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rn CITY OF NEWPORT BEACH
u?'K z COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
~rrFOny 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newoortbeachca:aoit 1 (949) 644,3200
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Structural Observation Report
Project Address:
5 3l� 1-19r .1✓t�
Report Date: Z3 Z+
—11
'CNB Inspector Name:
CNB permit #:
Building Owner Name.
Owner's.Mailing Address (8 different from site);
Owner's Telephone P.
'CNB Plan Me& M
YA& TV
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Full Name of Structural observer: (SO):
so E-mail Address: if i -.Z .. GOA
Telephone #: `
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SO Ucense / Reg. #:
x-43205
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❑ �Met.Foundation,
PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED cheek a Ncabte boxes _
DIAPHRAGMS
JNDICATE LOCATIONS) DATE`
FOUNDATIONS '. SHEAR WALLS FRAMES , Floor/Rd_
_ OBSERVED _ OBSERVED
Coni riritl nal
ib Concrete
0 Sleef
O .Concrete
-1
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0o6 ngs 8 Slab
❑ �Met.Foundation,
0 Masonry
0 Concrete
0 Steel Deck
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Prestressed Concrete
0 Caissons, Piles, :
D Wood or Manut-
0 Masonry
O Wood
Gratle Seems>...
Shear Panels
❑ Other.
.O Other
1,3 Other.:
i0 .Other.
' ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
0 OBSERVED DEFICIENCIES.AND COMMENTS: ;P 6—
'
'O.REPORT CONTINUED ON ATTACHEDPAGES.
-
❑ FINAL SiRUCFU ,RAL OBSERVATION' REPORT
Thestnscture enerall wm" "lie's with the a" _ roved cogaWctlon documents, afid.alLobaeeved defldencks were corrected.
i declaie that the following statements are We4c the besfof my kriowied'ge:
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1 IN'am [he licensed tlesign professional retained by the owner to be nn responsible
xchar8e of h'e stipaturej obs"anration,
y y�2+ a or natllertlit msedrdesjgn profes@lonal whom I have designated above and ilia er
ha4e" fhe required 4116 4109 at eaoh signifioant
�OQROFESS/0.
Iny r@sponsible charge performeiii
o r t
'in with the
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congtrueUxr stage to,venfy that the structure Is gsnerel Conformance
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approved consUucti°n,doguRrQnts,
w C43205 m
R I understanli thatail defictemcles which I' have documented mustbe correoted, jpriorAo
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final aFzt nc of the tnuef rel systems by the `CIty of Newpbitlpbodh, BuflGirjg
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STAMP. -SERVER
�SIG,N9TiUR CTVRAL�OBsRERV��E}}R9.E'REC�OmR}yD.�.,.z - DATE
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