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Box 1768 1 Newport Beach, CA 92658-8915 www.newportbeachea.gov 1 (949) 644-3200 OWNER -BUILDER ACKNOWLEDGEMENT AND INFORMATION VERIFICATION (HSC 19825) NOTICE TO PROPERTY OWNER Dear Property Owner: 161; An application for a building permit has b an subV)tted in your name listingyyrs,eeIf as the builder o the property improvements specified at l �3 'i _ Ui✓w r3c L�otc isYvtl., Aivae' oil cel We are providing you with an Owner -Builder Acknowledgment and Information Verific tion Form to lIZZI make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. -Z -VVI. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 'ZA�. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 'Z -1+V3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. :7�4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. _Zy�5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. -Zvyl6. 1 understand if I am considered an "employer' under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide b�y•tAAhese laws may subject me to serious financial risk. ZVv 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 2 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. Forms\owner builder vedfdoc 08/12/16 1 oft •79. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. ;zivV 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: -;ZW 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. y�li( 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the City of Newport Beach, Building Division, for issuing the permit. Note: A copy of the property owner's driver's license or form notarization is required to be presented when the permit is issued to verify the property owner's signature. Print name of property owner: ZHZXlA ia/AlJ [[ _ Property Owner's Signature /// Date:. Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which 1 understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: 1613 I 2 6t/ CA Ni3 Name of Authorized Agent: h 1 lir C/ f/i Tel No d 31q- Li d; Address of Authorized Agent: 4io N, 4 -WA -rd / ` 6tLs C�l't flue (}� / 7 / I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the proaq#y owner's signature. 2 Property Owner's Signature: Date Note: A copy of the owner's driver's Iicens 66 form notarization is required to be presented when the permit is issued to verify the property owner s signature. Forms\owner builder verifdoc 08/12/16 2 oft _ L.. (� COMMUNIT�i r J 104 JUL!l / Gi-if-e,L� [717 Xy'04ro .°r DEVELOPMENT. _.. JAN 0 3 2019 CITY of 'KoR"r aePo Q, �-0��GW-(o a� rril( �vaE4 5�� ouf vr? i 2-cq 0- 'S`- �"b r v,�.Uc /hcr� tG C�( DESS c(cor G, GSi� Ccd- u7 2 C7 t 1l2 P e,�r�c ems- v %-<Krnk1 iscCvy �n� " , f ".V •Q_ �� r:. C'D��..-..G¢-E(.. a"7PC� Gc�v�%{. ✓�Ju V.. S'. -f ��y- f._... I, �^� �,: Cq,�e2/ �P' ivv� r�.e �Lc ✓i,-il f4 -e G v� .{�_ oG—�z(" �.� � 1�'' i� � _ i I 1 (J " e 05''S REMOVAL OF ENGINEER OF RECORD FROM PROJECT RECEIVED BY COMMUNITY DATE: SEPTEMBER 13TH, 2017 DEVELOPMENT PROJECT: FULLER RESIDENCE SEP 14 2017 ADDRESS: 1613 W BALBOA BLVD. NEWPORT BEACH, CA 92663 CITYOF DESIGNER: FRANCO STRUCTURAL DESIGN +%pORT gEPo ENGINEEROFRECORD: JOSE DE JESUS PRIETO LICENSEM, C76526 EXP. 12/31/2018 ATTENTION: CITY OF NEWPORT BEACH BUILDING AND SAFETY Per conversation between design Engineer Ronny Dorantes with Franco Structural Design and city inspector Richard Labare today