HomeMy WebLinkAboutX2017-0926 - Misc (3)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 Addre
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Re Date:
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CNB Inspector Name: CNB Permit*:
X 1 '91
Building Owner Name:
Owner's Mailing Address fd different from site);
Owners Telephone #: CNB Plan Check #:
Full Name of Structural Observer (SO):
SqE-mail Address: I
SO Telephone #: SO License / Reg. M.
❑ Concrete
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FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Roof)
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
❑ Conventional
Footings & Slab
❑ Concrete
❑ Steel
❑ Concrete
❑ Mat Foundation,
Prestressed Concrete
❑ Caissons, Piles,Wood
Grade Beams
❑ Masonry
or Manuf.
Shear Panels
❑ Concrete
El Masonry
❑ Steel Deck
Wood
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❑ Other:
❑ Other.
❑Other.
❑ Other.
MHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑ OBSERVED DEFICIENCIES AND COMMENTS:
❑ REPORT CONTINUED ON ATTACHED PAGES.
FINAL STRUCTURAL OBSERVATION REPORT:
�... �......«..e ..e..e.yn., �...,,..no� ,.ath tha anoroved construction
documents. and all observed deficiencies were corrected.
I declare that the following statements are true to the best of my knowledge:
;
1. 1 am the licensed design professional retained by the owner to be in responsible QROF=SS/pA,_
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 1.
approved construction documents; #N0. x+51994 P'Dt
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.
C% CAS
1 I STA,;.MP OF STRUCTURAL OBSERVER
ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORED EMPLOYEES OF THE CITY OF
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