Form Dsa 292 PDF Details

Form Dsa 292 is a critical document for businesses in California. It's used to report financial information to the state, and must be filed annually. Failing to do so can result in penalties and fines. This article will explain what Form Dsa 292 is, who needs to file it, and the consequences of not doing so. We'll also provide a link to the form itself so you can download it and get started.

QuestionAnswer
Form NameForm Dsa 292
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesCalifornia, Frontera, LOS, 292 form

Form Preview Example

This form must be submitted to the DSA by any special inspectors employed by an LEA laboratory as follows:

a)For projects with construction start date before June 1, 2013, submit this completed form to the DSA Regional Office with jurisdiction over the project;

b)For projects with construction start date on or after June 1, 2013, submit the form to the laboratory’s engineering manager. Do not file this verified report with the DSA.

A special inspector who contracts individually and directly with the school board, in accordance with California Code of Regulations (CCR), Title 24, Part 1, Section 4-335, shall file this form with the design professional in general responsible charge, and DSA, regardless of construction start date.

School District/Owner:

DSA File #:

-

 

 

 

Project Name/School:

DSA App #:

-

 

 

Name of Special Inspector:

DSA 152 Card #(s):

 

 

 

Date of the report:

 

 

 

 

 

Note that DSA approved construction documents, referred to below, are those

 

 

portions of the construction documents, duly approved by the DSA, that contain

(If applicable, list all inspection

information related to and affecting the Structural Safety, Fire/Life Safety and

card numbers for which this

Accessibility portions of the project.

verified report applies.)

 

 

 

The Special Inspection discipline covered by this report is identified on the approved DSA 103 as:

(List the discipline as a numbered item on form DSA 103, “Statement of Structural Tests and Special Inspections.” Example: “19. Welding.”)

A separate Verified Report (form DSA 292) must be completed for each general discipline.

1. REASON FOR FILING THIS VERIFIED REPORT: (Check applicable box)

Interim Verified Report: (List affected form DSA 152 Inspection Card Section #[s].) (Refer to DSA Procedure 13-01 for additional information and instructions)

Final Verified Report: (Conclusion of the work requiring special inspection.)

Construction work suspended for more than one month. Date of last inspection:

Termination of special inspector’s services prior to completion of the work requiring special inspection.

Date of last inspection:

DSA Request dated:

Complete certifications below and attach additional documentation if necessary. (All must be checked.)

2. CERTIFICATIONS:

A.

I personally performed the following special inspections: (List all special inspections covered by this report. Identify each test/inspection performed by item number and letter found on the approved form DSA 103. Example: “19.2b”)

for the following portions of construction: (List specific portions of construction which you personally inspected; for projects with Inspection Card, list applicable section and block numbers for each card.)

DSA 292 (rev 06-13-13)

 

Page 1 of 2

DIVISION OF THE STATE ARCHITECT

DEPARTMENT OF GENERAL SERVICES

STATE OF CALIFORNIA

DSA 292

Revised June 13, 2013

SPECIALINSPECTIONVERIFIEDREPORT

Date of Report:

DSA App. #:

-

B. My inspections were performed in accordance with the requirements of the DSA approved construction documents.

C.I know of my personal knowledge that: (Check only 1 box.)

The required special inspections met the requirements of the DSA approved construction documents; any non- compliant inspected work issues have been resolved by the date of this report.

Any non-compliant inspected work that has not been resolved by the date of this report is listed on an attachment to this report (form DSA 211).

D. All special inspection reports pertinent to my services have been filed as required by Sections 4-335 and 4-336 of Part 1, Title 24, CCR.

I declare under penalty of perjury that I prepared the above report and that all statements are true.

SPECIAL INSPECTOR SIGNATURE:

DATE:

 

 

 

PRINT NAME:

DSA CERTIFICATION NO.: (If applicable.)

 

 

 

ADDRESS:

 

 

 

 

 

CITY:

STATE:

ZIP:

 

 

E-MAIL ADDRESS:

PHONE NUMBER:

 

 

 

Submit completed form to the DSA Regional Office with construction oversight authority for the project.

DSA OAKLAND

DSA SACRAMENTO

DSA LOS ANGELES

DSA SAN DIEGO

1515 Clay Street, Suite 1201

1102 Q Street, Suite 5200

700 N. Alameda Street, Suite 5-500

10920 Via Frontera Rd., Suite 300

Oakland, CA 94612

Sacramento, CA 95811

Los Angeles, CA 90012

San Diego, CA 92127

DSA 292 (rev 06-13-13)

 

Page 2 of 2

DIVISION OF THE STATE ARCHITECT

DEPARTMENT OF GENERAL SERVICES

STATE OF CALIFORNIA

How to Edit Form Dsa 292 Online for Free

You may fill in Frontera effectively with our online tool for PDF editing. FormsPal expert team is continuously working to expand the tool and insure that it is much faster for people with its multiple features. Take your experience to another level with constantly growing and amazing possibilities we provide! Getting underway is easy! All that you should do is take the next easy steps directly below:

Step 1: Open the PDF inside our tool by hitting the "Get Form Button" at the top of this webpage.

Step 2: This editor will let you customize PDF forms in various ways. Modify it with customized text, adjust existing content, and put in a signature - all within the reach of a couple of clicks!

When it comes to blanks of this particular form, this is what you should know:

1. Begin completing your Frontera with a number of necessary blank fields. Gather all of the necessary information and make sure not a single thing omitted!

Stage no. 1 of filling out dsa form 292

2. The third step is to fill in the next few fields: Termination of special inspectors, DSA Request dated, Complete certifications below and, CERTIFICATIONS, I personally performed the, for the following portions of, DSA rev DIVISION OF THE STATE, DEPARTMENT OF GENERAL SERVICES, and Page of STATE OF CALIFORNIA.

Writing segment 2 in dsa form 292

3. The next section is considered fairly simple, DSA SPECIAL INSPECTION VERIFIED, Date of Report, DSA App, My inspections were performed in, I know of my personal knowledge, The required special inspections, All special inspection reports, I declare under penalty of perjury, DATE, PRINT NAME, ADDRESS, CITY, DSA CERTIFICATION NO If applicable, STATE, and ZIP - these empty fields will have to be completed here.

Completing section 3 of dsa form 292

It's easy to make an error while completing your DSA CERTIFICATION NO If applicable, thus be sure to look again prior to when you send it in.

4. This specific paragraph comes next with all of the following fields to fill out: EMAIL ADDRESS, and PHONE NUMBER.

dsa form 292 conclusion process clarified (part 4)

5. The pdf should be completed by dealing with this part. Further you'll see an extensive set of blanks that have to be filled out with specific information in order for your form usage to be faultless: Submit completed form to the DSA, DSA OAKLAND Clay Street Suite, DSA SACRAMENTO Q Street Suite, DSA LOS ANGELES N Alameda Street, DSA SAN DIEGO Via Frontera Rd, DSA rev DIVISION OF THE STATE, DEPARTMENT OF GENERAL SERVICES, and Page of STATE OF CALIFORNIA.

dsa form 292 conclusion process shown (part 5)

Step 3: As soon as you have looked again at the information in the document, press "Done" to complete your form. Right after setting up a7-day free trial account here, it will be possible to download Frontera or send it through email directly. The file will also be easily accessible through your personal account menu with all of your changes. We do not share any information that you use when filling out forms at our site.

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