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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 926588915
www.newportheachca.gov 1(949) 644-3200
CONTRACTOR/PROPERTY OWNER SELF -CERTIFICATION DECLARATION
FOR PLUMBING FIXTURE REPLACEMENT
Project Address: 1 I L4 V
Date:
Permit
The following is to be completed by the California licensed contractor or owner, participating in the City of Newport
Beach Self -Certification Program. Please type or print.
Installer's Name: SCo k CAt,V -- e"V 1 S Ucense No (Iaoplicable) p b _
Installer's Mailing Address: '2DTC1 r m _ K�1 AP 1 t40 Phone # (required):
Installer's Email: Sco VC- '-t�' L,Tt�e v, "Jp_tQY�FAX# N Ig .
Installer
I certify that the installation is in compliance with applicable code requirements.
I further affirm that I have reviewed and understand the requirements of the 2019 Caldomia Green Building Standards
Code (CGBSC) Section 301.1.1 and that all self -certification reports submitted will be based on the erode requirements
contained therein.
I declare that all plumbing fodures subject to the CGBSC 301.1.1 has been replaced meeting the low flow
requirements:
Kitchen faucets: 1.8 gat/minute at 60 psi I Shower heads: 1.8 gallminute at 80 psi 1
Water closet 1.28 gayflush Faucets: maximum Bow rate of 12 gallminute at 60 psi,
and minimum 0.8 gallminute at 20 psi
/4-23
Property Owner (Required)
As the property owner of the project address noted above, I have read, understand and agree to participate in the
Plumbing Furture Replacement Self -Certification Program. 1 further understand that by participating in this program, the
plumbing system will not be inspected by a City of Newport Beach Building Inspector during construction or after
installation unless requested. The Building Division may request and reserves the right to verify rode compliance after
the installation is complete.
Date
Email
This form must be completed and returned to the City of Newport Beach, Building Division, for a final approval
of the combination permit. Please return this form to the Building Division by mail or fax.
Please mail to: City of Newport Beach Phone: (949) 718-1888
Community Development Department Fax #: (949) 644-3260
Building Division
P. O. Box 1768
Newport Beach, CA 92658
E`°''O CITY OF NEWPORT BEACH
° � Community Development Department I Building Division
nn 100 Civic Center Dr.l P.O. Box 1768 1 Newport Beach, CA 92658
www.newoortbeachca.aov1(949)644-3200
�'�Lraox��r
CALGREEN DOCUMENTATION COMPLIANCE CERTIFICATION
ADDRESS: I!Zc/ 0 OCr'_c-t'PU/-�- PERMIT NO.: XZ0 `ZO - I/G'�-
THIS FORM SHALL BE COMPLETED AND SIGNED PRIOR TO REQUEST FOR FINAL BUILDING
INSPECTION. ONE COPY OF THIS FORM SHALL BE SUBMITTED TO THE BUILDING INSPECTOR AT
FINAL INSPECTION AND ONE SHALL BE PROVIDED TO THE BUILDING OWNER AS PART OF THE CAL
GREEN CERTIFICATION PACKAGE.
The following section shall be completed by a person with overall responsibility for the planning and
design portion of the project.
REQUIRED DOCUMENTATIONS PROVIDED TO THE PROPERTY OWNER(S)
Franchise Hauler for Construction/Demolition Waste
B"'VOC Contents Limitation
[Y"Formaldehyde Emissions Limitation
iS T-24 Energy Certificate of Installations (Env., QII, Lighting, Photovoltaic, Mech., Plumb.)
15'IT-24 Energy Certificate of Verifications or Acceptance ( Env., QII, Lighting, Photovoltaic, Mach.,
/Plumb.,_HERS)
& Operations and Maintenance Manual
MOISTURE CONTENT OF BUILDING MATERIAL (RESIDENTIAL CONSTRUCTION ONLY)
L 1 certify that the moisture content of the wall and floor framing is less than 19 percent as
determined in accordance with Section 4.505.3 of CAL Green prior to being enclosed.
DECLARATION STATEMENT
• 1 certify under penalty of perjury, under the laws of the State of California, the information
provided is true and correct.