September 13, 2017. Mr. Labare raised concerns regarding the construction methods employed by Mr. Phillip Chang in the construction of the structural upgrade of the garage of unit two of the project on the above mentioned address. Mr. Chang has been notified by city inspector that engineering of record's advice and supervision is required when digging and set up temporary shoring and support. This letter is to notify you that as of today, September 13, 2017 no request have been made verbal or in writing to Mr. Ronny Dorantes or myself for inspections or structural review of design modification. This letter serves as a notice that I and Mr. Ronny Dorantes have decided to detach ourselves from any liabilities involved with any decisions, practices and modifications taken and performed by the owner, Contractor or Mr. Phillip Chang himself on this project as of August 25, 2017. We are not and have not been part, nor agreed on any decisions taken from that date and on. 4;5� Jo a De JIrSus Prieto C.eII �*-0--z0is R6NN,f �:)6V-0i * xp.14&& 74t t �\ Exp. ! WE 2613'/% W. BALBOA BLVD. NEWPORT BEACH; CA 92663 1613. W BALBOA RESIDENCE 3/29/2018 HEADER BEAM CALCULATION TO SHOW THAT 46 HEADER BEAM TO BE USED IN OPENING BETWEEN KITCHEN AND LIVING ROOM WILL WORK OUT, THE 4x6'DOUGLAS FIR HEADER BEAM HAS BEEN SET UP AND THIS CALCULATION HAS BEEN ADDED. AS PER REQUEST OF PLAN.. CHECKER TO CERTIFIY THAT THIS OPENING OF 8 ft WILL HAVE ENOUGH A l #eA er (-or OJ )Oevl i vil i v1 o14 2. J >ea � 1_ 0 0.d S compvsi4e SIhE�G-s IZOO �" 7 iQ WI•�•JlJ Mi sc. 6.0 es; 1.5 ps� 1.Y ps-� re4 cl Q- 12O0� i v� r"Aa r -J 2-� psT rr -ev osf /1Y �s lti:P��'YI rvtibvv / A' � ��✓�"1q r) ` 1Zn�^ra'1 a„ 6„ 19,50 (i•V u V% � j i ✓ IWj Y* 4019yn �.k� 240 ps-�-- 1_0Aa 'ng 0n geotdCY &1%, TOW . Protecti Job Rer, rasa:. 1613 W Balboa Blvd.-HDR•Bearn Calculation N/A Franco Structural Design 'Section Sheet no.lrev, HDR'1 1 Eelc. byI Data i Chkd by Date i App'd by Data RD 3129/2018 I RD G2 9120 1 8 , STRUCTURAL WOOD BEAM ANALYSIS & DESIGN {NOS} In accordance with tho ANSIIAF&PA NDS -2012 using the ASD inethod TEDDS calculation version 1-7.03 L.Od EO VOI.pa- Can, bi=i.. T 0.191 ao k'ip a Banding. Moment epvalnpo 00 ~��"'-"-._.�__—•----- 1.525 - ."�^.' t5 rpt a ' kip= 0-4 5haar Force envNepe a Act Do o res .oe e n t. Applied loading Beam loads: Dead self weight of beam x 1 D.L Dead full UDL 76 Wit L.L Live full UDL 110 Iblft Load.combinations Load combination 1. Support A Dead x 1.00 Live x 1.00 Span 1 Dead x 1.00 Live x 1.00 Support B Dead x 1.00 Live'x 1.00 Analysfs results Maximum moment M.ia = 7525 lb—ft Mmr = D Ib it A.FTek6 Project .lob Ref. Tedds 1613 W Balboa Blvd. HDR Beam Calculation N/A Franco Structural Design Section Sheet noJrev. HDR1 2 Calc. by Date Chk'd by Dale App'd by Date RD 3/29/2018 RD 3/29/2018 Design moment Maximum shear Design shear Total load on member Reaction at support A Unfactored dead load reaction at support A Unfactored live load reaction at support A Reaction at support B Unfactored dead load reaction at support B Unfactored live load reaction at support B M = max(abs(Mmax),abs(Mmin)) =1525 Ib ft Finax = 763 Ib Fmlo = -763 Ib F = max(abs(Finax),abs(Fmm)) = 763 Ib Wtat = 1525 ib RA -max = 763 Ib RA In = 763 Ib RA_oead = 323 Ib RA_uve = 440 lb Re mex = 763 Ib Re_mlb = 763 Ib Ra Dead = 323 Ib Re uve = 440 Ib Sawn lumber section details