preapproval of Manufacturer’s Certification (OPM) Type: New Renewal Update to Pre-CBC 2013 OPA Number: Manufacturer Information Manufacturer: GCX Corporation Manufacturer’s Technical Representative: Rob Glaser Mailing Address: 3875 Cypress Drive, Petaluma, CA. 94954-5635 Telephone: (800) 228-2555 Email: [email protected] Product Information Product Name: GCX Wall Mount with M & VHM Arms Product Type: Cantilever Product Model Number: 13”, 19”, 25”, 31”, 37” & 49” Wall Channels w/M, VHM & VHM25 Arms General Description: Wall Mounted Monitor and Keyboard Support 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, 2016. Signature of Applicant: Date: 5/3/16 Title: Principal Engineer Company Name: EASE Co. 2 M M 5 5 M M M 5 5 o 5 o o ” n , , n n n 3 M i 3 3 M t 3 3 M & 2 & 25 & 5 5” V M ” M V M , M M Mo H 3 o H 3 on d M n d d M & ni M & it K K & K A K A V A V V H H H b M b M d M E d M E K A m K A m m K A m m A a a d a d i l b : S b S E E m m m r d m g d a a a S S S : t r g t V V V V V V VH H H H H H H M M M M M M V V V H H H M M M M & VHM Arms & VHM Arms 1”, 37” & 49” Wall Channels w/M, , 1”, 37” & 49” Wall Channels w/M, or and Keyboard Support tor and Keyboard Support ”, 3 7 ma, CA. 94954 - 5635 Email: rglaser@gcx. t with M 19”, 2 & VH nted M @ ma, CA. 94954 5635 cx.c nt H un Email: rgla M 2 M M & V w with er@ @ ted Jeffrey Enzler & 49” Wall Channels w/M & 49” Wall Channels w/M OPM-0165-13 01/31/2017 // 01/31/2017 OPM-0165-13: Reviewed for Code Compliance by Jeffrey Enzler Page 1 of 11
Transcript of OSHPD PREAPPROVAL OF MANUFACTURER'S CERTIFICATION (OPM) · PDF fileJeffrey EnzlerJeefffrreeyy...
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-700 (REV 12/16/15) Page 1 of 2
APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER’S CERTIFICATION (OPM)
OFFICE USE ONLY
APPLICATION #: OPM-0165-13
OSHPD Preapproval of Manufacturer’s Certification (OPM)
Type: New Renewal Update to Pre-CBC 2013 OPA Number:
Manufacturer Information
Manufacturer: GCX Corporation
Manufacturer’s Technical Representative: Rob Glaser
Mailing Address: 3875 Cypress Drive, Petaluma, CA. 94954-5635
Telephone: (800) 228-2555 Email: [email protected]
Product Information
Product Name: GCX Wall Mount with M & VHM Arms
Product Type: Cantilever
Product Model Number: 13”, 19”, 25”, 31”, 37” & 49” Wall Channels w/M, VHM & VHM25 Arms
General Description: Wall Mounted Monitor and Keyboard Support
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, 2016.
Signature of Applicant: Date: 5/3/16
Title: Principal Engineer Company Name: EASE Co.
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01/31/2017 OPM-0165-13: Reviewed for Code Compliance by Jeffrey Enzler Page 1 of 11
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-700 (REV 12/16/15) Page 2 of 2
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: 909-606-7622 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 1950-16
Other* (Please Specify):
*Use of criteria other than those adopted by the California Building Standards Code, 2016 (CBSC 2016) 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 2016 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 2016 & ALL PRE-2016 CODE BASED PROJECTS
Signature: Date: 01-31-2017
Print Name: Jeffrey Enzler
Title: DSE
Condition of Approval (if applicable):
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