• [certify that the installed measures, materials, components, or manufactured devices identified
on this certificate conform to all applicable codes and regulations, and the installation is
consistent with the plans and specifications approved by the enforcing agency.
GrA4LOf
Date Signed:
3
re:
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915
www.newportheachca.gov 1 (949) 644-3200
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be filled out by the permit tee or homeowner)
Project Address: I1 z'-/ (ti) &ea400l Av-e-
Permit Number: _X2-0 Zn -// (o $
Property Owner. A%Jil.
Licensed ContractoriAme-5 L)aa i.. sh ., 6j'u ,r Lic #: _Q 013 8 9'
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 R315.2 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.
® 1Cll/ Carbon Monoxide Alarm: On the ceiling or wall outside of each separate
sleeping area in the immediate vicinity of bedrooms or in each hallway outside of
the rooms, and each level of the dwelling. Detectors are also required in
bedrooms with gas fired appliances
❑Er""� Smoke Alarms: Installed in each room used for sleeping purposes, outside
each 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 1 am the permittee or homeowner of the
project. I further certify that Woke alarms and carbon monoxide alarms are
present and tested to I in all the following locations:
Signat Date: fir/
NOTE. elf -cent rs only used for projects to the exterior of the structure where access to the
inte . r of the dwelling by the City of Newport Beach Building Inspector is not achieved during the course of
construction.
FomslSmakeDeb,ctomndCarbonMonorideSelfCert 08/12/16
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P_O. Box 1768 1 Newport Beach, CA 926588915
www.newportbeachca_gov 1 (949) 644-3200
CONTRACTORIPROPERTY OWNER SELF-CER77FICA71ON DECLARATION
FOR PLUMBING FIXTURE REPLACEMENT
Project Address: i i Z L4 Q r-e, viDate:_1 1 ( Z -3 Permit*.
The following is to be completed by the California licensed contractor or owner, participating in the City of Newport
Beach Self -Certification Program. Please type or print.
Installers Name: 5co N -il t,Vk a yi s License No (rfappocalte) jg
S�t b z Lj
Installers tNaTing Address: *2-t77r L Gezv+� _ tS ,,, ,,. D � $� � Phone # (required) � .
Installer's Email:_ _5c o lk
Installer
I certify that the Installation is in compliance with applicable code requirements.
I further affirm that 1 have reviewed and understand the requirements of the 2019 California Green Building Standards
Code (CGBSC) Section 301.1.1, and that all self-cerfification reports submitted will be based on the code requirements
contained therein.
I declare that all plumbing fbdures subject to the CGBSC 301.1.1 has been replaced meeting the low flow
requirements:
Kitchen faucets: 1.8 gaUminute at 60 psi Shower heads: 1.8 gallminute at 80 psi
tlVdter closet 128 gayflush Faucets: miaximum flow rate of 12 gaUminute at 60 psi,
and minimum 0.8 galirninute at 20 psi
114•23
Property Owner (Required)
As the property owner of the project address noted above, 1 have read, understand and agree to participate in the
Plumbing Fodure Replacement Self -Certification Program_ 1 further understand that by participating in this program, the
plumbing system will not be inspected by a City of Newport Beach Building Inspector during construction or after
installation unless requested. The Building Division may request and reserves the right to verify code compliance after
the installation is complete.
k"
bate
Effmd
This form must be completed and returned to the City of Newport Beach, Building Division, for a final approval
of the combination permit. Please return this form to the Building Division by mail or fax.
Please Mai to: City of Newport Beach Phone. (949) 718-1888
Community Development Department Fax* (949) 644-3250
Building Division
P_ O. Box 1768
Newport Beach, CA 92M
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.newOortbeachcapov 1 (949) 644-3200
Structural Observation Report
Project Address:
Report Date:
CNB Inspector Name:
CNB Permit #:
1124 W. Oceanfront
03/08/2022
Building Owner Name:
Owners Mailing Address (ff different from site);
Owner's Telephone #:
CNB Plan Check*.
Full Name of Structural Observer (SO):
SO E-mail Address:
SO Telephone #:
SO License / Reg. #:
Amir Deihimi
amir@corestructure.com
(949) 500-3800
C78194
PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check aoolicable boxes)
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Roof)
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
❑ Conventional
Footings & Slab
❑ Concrete
❑ Steel
❑ Concrete
Final Framing
03/08/22
❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concrete
❑ Steel Deck
❑ Caissons, Piles,
Grade Beams
Wood or Manuf.
