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XXIO.1 1?
719 5aSm;ne Ove
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
Structural Observation Report
Project Address:
-70 ANjE. )d[u,.: tirf t'iMj-i cA
Report Date:
2/2,0/ ( 9
CNB Inspector Name:
CNB Permit #:
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 #:
SO License / Reg. #:
3-tr1U() 6e7.a t
emllw (�) b;Js S i11C. /)'e
❑ Concrete
PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check applicable boxes)
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Roof)
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
Conventional
ootin s & Slab
❑ Concrete
ElSteel
❑ Concrete
FN i7 Q PT -we 8+ d
❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concrete
❑ Steel Deck
❑ Caissons, Piles,
Grade Beams
❑ Wood or Manuf.
Shear Panels
❑ Masonry
❑ Wood
❑ Other:
❑ Other:
❑ Other:
❑ Other:
ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑ OBSERVED DEFICIENCIES
AND COMMENTS:
i
❑ 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.
STAMP OF 51 KUU IURAL UBStKVtK
STRUCTURAL OBSERVATION DOES NOT WANE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH.
ro=ASlmolunlObse tionRepon&InsWgions
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