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x20111— SH019
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658
i www.newaortbeachca.aov 1 (949) 644-3200
Structural Observation Report
Project Address: /
ev qhs �
Report date:
'z'J&
C B Inspector Name: CNB Permit #:
tr X.2�'t7 3
Bulling Owner Name:
Owners Mailing addres Qif different from site);
arl ice
Owner's Telephone C B Plan Che #:
A 5i-101
Oar �(NN 44 e.`r
&
❑ Steel
F 11 Name of aura Observe SO):
SO email Address:
t/-,mdF�CSl�y��7zz�
SO Tele hone #: SO License / Reg. M
c-��i7t8
❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concrete
..TeueMTc AMn CMJWFCTlnPJR r1RC1=RVFn rrhark annlirahla hoxesi
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Roo
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
❑ Conventional
Footings & Slab
❑ Concrete
❑ Steel
❑ Concrete
final acceptance of the structural systems by the City of Newport Beach, Building
oATE OQ j
FOF
❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concrete
❑ Steel Deck
❑ Caissons, Piles,
Grade Beams
Wood or Manuf.
Shear Panels
❑ Masonry
❑ WoodQi9
❑ Other:
❑ Other:
❑ Other:
❑Other:
ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑ OBSERVED DEFICIENCIES AND COMMENTS:
❑ REPORT CONTINUED ON ATTACHED PAGES.
FINAL STRUCTURAL O¢SERVATION REPORT:
�__._._. ................n,..........uee ..a.k okr a....e,.e..va r.,.�afntrtlnn documents. and all observed
deficiencies were cor Ed.
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
g�� AROH//
F MOSS F
charge of the structural observation;
2. 1, or another licensed design professional whom I have designated above and is under.+
4�
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
C-19718
approved construction documents;
3. 1 understand that all deficiencies which I have documented must be corrected, prior to
* 7.31-19
S RENEWAL
�qp
final acceptance of the structural systems by the City of Newport Beach, Building
oATE OQ j
FOF
Division.
CALF
5 . STAMP OF STRUCTURAL OBSERVER
STRUCTURAL OBSERMALON DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH.
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