Design and construction of a 393,000 SF cast-in-place parking structure in a congested urban environment. The seven-level facility was built on an existing on-grade parking lot in the heart of an operating hospital campus. A multi-story hospital was also being built concurrently on-site. Careful coordination with Sutter Health services and adjacent contractors was required. The new structure provides 1,067 parking spaces for staff, patients and visitors. Integrated Project Delivery (IPD) included the Owner, Architect, and Contractor to optimize the preconstruction and construction processes. The project required extensive below grade parking system evaluation, including multiple deep foundations, soil improvement and waterproofing systems. We self-performed the concrete on the project, placing of 25,000 CY of concrete in 8 months. We met 21 sustainable elements in design and construction, as well as recycled 96% of construction waste, exceeding the City of Oakland’s 65% requirement.