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CITY OF NEWPORT BEACH 3ggj 5rAjoe do
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.aov (949) 644-3200
Structural Observation Report
Project Address:,,_, &'j f Jy)e' j5��
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Reporl Date: 4-8-19
CNB Inspector Name:
CNB Permit #:
Building Owner Name:
oh .t Fenny f qS#V A
Owner's Mailing Address (if different from site);
same
Owners Telephone #;
g411- 40- 8 51
CNB Plan Check #:
Full Name of Structural Observer (80):
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$O E-mail Address:
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SO Telephone #:
7/y- 1507-172?
SO License f Reg. #:
CbW4
PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check anolicable boxesl
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Root]
INDICATE LOCATIONS)
OBSERVED
DATE
OBSERVED
❑ Conventional
Footings & Slab
❑ Concrete
❑ Steel
❑ Concrete
❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concrete
❑ Steel Deck
❑ Caissons, Piles,
Grade Beams
❑ Wood or Manuf.
Shear Panels
❑ Masonry
❑ Wood
Other: Yt+rnrr�w
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❑ Other:
❑ Other:
11 Other
ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑ OBSERVED DEFICIENCIES AND COMMENTS:
I
O REPORT CONTINUED ON ATTACHED PAGES.
❑ FINAL STRUCTURAL OBSERVATION REPORT:
The structure generally complies with the approved construction documents, and all observed deficiencies were corrected.
1 declare that the following statements are true to the best of my knowledge:
I am the licensed design professional retained by the owner to be in responsible
charge of the structural observation;
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;
I 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,
STRUCTURAL OBSERVATION DOES NOT WANE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH.
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DAILY REPORT OF
OBSERVATION AND TESTING
i GMU Geotechnical; Inc.
23241 Arroyo Vista, Rancho Santa Margarita, CA 92688
Phone(949)888-6513
FAX (949) 888-1380
JOB LOCATION
CLIENTOR OWNER
REPORT SEQUENCE NO.
PURPOSE OF FILL OR NATURE OF STRUCTURE TO BE SUPPORTED
DATE
DAY OF WEEK
GENERAL CONTRACTOR
9 9
GRADING OR EARTHWORK CONTRACTOR
JOB ENGINEER
HOURSCHARGED
CONTRACTOR'S SHIFT
CONTRACTOR'S SUPT OR FOREMAN
ASSISTANTS
HOURS CHARGED
SOURCE & DESCRIPTION OF FILL MATERIAL
WEATHER
APPROXIMATE YARDAGE
PLACED THIS SHIFT TOTAL TO DATE
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PROJECT
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