Form 102 Icai PDF Details

Form 102 Icai is a document that is used to indicate whether or not an organization is carrying out its business activities in accordance with the provisions of the Companies Act, 2013. This form must be submitted to the Registrar of Companies within 30 days of incorporation of the company. The information provided in this form will help the Registrar determine whether or not the company is being operated lawfully. It is important to note that failure to file Form 102 Icai may result in penalties and prosecution.

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Form NameForm 102 Icai
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesform 102 icai filled sample pdf, articleship form 102 icai filled sample pdf, form 102, form 102 sample

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This form has been completed by the

Architect/Engineer responsible for the project or by the

 

 

School District,

in accordance with California Code of Regulations, Title 24, Part 1, Section 4-331 and submitted to DSA.

 

 

 

 

 

 

 

 

 

DSA Use Only: Date Cards Issued by DSA:

Number of cards issued:

 

Issued by:

 

 

 

 

 

 

 

 

 

 

 

 

1. GENERAL INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School District/State Agency:

 

 

 

DSA File #:

-

 

 

 

 

 

 

 

 

 

 

 

 

School Name:

 

 

 

DSA App. #:

-

 

 

 

 

 

 

 

 

 

 

 

 

Project Name:

 

 

 

CDS #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of DSA 102-IC Submittal:

 

 

 

Construction Start Date:

 

 

 

 

 

 

 

 

 

 

 

 

Submitted by:

 

 

 

Phone #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email:

 

 

Number of attached pages: (If none, enter “0.”)

 

 

 

 

 

 

 

 

 

 

 

 

For initial submittal, complete Sections 1 through 5, or

 

 

 

 

 

 

Check this box if amending the original or previously submitted 102-IC and enter only the amending information in applicable sections. Note: Additional inspection cards must be requested by submittal of a new 102-IC, with new date.

2. SCOPE OF WORK FOR THIS CONSTRUCTION PROJECT - AGGREGATE SCOPE OF ALL CONTRACTS

 

 

a. Check this box if the scope of work includes any site work, including non-building site structures.

 

 

 

 

 

 

 

 

 

 

b. Check this box if the scope of work includes any buildings, and list building unique identifiers (numbers, letters or names), as

 

 

identified on the DSA approved plans: (Do not list non-building site structures here. See DSA Procedure 13-01 for definition.)

 

 

 

 

 

 

 

 

 

 

c. Check this box if there is scope of work shown on the DSA approved plans or within the DSA project application that is not

 

 

included in items a. or b. above:

 

 

 

 

 

 

 

(For buildings, list building numbers, letters or names; for site work/non-building site structures, provide brief description below.)

 

 

Project Phasing: Will Items indicated above be in future phase(s)? □ Yes □ No

Number of anticipated phases?

 

3. LISTING OF PROJECT PARTICIPANTS

 

 

 

 

 

 

List primary collaborators of designated tracks in DSAbox.

 

 

 

District /Owner:

 

 

Contact Name:

 

 

 

 

 

 

 

 

 

Title:

 

Email:

 

Phone #:

 

 

 

 

 

 

 

 

 

Design Professional in General

 

 

 

 

 

 

Responsible Charge: (Firm Name.)

 

 

 

 

License #:

 

 

 

 

 

 

 

Name:

 

Email:

 

Phone #:

 

Project Inspector:

 

DSA-5 Approval Date:

 

Phone #:

 

 

 

 

 

 

 

 

Email:

 

 

 

DSA Certification #:

 

In-Plant Inspector:

 

DSA-5 Approval Date:

 

Phone #:

 

Email:

 

 

 

DSA Certification #:

 

 

 

 

 

 

 

 

General Contractor: (Firm Name.)

