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Box 1768 1 Newport Beach, CA 92658 www.newportbeachca.00v 1 (949) 644-3200 SPECIAL INSPECTION REPORT Project Address: 4' li-linans Res— 161') An'++q JA'nu Permit Number: X1,019 r 1 y1 l Inspection Type (s): )^ Inspection Date (s): ' �i' 1 q ( ) Periodic (>t.)-Continuous f,#stTe�a M,�des To the best of my knowledge, the work inspected was in accordance with the Building Division approved design drawings, specifications and applicable workmanship provisions of the U.B.C. except as noted above. SpecialinspedionReport 8-24-15 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.aov 1 (949) 644-3200 Structural Observation Report Project Address: I�� Report Date: ' I I CNB Inspector Name: CNB Permit #: Building Owner Name: Owner's Mailing Address (if different from site); Owner's Telephone #: CNB Plan Check #: �55) PITn'aJAV S m Full Name of Structural Observer (SO): ( SO E-maildress: SO Telephone' #: SO L`icense / Reg. #: \f r N4yNJ r PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check applicable boxes) FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (Floor/Roof) INDICATE LOCATION(S) OBSERVED DATE OB ER ED Conventional Footin s & Slab ❑ Concrete ❑ Steel ❑ Concrete ll &Y1 R ElMat Foundation, Prestressed Concrete ElMasonry ❑ Concrete ❑ Steel Deck V0 �N io1A C 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: ❑ 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. 11n^ OBSERVATION DOES c ` ^ S� i EXP STAMP OF STRUCTURAL OBSERVER FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Fotms\Sm mumlObsmation Won&Ins ctwm STRUCTURAL OBSERVATION REPORT INSTRUCTIONS When structural observation is required for a project, the structural observer shall perform site visits at significant construction stages throughout the progress of the work. Site visit frequency shall allow for correction of observed deficiencies without substantial effort or uncovering of the completed work. Structural observation site visits shall be performed for each construction stage identified on the approved construction documents. The structural observer may utilize the City of Newport Beach "Structural Observation Report" form, or a similarly formatted report, to record the requiredobservation visits. If the City's form is not used the alternate report shall be on the structural observer's letterhead, state the site address, plan check and permit numbers, stages and elements observed, date observed, and complete contact information for the structural observer. All structural observation reports, regardless of form used, shall include the license stamp and wet signature of the structural observer responsible for the project. OBSERVED DEFICIENCIES When a deficiency is noted, the structural observer shall give copies of the completed structural observation report to the owner or owner's representative, project contractor, and the Chief Building Official or designee. The contractor shall resolve all deficiencies prior to final inspection or acceptance of the structural work by the Chief Building Official, or designee. FINAL STRUCTURAL OBSERVATION REPORT The structural observer shall submit a final structural observation report to the Chief Building Official, or designee, upon completion of the structural system. The final structural observation report shall state that the structural system conforms to the approved construction documents and that all previously observed deficiencies have been corrected. Final inspection or other acceptance of the structural system by the Chief Building Official, or designee, will not occur until the final structural observation report is received. 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Bell Gardens, CA 90202 P#800-388-8998 F#562-216-4001 A/�im CCLE SOLD TO: DENNIS HOLLAgD SHII 1612 ANTIGUA WAY f l NEWPORT BBACA , CA 92660 r' ,a ITY ' SHIP" t0'ry iHIS OR LINE li! ®1$ SHIPMENd :8/0 tiEN I s Y 1 PCS 0 --iVI01H 50#-WF CAM �• e�- �'. tv1,1J8") HEAT"65NeER Y�bYg144707 ''q 2 Y PCs 0 BErdl CUT 70 35 0.H8"l',1tq SO HE SC1jF.tA11,' .r ba` �1 s�lF ;4�x+r�sik" R 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.clov 1 (949) 644-3200 Structural Observation Report Project Addre7ss. Report Date: CNB Inspector Name: CNB Permit #: Building Owner Name: Owner's Mailing Ad ress (if difterent from site); Owner's Telephone #: CNB Plan Check #: LW4 5 Full Name of Structural Observer (SO): I SO E-mail Atldr as: � / (�' t SO Telephone #: SO License / Reg. #: ,� ,gyp PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSE E (check aplicab el boxes) FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (Floor/Roof) INDICATE LOCATION(S) 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 ElWood li l,(•,t 1�� `( �,� 1f ❑ Other: ❑ Other: ❑ Other: ❑ Other: ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. ❑ OBSERVED DEFICIENCIES AND COMMENTS: ❑ REPORT CONTINUED ON ATTACHED PAGES. FINAL STRUCTURAL OBSERVATION REPORT: IIj,SI 2 /u IV The structure generally complies with the approved construction documents, and all rJ4­5 ON L-4 01 %Vi S P,�$> observed deficiencie"ere 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. It JIS12 SI.GNATU =RECORD DATE I•�:�.ya:w,uu�,nT•�x.�l E. S�js3Q EXP OBSERVER FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OFNEWPORT BEACH. ea�e�sm,rn,.�ion��araNcmotta��NG�o� STRUCTURAL OBSERVATION REPORT INSTRUCTIONS When structural observation is required for a project, the structural observer shall perform site visits at significant construction stages throughout the progress of the work. Site visit frequency shall allow for correction of observed deficiencies without substantial effort or uncovering of the completed work. Structural observation site visits shall be performed for each construction stage identified on the approved construction documents. The structural observer may utilize the City of Newport Beach "Structural Observation Report" form, or a similarly formatted report, to record the required observation visits. If the City's form is not used the alternate report shall be on the structural observer's letterhead, state the site address, plan check and permit numbers, stages and elements observed, date observed, and complete contact information for the structural observer. All structural observation reports, regardless of form used, shall include the license stamp and wet signature of the structural observer responsible for the project. OBSERVED DEFICIENCIES When a deficiency is noted, the structural observer shall give copies of the completed structural observation report to the owner or owner's representative, project contractor, and the Chief Building Official or designee. The contractor shall resolve all deficiencies prior to final inspection or acceptance of the structural work by the Chief Building Official, or designee. FINAL STRUCTURAL OBSERVATION REPORT The structural observer shall submit a final structural observation report to the Chief Building Official, or designee, upon completion of the structural system. The final structural observation report shall state that the structural system conforms to the approved construction documents and that all previously observed deficiencies have been corrected. Final inspection or other acceptance of the structural system by the Chief Building Official, or designee, will not occur until the final structural observation report is received. x �t NXIIr,�f y .. CITE' OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT _, BUILDING DIVISION `t<,,. wk, %' 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658 www.newportbeachca.goV 1 (949) 644-3200 SPECIAL INSPECTION REPORT Project address: Oltmans Residence. 1612 Antigua Way, Newport Beach, CA Permit Number: X2019-1969 Inspection Type (s): Field Welding & Epoxy Inspection Date (s): 9/26119 Periodic Describe Inspection, Including Location(s): Observed the field welding of 2 shear clips at W 12 X 50 beam and HSS columns. Certified welder Roland Romero # P018257 on file. Completed welds were verified for size, length, location and are free from visible defects. Observed the placement of 3 anchor bolts, 2 HD's at sill plates (5/8"), 1/2" bolts at column base plates using Simpson Set XP epoxy (Lot # 1000001055, exp 1120). Prior to placement verified min embed and proper cleaning of holes using nylon brush and compressed air. Details 2/S-3, 11/S-3 & 5/S-3. Area of work is Kitchen/ Living room remodel Total Inspection Time Each Day: Date: i 9/26119 I i Hours: - Min List All items Requiring Correction (include Previously Listed. Uncorrected Items): Comments' Other than any noted discrepancies all work was done per approved plans, job site specifications, applicable codes, RR's and WPSs to the beat of my knowledge and appeared to be in compliance at rime orinsna .fine Special Inspector Signature: Date: 9/26/19 Print Full Name: i Newport Beach Registration No.: Peter Gilpin NB-0381 Speciallnspectionkeport 8-24-25