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CITE' OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newoortbeachca.gov (949) 644-3200
Structural Observation Report
Project Address:
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Report Date:
3/1/ I1'
CNB Inspector Name:
CNB Permit #:
Building Owner Name:
Owner's Mailing Address (if different from site):
Owner's Telephone M
CNB Plan Check #:
Full Name ofS ctural Observer (SO):
SO E-mail Address:
SO Telephone #:
SO License / Reg. #:
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❑ Masonry
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PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check aoDlicable boxes)
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Roof)
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
❑ Conventional
Footings & Slab
❑ Concrete
❑ Steel
❑ Concrete
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❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concrete
❑ Steel Deck
and Wood Pyynir-- .
❑ Caissons, Piles,
Grade Beams I
❑ Wood or Manuf.
Shear Panels
❑ Masonry
❑ Wood
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❑ Other:
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❑Other:
❑ ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑ OBSERVED DEFICIENCIES AND COMMENTS:
❑ 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. 1 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
'3/4111
DATE
STAMP OF STRUCTURAL OBSERVER
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH.
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