Shear Panels
❑ Masonry
Wood
❑ Other:
❑ Other:
❑ Other:
❑ Other:
.V ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑ OBSERVED DEFICIENCIES AND COMMENTS:
Final Framing Observation, No deficiencies.
❑ REPORT CONTINUED ON ATTACHED PAGES.
91 FINAL STRUCTURAL OBSERVATION REPORT:
The structure generally complies with the approved construction documents, and all observed deficiencies were corrected.
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;
2. I, or another licensed design professional whom I have designated above and is under
my responsible charge, have performed the required site visits at each significant
construction stage to verify that the structure is in general conformance with the
approved construction documents;
3. 1 understand that all deficiencies which I have documented must be corrected, prior to
final acceptance of the structural systems by the City of Newport Beach, Building
Division.
�• /�f�/ �y�T�� 03/08/2022
SIGNATURE OF STRUCTURAL OBSERVER OF RECORD DATE
QROFESS/pN
q
� m
No. C78194
{7 ti7
gTFOF CALIFO�
STAMP OF STRUCTURAL OBSERVER
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BYAUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH.
Fo=69wc4rtalOWmaboa Vort&IosnocWw
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.gov 1 (949) 644-3200
Structural Observation Report
Project Address:
Report Date:
CNB Inspector Name:
CNB Permit M
1124 W. Oceanfront
11/09/2021
Building Owner Name:
Owners Mailing Address (if different from site);
Owner's Telephone M
CNB Plan Check #:
Full Name of Structural Observer (SO):
SO E-mail Address:
SO Telephone #:
SO License / Reg. P
Amir Deihimi
amir@corestructure.com
(949) 500-3800
C78194
PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check applicable boxes)
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Roof)
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
❑ Conventional
Footings & Slab
❑ Concrete
❑ Steel
❑ Concrete
Exterior Shear and Roof
and Floor Sheathing
11/09/2021
❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concrete
❑ Steel Deck
❑ Caissons, Piles,
Grade Beams
Wood or Manuf.
Shear Panels
❑ Masonry
Wood
❑ Other:
❑ Other:
❑ Other:
❑ Other:
•a( ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑ OBSERVED DEFICIENCIES AND COMMENTS:
The above items are installed in accordance with engineered drawings; there were no observed deficiencies at the time of inspection.
❑ REPORT CONTINUED ON ATTACHED PAGES.
FINAL STRUCTURAL OBSERVATION REPORT:
The structure generally complies with the approved construction documents, and all observed deficiencies were corrected.
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;
2. I, or another licensed design professional whom I have designated above and is under
my responsible charge, have performed the required site visits at each significant
construction stage to verify that the structure is in general conformance with the
approved construction documents;
3. 1 understand that all deficiencies which I have documented must be corrected, prior to
final acceptance of the structural systems by the City of Newport Beach, Building
Division.. .i-
I I IF' `--A5wdWA(1I`-- 11/09/2021
QROFESS/pN
9
DflF��
s
� m
No. C78194
Jl c l v o- �F
gTFOF CAL)FOR
STAMP OF STRUCTURAL OBSERVER
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH.
Fo=v StNC1falObsel atlonRepon&imtmetiom
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.Qov 1 (949) 644-3200
Structural Observation Report
Project Address:
1124 W. Oceanfront
Report Date:
08/02/2021
CNB Inspector Name:
CNB Permit M
Building Owner Name:
Owners Mailing Address (if different from site);
Owner's Telephone #:
CNB Plan Check #:
Full Name of Structural Observer (SO):
SO E-mail Address:
SO Telephone M
SO License / Reg. M
Amir Deihimi
amir@corestructure.00m
(949) 500-3800
C78194
PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check aunlicable boxes)
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
Floor/Roof)
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
df Conventional
Footings & Slab
❑ Concrete
❑ Steel
❑ Concrete
Foundation Slab rebars
08lD2/2021
❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concrete
❑ Steel Deck
❑ Caissons, Piles,
Grade Beams
❑ Wood or Manuf.