Nominal breadth of sections boom = 4 in Dressed breadth of sections b =3.5 in Nominal depth of sections doom = 6 in Dressed depth of sections d = 5.5 in Numher of sactinnc in memher N = 1 Overall breadth of member Species, grade and size classification Bending parallel to grain Tension parallel to grain Compression parallel to grain Compression perpendicular to grain Shear parallel to grain Modulus of elasticity Modulus of elasticity, stability calculations Mean shear modulus Member details Service condition Length of span Length of bearing Load duration Section properties Cross sectional area of member Section modulus USE 4x6 bb= Nxb=3,5in Douglas Fir -Larch, Select Structural grade, 2" & wider Fb = 1500 Ib/int Ft = 1000 Ib4n2 F. = 1700 lb/in' Fcyetp = 625 Ib/int Fv = 180 Win' E=1900000lb/in2 Emin = 690000 Ib/int Gdol = E 116 =118750 lb/in' Dry Lei = 8 It Lb =4 in Ten years A= N x bx d = 19.25 inz Sx=Nx bx dz/6=17.65 in3 Sv=dx(Nxby/6=11.23in3 Second moment of area 6 = N x b x d3 / 12 = 48.53 in Ir=dx (Nx b)3/12=19.65 in' iJab Ref. 4 TEMA i'Project Vedas 1613 W Balboa Blvd, HDR Beam Calculation NIA FrancoStructural Design Seglon Shoat.aoJrev. HDR 1 3 Calc. by Date Chk'd by Date App'd bIr I Data j RD 3129/2018 I RD i 3/29/2018 l I! Adjustment factors, CIE = 1.00 Load duration factor - Table .2:3,2 CD 1.00 Temperature factor- Table 2.3.3 ci _ 1.00 Size factor for bending - Table 4A CFn= 1.30 Size factor for tension - Table 4A CFt= 1.30 .Sizefactor' for compression - Table 4A 0F,, 1.10 Flat .use factor - Table 4A Cm = 1.05' Incising factor modulus of elasticity -- Table 4,3;8 Bearing perpendicular to grain-cl.3.10.2 Design compression perpendicular to grain- F,, -Perp' = Ftperp x Cry' Ci x Cb = 625 Iblinz Applied compression stress perpendicular to grain- fd-Pem = RB --max / (N x.b -x Lb)=-541bliaz fa_P.ry / F W- = 0.087 PA SS - Design compressive stress -exceeds applied compressive stress at bearing Strength in bending -c1.3,3.1 Design bonding'. stress Actual bending. stress Strength. in shear parallel to grain - cl.3.4.1. Design' shear stress Actual shear stress - eq,3.4-2 Deflection - el.3.5:1 Modulus of elasticity for deflection Design deflection Total deflection Fb' = Fbx CD x Ct x'Ct x CFs x C! x C, =1950 Iblinz fb = M 1 S, = 1031 Iblin2 fa b Ft,' =0.532 PASS Design Lending stress exceeds actual bending stress F,,'= F, x Cc.x' Ct x Ci =1 BO Iblin2 f, = 3 x F 1(2'x A)= 59 fblin2 f / F =0:339 PASS - Design shear stress exceeds actual shear stress E' ='E x' Cue: x CI x CSE = 1900000' Iblin2 Sed. = min(OA in, 0.003x. Lm) = 0:288 in Sh sr= 0.191 in Sh srl bad. =0.662' PASS . Total deflection is less than design. deflection CIE = 1.00 Incising factor for bending, shear, tension& compression -Table 4:3.8 Ci = 1.00 Incising factor for perpendicular compression - Table 4.3.8 C+a:aara - 1.0.0 Repetitive member factor- cl.4.3,9 Cr = 1.00 Bearing area -factor - DO. 10.4 1.00 Depth -to -breadth ratio- dab. i (N x.bPPm) = 1.50 - Beam is fully restrained Beam stability factor- cl.3.3.3 Q Bearing perpendicular to grain-cl.3.10.2 Design compression perpendicular to grain- F,, -Perp' = Ftperp x Cry' Ci x Cb = 625 Iblinz Applied compression stress perpendicular to grain- fd-Pem = RB --max / (N x.b -x Lb)=-541bliaz fa_P.ry / F W- = 0.087 PA SS - Design compressive stress -exceeds applied compressive stress at bearing Strength in