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CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.aov 1(949) 6443200
Structural Observation Report
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Report ate-
CNB Inspector Name:
CNB Permit #:
Building Owner Name:
Owners ailing Address (if different from site);
a Telephone #:
CNB Plan Check A
❑ Concrete
❑ Steel
t
❑ Concrete
Full Name of Structural Observer (SO):
SO E-mail Address:
90 Tele hone #:
SO License / Reg. #:
❑ Concrete
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lwpa'y
❑ Caissons, Piles,
Grade Beams
❑ Wood or Manuf
Shear Panels
❑ Masonry
PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check annlicahla hnYeat
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
Floor/Roo
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
Conventional
Pootin s & Slab
❑ Concrete
❑ Steel
❑ Concrete
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❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concrete
❑ Steel Deck
❑ Caissons, Piles,
Grade Beams
❑ Wood or Manuf
Shear Panels
❑ Masonry
❑ Wood
❑ Other.
❑ Other.
❑ Other:
❑ Other:
EMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑ OBSERVED DEFICIENCIES AND COMMENTS:
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❑ REPORT CONTINUED ON ATTACHED PAGES.
❑ FINAL STRUCTURAL OBSERVATION REPORT:
The structure generally compiles with the approved construction documents, and all observed defictencleeVniregrinacted7l
I declare that the following statements are true to the best of my knowledge:
1. I am the licensed design professional retained by the owner to be in responsible
charge of the structural observation; OFT?
2. I, or another licensed design profession om I have designated above and is under e 4
my responsible charge, have perform a required site visits at each significant oo
construction stage to erify that s ure ' in general conformance with The
approved construction menta
3. I understand that all do fic ncies f I e documented must be corrected, prior tok�'�, /���..
final accept nce of ctu I s by the City of Newport Beach, Building �b��
Divisior
OFSTRUCTURALOBSERVER
STRUCTURAL OBSERVATION D"S NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CRY OF NEWPORT BEACH.
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CITY OF NEWPORT BEACH
CONMUNM DEVELOPMENT DEPART14IENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newpodbeachca.gov 1 (949) 644-3200
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be filled out by the permittee or homeowner)
Project Address: l v(./c> ®Z e tTj7jj�&�r Al' Gj°0?
Permit Number. _YJI;5 — 3A /S / yjl7lr
Properly Owner:. �/➢ `ter o4
Licensed Contractor: j�11s �41� Lic
The State of California now requires that smoke and carbon monoxide detectors must be
installed in all residential buildings
California Residential Code (CRC) Section R314.1, CRC 83152 states in part that
existing dwellings be "retrofitted with smoke detectors and carbon monoxide detectors.
CRC Section R314.3, CRC R315.3 defines required locations.
Both boxes below must be checked.
Carbon Monoxide Alarm: On the ceiling or wall outside of each separate
sleeping area in the immediate vicinity of bedrooms
the rooms, and each level of the dwelling. Detectors aare ch hal also requtired iide n
bedrooms with gas fired appliances
Smoke Alarms: Installed in each room used for sleeping purposes, outside
2reach sleeping area, and on each level of the dwelling unit.
Retrofitted detectors may be battery operated for buildings where no alterations are
performed on the interior. Multiple -purpose alarms (carbon monoxide and smoke alarms)
shall comply with all applicable standards and must be approved by the State Fire
Marshall. The devices must be installed per manufacturer's specifications.
1, the undersigned, hereby certify that t-18hpermittee or homeowner of the
project. I further certify the `rrlo"me�' r d carbon monoxide alarms are
Present and tested to be adt'd al Ing locations:
Signature: Date: /(J
MI0TE: This s9e ertifi "n is ocI used for projects to the exterior of the structure where access to the
interior of the''dwelling by the City of Newport Beach Building Inspector is not achieved during the course of
construction.