Shear Panels
❑ Masonry
❑ Wood
❑ Other:
❑ Other:
❑ Other:
❑ Other:
.0 ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑ OBSERVED DEFICIENCIES AND COMMENTS:
The above items are installed in accordance with engineered drawings; there were no observed deficiencies at the time of inspection.
❑ REPORT CONTINUED ON ATTACHED PAGES.
❑ FINAL STRUCTURAL OBSERVATION REPORT:
The structure generally complies with the approved construction documents, and all observed deficiencies were corrected.
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,
2. I, or another licensed design professional whom I have designated above and is under
my responsible charge, have performed the required site visits at each significant
construction stage to verify that the structure is in general conformance with the
approved construction documents;
3. 1 understand that all deficiencies which I have documented must be corrected, prior to
final acceptance of the structural systems by the City of Newport Beach, Building
Division.
08/02/2021
SIGNATURE OF STRUCTURAL OBSERVER OF RECORD DATE
STAMP OF STRUCTURAL OBSERVER
STRUCTURAL OBSERVATION DOES NOT WANE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH.
Forms\Sh =alObservato poR&Wtrucdom
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.gov 1 (949) 644-3200
Structural Observation Report
Project Address:
1124 W. Oceanfront
Report Date:
04/22/2021
CNB Inspector Name:
CNB Permit #:
Building Owner Name:
Owner's Mailing Address (if different from site);
Owner's Telephone #:
CNB Plan Check #:
Full Name of Structural Observer (SO):
SO E-mail Address:
SO Telephone #:
SO License / Reg. #:
Amir Deihimi
amir@corestructure.com
(949) 500-3800
C78194
PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED check applicable boxes
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(FloodRoof)
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
Conventional
Footings & Slab
❑ Concrete
❑ Steel
❑ Concrete
Concrete wall footings,
anchor bolts and
holdowns
04/22/2021
❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concrete
-
❑ Steel Deck
❑ Caissons, Piles,
Grade Beams
❑ Wood or Manuf.
Shear Panels
❑ Masonry
❑ Wood
❑ Other:
❑ Other:
❑ Other:
❑ Other:
.V1 ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑ OBSERVED DEFICIENCIES AND COMMENTS:
The above items are installed in accordance with engineered drawings; there were no observed deficiencies at the time of inspection.
❑ REPORT CONTINUED ON ATTACHED PAGES.
❑ FINAL STRUCTURAL OBSERVATION REPORT:
The structure generally complies with the approved construction documents, and all observed deficiencies were corrected.
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;
2. 1, or another licensed design professional whom I have designated above and is under
my responsible charge, have performed the required site visits at each significant
construction stage to verify that the structure is in general conformance with the
approved construction documents;
3. 1 understand that all deficiencies which I have documented must be corrected, prior to
final acceptance of the structural systems by the City of Newport Beach, Building
Division.
�/•fJ��r.�r /�� �� 04/22/2021
SIGNATURE OF STRUCTURAL OBSERVER OF RECORD DATE
QROFESS/pN
q
Z
c� m
No. C78194
JT Clvo, �P
�lFOF CAOF���
STAMP OF STRUCTURAL OBSERVER
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CRY OF NEWPORT BEACH.
Forms\S[mrn 10bse adon epottffilu c[iov
o�Aqv'�`
por?CITY OF NEWPORT BEACH
" COMMUNITY DEVELOPMENT DEPARTMENT
uT BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
y<rFonNXwww.newportbeachca.gov 1 (949) 644-3200
BUILDING HEIGHT CERTIFICATION
Project Street Address: �� Z t/ W , a4azz riedo "'
Building PermitNumber(s): Zr72W (/��
As the surveyor of record for the project at the above address, I hereby certify that I have reviewed the
City of Newport Beach approved plan and original topographic survey and based the elevations listed
below on those plans.
Elevations shall include an allowance for roofing material thickness If not yet installed. Provide
each critical ridge and flat roof, or roof deck railing elevations indicated on the approved plans.
Use the format below on the back of this form if additional space is necessary or further
explanation Is needed. Provide original copy to the inspector before roof framing inspection.