bending -c1.3,3.1 Design bonding'. stress Actual bending. stress Strength. in shear parallel to grain - cl.3.4.1. Design' shear stress Actual shear stress - eq,3.4-2 Deflection - el.3.5:1 Modulus of elasticity for deflection Design deflection Total deflection Fb' = Fbx CD x Ct x'Ct x CFs x C! x C, =1950 Iblinz fb = M 1 S, = 1031 Iblin2 fa b Ft,' =0.532 PASS Design Lending stress exceeds actual bending stress F,,'= F, x Cc.x' Ct x Ci =1 BO Iblin2 f, = 3 x F 1(2'x A)= 59 fblin2 f / F =0:339 PASS - Design shear stress exceeds actual shear stress E' ='E x' Cue: x CI x CSE = 1900000' Iblin2 Sed. = min(OA in, 0.003x. Lm) = 0:288 in Sh sr= 0.191 in Sh srl bad. =0.662' PASS . Total deflection is less than design. deflection 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 Address: Report Date: CNB Inspector Name: CNB Permit #: 1(,13`,1z ' . fJ . • 4 C&A C 3 241 I 13 DATE OBSERVED ❑ Building Owner Name: Owner's Mailing Address (if different from site); Owner's Telephone #: CNB Plan Check. #: 11�13U tV. l ,)biq blvd N 1W14 WI -PI -S I ❑ Masonry t. tc,n Full Name 8f Structural Obs rver (SO): _ SO E-mail Address: SO Telephone #: y,74-296 SO License / Reg. #: C11 5 6/ Jia �} . ® Caissons, Piles, Grade Beams 14 ❑ Masonry wr= n1ml V TI io AI cr cnAGkIT¢ Akin Cnknd Fr.TIn K1.9 nRSFRVED Ic heck aDDllcable boxes) I declare that the following statements are true ;to'the best of my knowledge: ppESS1 1. I am the licensed design professional retained by the owner to be in responsible QQ` �ESU,9 charge of the structural observation;O�ii 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 ti vU�, 02 -_ construction stage to verify that the structure is in general conformance with the Ly approved construction documents; W (jp. C 78528 3. 1 understand that all deficiencies which I have documented must be corrected, prior toCG EXP., ZIP �d � final acceptance of the structural systems by the City of Newport Beach, Building * \STCIV- QP Division. � 312"1 STAMP OF STRUCTURAL OBSERVER c1.1 I17I IDA] nRCFRVFR r)F RFCr1Rn DATE OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Forms\SvuaurnlObzerex�innRepunR I nswaions 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 ❑ Wood ❑ Other: [X Other: ❑ Other: ❑ Other: ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. -- ❑ OBSERVED DEFICIENCIES AND COMMENTS: _ CoMI111C.rt,{j f •Cvnv'1 L 'L ce — M --S vink -ow4owk, ioerA ❑ REPORT CONTINUED ON ATTACHED PAGES. FINAL STRUCTURAL OBSERVATIONREPORT: - 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: ppESS1 1. I am the licensed design professional retained by the owner to be in responsible QQ` �ESU,9 charge of the structural observation;O�ii 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 ti vU�, 02 -_ construction stage to verify that the structure is in general conformance with the Ly approved construction documents; W (jp. C 78528 3. 1 understand that all deficiencies which I have documented must be corrected, prior toCG EXP., ZIP �d � final acceptance of the structural systems by the City of Newport Beach, Building * \STCIV- QP Division. � 312"1 STAMP OF STRUCTURAL OBSERVER c1.1 I17I IDA] nRCFRVFR r)F RFCr1Rn DATE OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Forms\SvuaurnlObzerex�innRepunR I nswaions INSPECTOR'S DAILY REPORT OF C(OMPACTED';4fILL Jo lylame ! 