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AQX Engineering, Inc.
STRUCTURAL OBSERVATION REPORT FORM
STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the approved plans
and specifications, at significant construction stages and at completion of the structural system. Structural observation does not include
or waive the responsibility for the inspections required by Section 108, 1701 or other sections of the code.
�j� Report No.�
This report includes all construction work through �/y oT/� 4 Page No. 1 of 1
Project Addr ss
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Structural Observer of Record (SOR): S. 5289
Phone No. of SOR:
Building Permit No.: Structural Observation performed by
Professional Lic./Reg. No. of Observer. S. 5289
Phone No. of Observe[p141662 0510
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FOUNDATION
WALL
FRAMES
FLOOR
ROOF
PORTION OBSERVED AS NEEDED
❑ Footing, Stem Walls
❑ Concrete
❑ Steel Moment Frame
❑ Concrete
❑ Concrete
Mat Foundation
❑ Masonry
❑ Steel Braced Frame
❑ Steel
❑ Steel
❑ Caisson, Piles, Grade Beams
❑ Wood
❑ Concrete Moment Frame
❑ Wood
❑ Wood
❑ Retaining Foundation
Hillside Special Anchors
❑ Other:
❑ Masonry Wall Frame
❑ Others.
❑ Others.
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❑ Others:
❑ Others:Framing
OBSERVED DEFICIENCIES:
CONSTRUCTION APPEARS GENERALLY TO CONFORM TO THE STRUCTURAL PLANS
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1. I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE
CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE REQUIREMENTS
OF THE 0.e.
2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO 1 HAVE DESIGNATED ABOVE AND IS UNDER
MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH
SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF THE STRUCTURE IS IN GENERAL
CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS;
3. ALL DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED ABOVE;
1. 1 RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE
COOE
I7. C _ BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
D.
STAMP OF STRUCTURAL OBSERVER OF RECORD