 

 

 

 

License #:

 

 

 

 

 

 

 

 

 

Name:

Email:

 

 

Laboratory of Record:

Phone #:

LEA #:

Engineering Manager

 

License #:

Name:

Email:

Phone #:

 

 

 

Geotechnical Engineer

 

License #:

Name:

Email:

Phone #:

 

 

 

DSA 102-IC (rev 07-12-13)

 

Page 1 of 4

DIVISION OF THE STATE ARCHITECT

DEPARTMENT OF GENERAL SERVICES

STATE OF CALIFORNIA

 

DSA 102-IC

 

Revised July 12, 2013

 

CONSTRUCTIONSTARTNOTICE/INSPECTIONCARDREQUEST

 

 

 

 

 

 

 

 

4. PROJECT DELIVERY METHOD

 

 

 

 

□ Design / Bid / Build

□ Design Build

□ Lease-Lease Back

 

 

□ CM Multi-Prime

□ CM at Risk

□ Owner Builder

5. LISTING OF PROJECT COLLABORATORS FOR DSAbox PERMISSIONS

Design Professional with delegated responsibility requiring separate folder with Viewer/Uploader permission: (Verification of DSA-1.DEL required.)

Discipline:

 

Name:

 

 

 

 

License#:

Email:

 

Phone #:

 

 

 

 

Discipline:

 

Name:

 

 

 

 

License#:

Email:

 

Phone #:

 

 

 

 

Design Professional with delegated responsibility for Viewer permission in project folder: (Verification of DSA-1 required.)

Structural Engineer: (Firm name.)

 

 

License#:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name:

 

Email:

Phone #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mechanical Engineer: (Firm name.)

 

 

License#:

 

 

 

 

Name:

 

Email:

Phone #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Electrical Engineer: (Firm name.)

 

 

License#:

 

 

 

 

Name:

 

Email:

Phone #:

 

 

 

 

Architect/Engineer project folder collaborators:

PERMISSION LEVEL

 

 

 

 

View

View/Upload

 

 

 

 

□

 

□

Name:

 

 

Email:

Name:

 

 

Email:

 

□

 

□

 

 

 

□

 

□

Name:

 

 

Email:

 

 

 

 

 

□

 

□

 

 

Name:

 

 

Email:

 

 

 

 

 

 

 

 

 

 

Name:

 

 

Email:

 

□

 

□

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School District/Owner project folder collaborators:

PERMISSION LEVEL

(Includes CM Multi-Prime, Facilities and Program Managers, if applicable.)

View

View/Upload

Name:

 

 

Email:

 

□

 

 

□

 

 

 

 

 

Name:

 

 

Email:

 

□

 

 

□

 

 

 

□

 

□

Name:

 

 

Email:

 

 

 

 

 

□

 

□

 

Name:

 

 

Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Project Inspector project folder collaborators:

PERMISSION LEVEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

View

View/Upload

 

 

 

 

□

 

□

Name:

 

 

Email:

Name:

 

 

Email:

 

□

 

 

□

Name:

 

 

Email:

 

□

 

□

Laboratory of Record project folder collaborators:

PERMISSION LEVEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

View

View/Upload

Name:

 

Email:

 

□

 

□

 

 

 

 

□

 

□

 

Name:

 

 

Email:

 

 

 

Name:

 

 

Email:

 

□

 

□

 

 

 

 

□

 

□

Name:

 

 

Email:

 

 

 

 

 

□

 

□

Name:

 

 

Email:

 

 

General Contractor project folder collaborators:

PERMISSION LEVEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

View

View/Upload

Name:

 

 

Email:

 

□

 

□

 

 

 

 

 

 

 

□

 

□

Name:

 

 

Email:

 

 

 

 

 

□

 

□

 

Name:

 

 

Email:

 

 

 

 

 

 

 

 

Name:

 

 

Email:

 

□

 

□

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DSA 102-IC (rev 07-12-13)

 

Page 2 of 4

DIVISION OF THE STATE ARCHITECT

DEPARTMENT OF GENERAL SERVICES

STATE OF CALIFORNIA

 

DSA 102-IC

 

Revised July 12, 2013

 

CONSTRUCTIONSTARTNOTICE/INSPECTIONCARDREQUEST

 

 

 

 

 

 

Prime Contractors requiring separate folder with Viewer/Uploader permission:

 

 

(Used with CM Multi-Prime project delivery.)