'a Job LocationJo -'a f C�,JI No � Page of 16p-G- GeneralColtractor Grading Contractor DateDay, I1`I� of Week W Grading Shift Mrs. - Contractor's Supt f Foreman & Signature � Field T Mrs on Site /,} 11 From Z1COAo Source and Descriptions of Fill aterlals \`—VY C/ Approximate Fill Yardage Total Req'd Placed this shift Total to dale `� l rWeather Report Sequence No. Test No. Test - Location Elevation or Depth Soil Type Fill Moisture o Test Dry Density IDsicu.It %of Max Dry Density Remark C� (-Q� 112.Q `Zo. i( I l 111-2- SO •p t L J - \f tam -' ��C�iryI ; `�_ 1 L Remarks scribe equipment used hauling, spreading, watering, condition and acting; also report thickness if lifts, removal of poor soil insufficiently compacted, and ca On unusual events.) t sale/ �lu� 1 l Sketch it I l Z3 Copy to Client( ) Copy to CICI ( ) CAL LAND ENGINEERING, INC. ^^�,�.� � „•� Company Policy Four let hours minimum Charge (including travel tinsel Quartech Consultants, Inc by:-�_— INSPECTOR'S DAILY REPORT OF COMPACTED; FILL Joame 77 ! � tet Job Location .7 161�� c 6 3 130 r:J Job No I� f �\ Page o lel' General cci tractor Grading Contractor Date Day of Week K, 1c), ? c Grading Shift Hrs - _ Contractor's 5pKaf Fyreman• Signature Field Tech His on Site Fronj?—,� To Source and Descriptions of Fill Materials D ` —'-" Approximate FII Yardage LAW II,,��l' `, 4v', V'\ f( `�t�j G _ �CUJ(AA ( Total Read Placed this shift Total to date 12 3 Q Weather Report Sequence No. Test Test Elevation Soil. Fill Test Dry %of Max Remark No. - Locabon or! Type Moisture Density Dry Depth % Ibs/cu.ft. �jDensity I 2 I It -7 13.6 RO,c- TCP ll O 11o 90`7 1 7 - i CA c I ;I Remarks C, scribe equipment' used hauling, spreading, watering, condition and compacting; also report thickness If IIRs, removal of poor soil insufficiently compacted, and comment in unusual events.) ! L rel sT r- ! I e ( i y Sket h y{�i Vn Copy to Client ( ( copy to QC ( ) CAL: LAND ENGINEERING, INC. Company Polity Four 111 noun minimum Charge (including travel time) Quartech Consultants, Inc. by:— JTS INSPECTION SERVICES OFFICE/CELL: (323) 630-9436 8990 KRISTIN DRIVE. E-mail: daniel.sigala@sbcglobal.net DOWNEY, CA 90240 REGISTERED SPECIAL/DEPUTY INSPECTOR — CERTIFICATE OF COMPLIANCE BUILDING DEPARTMENT Pro'.Date Shotcrete Project Name _ p/i �J sr�Pfit # ❑ Rebar Project Address i , Owner Name GZ Phone # Address Anchors bolts General Contractor Phone # Address Fax # Site Contact Cell # Sub -Contractor Phone # Address Fax # Engineering Firm ,e Phone # Address Fax # TYPE OF INSPECTION Reinforced Concrete ❑ Shotcrete ❑ Gunite ❑ Rebar ❑ eldin ❑ Structural Masonry ❑ Prestress ❑ Anchors bolts ❑ Dowels 2r Fireproofing ❑ Post -Tension ❑ Framing ❑ Nailing Insp. ❑ Grading ❑ Others Quality Control ❑ C tinders Samples Core Panels Mortar Grout Masonry prism To the Building Official Building Inspector I hereby certify that the following portions of the work at the above address which required Special/Deputy Inspection and for which I was employed to inspect, were inspected by me and complv with the applicable provisions of the Building Codes and approved drawings. Inspector (Print Inspection Sign: HOURS: Mon, Verified By: (Print & Sign) . License#: Type: Date: _77 Tues, Wed, —Thur, — Fri, Sat, —Sun, 0 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 Address: b C11(e403 ReportDate: l2 (2� 1 CNB Inspector Name: CNB Permit* Building Owner Name:wn is Mailin let$ Addres (if