“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENTFACILITIES 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-0421-13
OSHPD Preapproval of Manufacturer’s Certification (OPM)
Type: New Renewal Update to Pre-CBC 2013 OPA Number:
Manufacturer Information
Manufacturer: MEDIVATORS
Manufacturer’s Technical Representative: Megan Dickey
Mailing Address: 14605 28th Avenue N., Minneapolis, MN. 55447
Telephone: On File Email: On File
Product Information
Product Name: Advantage Plus
Product Type: Other mechanical and electrical components
Product Model Number: N/A
General Description: Endoscope Reprocessing System
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: 4/11/17
Title: Principal Engineer Company Name: EASE Co.
rroro
e
oo
e
o
e
cc
l
cc
e
ee
e
ee
cctre ree ce ce
pr
aae
r
aac
ro
c
ooc
ct
ce SS
cr
ce SS
or
es
oc mc mc ma
i
a
t
pl pppc oc ono no
E
S
no
E
S
em em
mm
nm
mm
n
mm
tp
aa
t
tp
a
t
so
i
so
l:
nn
E
e
E
e
Em
n
m
n
m O
t
m O
s
a
s
aa : OO
trical componentstrical components
ssing Systemssing System
apolis, MN. 55447
Email: On File
al and
e Rep
a
e
eapolis, MN. 55447
a
pe
Email: On
e
pr
anand
O Filee
Re
Jeffrey Y. Kikumoto
OPM-0421-13
05/11/2017/ /
05/11/2017 OPM-0421-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 1 of 10
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENTFACILITIES 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: 05-11-2017
Print Name: Jeffrey Kikumoto
Title: SSE
Condition of Approval (if applicable):
aadtd
did
dtd
dt
d
ototoeo
bebeo
beb
pdp
ydpp
ydy
o
tt
y y
r
tdm
h
E
dit
a
h
E
ttad
e
E
bt
d
e
E
x
be
do
S
x
byeo
S
p
yd
op
C
p
y dp
C
A
e
pt
the C
A
e
t
the Ca
A
e
he Ca
C
r
he Cal
C
ii
e Cali
C
ee
e Calif
E 1
eeo
Califo
S
r
Califo
S 5
nr n
Califor
S 5
nE
Califor
66
cE
Californ
A 6
E c
aliforn
A
x e
aliforni
A
x e
lifornia
A
xp
ifornia
C
p
fornia
C
pe
fornia B
C
e
ornia B
1
e
ornia B
1
r
rnia Bu
5
ri
rnia Bu
5
e
nia Bu
5
e
nia Buil
6
en
ia Build
6
n a
a Build
n a
a Build
c
Buildi
c
Buildin
F
e
Buildin
F
e
Building
F
Building
M
uilding
M
uilding S
M
ilding Slding St
1
(
ding St
1
(
ding Sta
9
P
ding Sta
9
P
ing Stan
9
Pa
ng Stan
5
ng Stand
5
e
g Stand
50
e
g Standa
0F
a
g Standa
0F
a
Standa
F -
Standar
M 1
s
Standard
M
s
Standard
M
( e
tandards
P e
andards
P
andards
1
P S
andards CC
e S
pandards CC
9
e S
edaa
ndards CCo
9
ase S
dadar
dards Co
5
a
drrot
dards Cod
5
a
rtttards Codd
5
s
wwit
ards Cod
0
s
wwtti
ards Code
0
e
wwhio
r
-
e
whho
d
hhe
d
1
S
e
s
S
ss pd
Cad
Ca
Crortw
otw
dt
w
dth
diho
ce DataDa a Datae D
th C lif i B ildi St d d For distribution system, interior ped in the CBSC 2016 may be used
g. For distribution system, interior pted in the CBSC 2016 may be used in
1ICC-ES 0 16
dopted by the California Building Standards Code, 201t permitted. For distribution system, interior partition wahose adopted in the CBSC 2016 may be used when ap
s, and/or Specify):
anufacturer’s Certificationcturer’s C
nd
opadopted by the California Building Standards Code, 201t permitted. For distribution system, interior partition walhose adopted in the CBSC 2016 may be used when app
is, y):
anufacturer’s Certification
l i
ES 0-1
ed by the California Building Standards Codemitted. For distribution system, interior partitioadopted in the CBSC 2016 may be used whe
/or Sp
ose n a
opt
CCC-E 6
20
annd
f ctuureer s Ceertifica
Jeffrey Y Kikumotos bu o sys e , e ost but o syste , te ohe CBSC 2016 may be ushe CBSC 2016 may be us
OPM-0421-13OPM 0421 13
05/11/2017
05/11/2017 OPM-0421-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 2 of 10
Jeffrey Y. KikumotoJeeffreyy Y. KKikuummottoo
OPM-0421-13
05/11/2017055//1111//20017
05/11/2017 OPM-0421-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 3 of 10
28
Jeffrey Y. Kikumoto
OPM-0421-13
05/11/201705//111/
05/11/2017 OPM-0421-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 4 of 10
38
Jeffrey Y. KikumotootKKK
OPM-0421-13OPM 0421 1313OOO 1131333
05/11/2017
05/11/2017 OPM-0421-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 5 of 10
48
Jeffrey Y. Kikumotoyyy
OPM-0421-13111
05/11/2017
05/11/2017 OPM-0421-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 6 of 10
58
Jeffrey Y. KikumotoKik momomoi
OPM-0421-13OPM 0421 13OO 33OO
05/11/201700
05/11/2017 OPM-0421-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 7 of 10
68
Jeffrey Y. Kikumotoyy
OPM-0421-1331111 11133333333333333
05/11/2017
05/11/2017 OPM-0421-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 8 of 10
78
Jeffrey Y. KikumotoJeffffrey Y KKiKiikkuuummootoo
OPM-0421-13O
05/11/2017
05/11/2017 OPM-0421-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 9 of 10
88
Jeffrey Y. Kikumoto
OPM-0421-1331133113313311
05/11/20177777
05/11/2017 OPM-0421-13: Reviewed for Code Compliance by Jeffrey Kikumoto Page 10 of 10