All elevation points are based on: WNAVD88 O NGVD29 O Assumed
Please provide the following elevation information for the highest roof ridges, flat roofs, or
parapets/guardrails. Additional elevation points may be requested by the Ruildi t
r �'��.L: rare
RIDGES (3:12 slope or greater)
1. Approved elevation point of ridge is O.6r� and actual elevation point isy0 . evs—.
2. Approved elevation point of ridge is and actual elevation point is
3. Approved elevation point of ridge is and Yctual elevation point is
I
FLAT ROOFS, PARAPETS AND GUARDRAILS
1. Approved elevation point of flat �roofoparapet is G
33Ciand actual elevation point is
2. Approved elevation point of flat roof or parapet is and actual elevation point is
3. Approved elevation point of flat roof or parapet is and actual elevation point is
I certify that the above height measurements are correct and the above project:
0 IS In compliance with the City -approved plans.
OIS NOT in compliance with the City -approved plans (Provide
Please describe any deviation from the City -approved plans on the back of this form.
Surveyor or Civil Engineer's* signature and seal
(Wet stamp and signature required)
* License number of 33965 or lower
ronnalauilding Height Cetti9oadan 11/02/16
J-z (
el
Date
DEPUTY 1 INSPECTION
1-800-DEPUTYI �!
Gen Contr: h
Sub-Contr: s CG
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658
www.newoortbeachca.gov 1 (949) 644-3200
SPECIAL INSPECTION REPORT
Project Address: Rea VIt — 11.1- Hu-9. lb('64040a
Permit Number: 94.1.01Q - 11 L 4R
Inspection Type (s):
Inspection Date (s): ( ) Periodic �,4 Continuous
aft Describe Inspection, including Location(s): /
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i�t�4In...tg .P ...... NAV� �YY1Lt�� ._.. /_ �nr Ri )l�iM—F>L1.(tk�p6
...... .52 `E...._`t'_....LS�.ebC1✓._ Quals...._r.l�f+ file__./. .... 5t� MIT -
List Tests Made:
.._...._..._..__..r...._..._..._.................._...._........_........._......._...._........._....._......_...._...._....._..._....._.....:._........._...._........_....._...._....._.._---
_-----
_-----------
_
ff Total Inspection Time Each Day:
Date �.t 2 2,
_ .._..._..
Hours:�..._.._...._...._..._
List All Items Requiring Correction (Include Previously Listed Uncorrected Items):
To the best of my knowledge, the work inspected was in accordance with the Building Division approved design drawings,
specifications and applicable workmanship provisions of the U.B.C. except as noted above.
Special Inspector :Signature:
Datek.
2
Print FullName:
Newport.Beach Registration No.:
e4m &Prm
r OAJ02
SpeciallnspectionReport 8-24-15
DAILY FIELD REPORT
Priority Engineering 335 E. Blueridge Ave Orange CA 92865 (949) 391-8200
Project Address % Project No.
Client / i Date Day
Contractor Weather
Equipment Te nician
observation/Testing Of G
Start _ End otaf Mileage j Pe�0.
Time Time Hours i =f7ZO 2 6 _ )) 6 cJ
Received By
Representing
k
Technician
DAILY FIELD REPORT
Priority Engineering 335 E. Blueridge Ave Orange CA 92865 (949) 391-8200
ProjectAddress Project No.
Client Date Day
Contractor Weather
Equipment
Tj5GPni . cian
Observation/Testing of
Start Z� Q I------ ---
End -J Total Mileage j Permit No.
Time Time Hours
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C,
4
4=1
A,
Received By Representing Technician
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92668
www.nemortbeachca.gov 1(949) 644-3200
SPECIAL INSPECTION REPORT
Project
Permit Number: k -t
DEPUTY I INSPECTION
1-800.DEPUTYI
��Gen Contr: y/'
Sub-Contr. see
Inspection Type (s):
Inspection Date (s): U 9 ( ) Periodic (�) Continuous
. ' . ', WAll ttenu7tMuift arrkdon (indu&PreWoL* Usted Uncorrected imm):
" P � r i � a l e .• .1 � ! . I .�
To the best of my knowledge, the work Inspected was in accordance with the Building Division approved design drawings,
soeci0cations and applicable workmanship provisions of the U.B.C. except as noted above.
s ` I hmpectdrsknoture:
oats -
Newport Beach Registration No.:
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