different from site); 11i* 1W v+c� Owner's Telephone #: CNB Plan Check #: OBSERVED OBSERVED ❑ ► gOpi " 81 ❑ Steel ❑ Concrete Footings & Slab Full Name o Structural Obs er (SO): SO E-mail Address: SO Telephone #: SO License / Reg. #: Mat Foundation, ❑ Masonry v 2 0 ':H434-16-7-01VC U \ PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check applicable boxes) 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. No. C 76526 Exp. 2 ?I STAMP OF STRUCTURAL OBSERVER OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Forms\Stmemra[Ob en,atioM potl&I�mctiom IMS. FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS INDICATE LOCATION(S) DATE (Floor/Roof) OBSERVED OBSERVED ❑ Conventional ❑ Concrete ❑ Steel ❑ Concrete Footings & Slab ❑ Mat Foundation, ❑ Masonry ❑ Concrete ❑ Steel Deck Prestressed Concrete ieEaissons, Piles, ❑ Wood or Manuf. ❑ Masonry ❑ Wood Grade Beams Shear Panels ❑ Other: ❑ Other: ❑ Other: ❑ Other: ❑ ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. ❑ OBSERVED DEFICIENCIES AND COMMENTS: 1 Gft& 6CAM 3byttAVAL% fit( &INALk (3)*1To9t69ftm, 1 2 # ,r» m -r ��y_ becim. &PM*n A—A a6cn com,6- re 2 l or loth ❑ REPORT CONTINUED ON ATTACHED PAGES. Wile- 90"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. No. C 76526 Exp. 2 ?I STAMP OF STRUCTURAL OBSERVER OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Forms\Stmemra[Ob en,atioM potl&I�mctiom IMS. 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 weft 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. CITY OF NEWPORT BEACH COMMUNITY UFVFLOPMFN'T IIFPARTMFNT BUILDING DIVISION 100 Civic Center Drive I P O. Box 1768 1 Newport Beach, CA 92658-8915 www newoortbeachca.uov 1 (949) 644-3200 ctriiii.-+oral Observation Report Vim. MV�N•^• �'— CNB Inspector Name CNB Permit R. ProjectAddresa: 6004 C 4 926.(,3 Report Dale 11/5 FOUNDATIONS SHEAR WALLS 1"%3f LLc w1' BLVD Alcw Po Building Owner Name: - Owner's MnilinAddieas (if tllffamnt from silo). Owners Telephone 1'. CNB Plan Check N: ❑ Conventional IVIlI/L. V• B%LAnA O%VO MEW adet n") I9'D ❑Concrete 1, plltLF,_ th-tel -1+-'i- - SO Telephone �. SCLicense 1 N Full Name of Structural Ob erver (SO): ?1A So Email Address: i�s}Sr 2(0 4o ❑ Masonry ❑ Concrete ❑ Steel Deck '.. u,cnrrnue n4CF'ovirn whack annitcable boxes) PLEASE INDIGAILZHKUUJUMM cLL.i•ilr•r �,•-----."'-_-"-'-- -- DIAPHRAGMS ---. :. .---- .. - - INDICATE LOCATIONS) _- DATE FOUNDATIONS SHEAR WALLS FRAMES (Floor/Roof) OBSERVED OBSERVED ❑ Conventional ❑ Concrete ❑Steel ❑Concrete Footings & Slab ❑ Mat Foundation, ❑ Masonry ❑ Concrete ❑ Steel Deck Prestressed Concrete W'Caissons, Piles, ❑ Wood or Manuf. ❑ Masonry ❑ Wood Grade Beams Shear Panels ❑ Other: ❑ Other: ❑ Other: ❑ Other: ❑ ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. OBSERVED DEFICIENCIES AND COMMENTS: U 1 vv a rw B f r't M 11 0.Lh'[ n+rick *6ckr Nn LRIREPORT CONTINUED ON ATTACHED PAGES. ❑ FINAL STRUCTURAL OBSERVATION REPORT: The structure generally complies with the approved construction documents, and all observed dericiencies 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. C 76526 STAMP OF STRUCTURAL OBSERVER DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. funnOSlrvnmalUL,m alnndkpunk hd,umm11l 1 0-C 2 6+rvwrnl N.Itevw-1ior1 12t pa/4 C %eOhAuw4ioq 2) S11ear lits on A'(hor r^dS mv%4 wr.,P qrr" 4Ipn(hv.s Pe. 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