 

 

 

Company:

 

License#:

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

 

 

 

 

Name:

Email:

Phone #:

 

Company:

 

License#:

 

Name:

Email:

Phone #:

DSA 102-IC (rev 07-12-13)

 

Page 3 of 4

DIVISION OF THE STATE ARCHITECT

DEPARTMENT OF GENERAL SERVICES

STATE OF CALIFORNIA

DSA 102-IC

Revised July 12, 2013

CONSTRUCTIONSTARTNOTICE/INSPECTIONCARDREQUEST

 

Special Inspectors and/or Geotechnical Engineers NOT employed by the Laboratory of Record (LOR):

(List individually. Separate folders will be created under the School District for each Special Inspector and/or Geotechnical Engineer. Do not complete this section if the Special Inspector/Geotechnical Engineer is employed by the LOR. See Section 3.)

Name:

Discipline:

Name:

 

Certification #:

 

Phone #:

 

(If applicable.)

 

 

Email:

 

 

 

Certification #:

 

Phone #:

 

 

 

(If applicable.)

 

 

 

 

 

 

Discipline:

Name:

Email:

Certification #:

Phone #:

(If applicable.)

 

 

 

Discipline:

Name:

Discipline:

Name:

Discipline:

Email:

 

Certification #:

 

Phone #:

 

(If applicable.)

 

 

Email:

 

 

 

Certification #:

 

Phone #:

 

 

 

(If applicable.)

 

 

Email:

 

 

Request for additional project folder collaborators:

 

PERMISSION LEVEL

 

 

View

View/Upload

Name:

Phone #:

□

□

Folder:

Email:

 

 

 

 

 

 

 

 

Name:

Phone #:

□

□

 

Folder:

Email:

 

 

 

Name:

Phone #:

□

□

Folder:

Email:

 

 

 

Name:

Phone #:

□

□

Folder:

Email:

 

 

 

Name:

Phone #:

□

□

Folder:

Email:

 

 

 

Name:

Phone #:

□

□

Folder:

Email:

 

 

 

Name:

Phone #:

□

□

Folder:

Email:

 

 

 

Name:

Phone #:

□

□

Folder:

Email:

 

 

 

Name:

Phone #:

□

□

Folder:

Email:

 

 

 

Name:

Phone #:

□

□

Folder:

Email:

 

 

 

 

 

 

 

 

Submit this form electronically to the DSA Regional Office with construction oversight authority for the project:

DSA OAKLAND

Oakfielddocs@dgs.ca.gov

DSA SACRAMENTO

Sacfielddocs@dgs.ca.gov

DSA LOS ANGELES

LAfielddocs@dgs.ca.gov

DSA SAN DIEGO

SDfielddocs@dgs.ca.gov

DSA 102-IC (rev 07-12-13)

 

Page 4 of 4

DIVISION OF THE STATE ARCHITECT

DEPARTMENT OF GENERAL SERVICES

STATE OF CALIFORNIA

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Step number 1 in completing form 102 icai filled sample pdf

2. Once your current task is complete, take the next step – fill out all of these fields - c Check this box if there is scope, Project Phasing Will Items, LISTING OF PROJECT PARTICIPANTS, List primary collaborators of, District Owner, Title, Design Professional in General, Name, Project Inspector, Email, InPlant Inspector, Email, General Contractor Firm Name, Name, and Laboratory of Record with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

form 102 icai filled sample pdf writing process described (part 2)

3. This 3rd section should also be rather easy, Laboratory of Record, Engineering Manager, Name, Geotechnical Engineer, Name, Email, Email, LEA, License, Phone, License Phone, DSA IC rev DIVISION OF THE STATE, DEPARTMENT OF GENERAL SERVICES, and Page of STATE OF CALIFORNIA - all of these empty fields will need to be filled in here.

Filling in part 3 of form 102 icai filled sample pdf

4. Filling in PROJECT DELIVERY METHOD, Design Bid Build CM MultiPrime, Design Build CM at Risk, LeaseLease Back Owner Builder, LISTING OF PROJECT COLLABORATORS, Design Professional with delegated, Discipline, License, Discipline, License, Name, Name, Email, Email, and Phone is essential in the fourth part - make sure to take your time and be mindful with each field!

Writing segment 4 of form 102 icai filled sample pdf

5. The final section to complete this PDF form is integral. You'll want to fill in the necessary blanks, for instance Name, Name, Email, Email, School DistrictOwner project, Name, Name, Name, Name, Email, Email, Email, Email, Project Inspector project folder, and Name, before submitting. Failing to do so could end up in a flawed and possibly nonvalid paper!

Part # 5 of filling out form 102 icai filled sample pdf

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