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CITY OF NEWPORT BEACH W M avl
COMMUNITY DEVELOPMENT DEPARTMENT frb v\-r
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be filled out by the permittee or homeowner)
Project Address:
Permit Number:
Property Owner:
Licensed Contractor: � Lic#:
CoweFv(1- Conyv// gJf#,rinG
The State of California now requires that smoke and carbon monoxide detectors must be
installed in all residential buildings
California Residential Code (CRC) Section R314.1, CRC R315.2 states in part that
existing dwellings be "retrofitted with smoke detectors and carbon monoxide detectors.
CRC Section R314.3, CRC R315.3 defines required locations.
Both bores below must be checked.
Carbon Monoxide Alarm: On the ceiling or wall outside of each separate
sleeping area in the immediate vicinity of bedrooms or in each hallway outside of
the jooms, and each level of the dwelling. Detectors are also required in
rooms with gas fired appliances
�❑ Smoke Alarms: Installed in each room used for sleeping purposes, outside
each sleeping area, and on each level of the dwelling unit.
Retrofitted detectors may be battery operated for buildings where no alterations are
performed on the interior. Multiple -purpose alarms (carbon monoxide and smoke alarms)
shall comply with all applicable standards and must be approved by the State Fire
Marshall. The devices must be installed per manufacturer's specifications.
I, the undersigned, hereby certify that I am the permittee or homeowner of the
project. I further certify that smoke alarms and carbon monoxide alarms are
present and to ted to be fun70faI4
al in all the following locations:
i Signature: ow(-6/ Date: 7 1 S 2.2
NOTE: This self -certification is only used for projects to the exterior of the structure where access to the
interior of the dwelling by the City of Newport Beach Building Inspector is not achieved during the course of
construction.
Forms\SmokeDetedorandCarbonMonoxideSelfCert 08/12/16
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.goov 1 (949) 644-3200
Structural Observation Report
Project Address:
1112 W Oceanfront, Newport Beach, CA 92661
Report Date:
09/22/2021
CNB Inspector Name:
CNB Permit #:
Building Owner Name:
Owner's Mailing Address (if different from site);
Owner's Telephone #:
CNB Plan Check #:
Bill Kriste
0430-2021
Full Name of Structural Observer (SO):
SO E-mail Address:
SO Telephone #:
SO License / Reg. #:
Ryan Romero
rromero@gouvisgroup.com
(949) 752-1612
C72185
PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check applicable 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
I1�
❑
Caissons, Piles,
Grade Beams
Wood or Manuf.
hear Panels
❑
Masonry
Wood
04
p+e} �N70 117
Oq YZ
❑
Other:
Other:
Fla"rimetplle
❑
Other:
Othe: r
�yf �Slnr Leo if
r7q/,LZ
ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑
OBSERVED DEFICIENCIES AND COMMENTS:
0
t
6:f IL
❑ REPORT CONTINUED ON ATTACHED PAGES.
Rf FINAL STRUCTURAL OBSERVATION REPORT/ " +L
The structure generally complies with the approv d constEylgiiefrillocurnents,
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.
ZI
STAMP OF STRUCTURAL OBSERVER
nRSFRVATInN ❑nFR NnT WAIVF ANY RFnIIIRFMFNTS FnR RI III nING INSPPnTInN RV AI ITHn017Fn FMPI nVFFS nF THE riw nF N9W0n0T RFArH
Forms\StmemmlObsemanoaR port&lnsmetions
-:�.
„ .,.�.:.,w.„„ qx� .
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.
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.newoortbeachca.gov 1 (949) 644-3200
Structural Observation Report
Job: 65601
Project Addre
8112- ss:
%P_-Cr. 6`
Report Date:
6-18-2021
CNB Inspector Name:
.5(7 /lU/Je lC.
CNB Permit #:
'-f g
Building Owner Name:
Owner's Mailing Address (if different from site);
Owner's Telephone #:
CNB Plan Check #:
JJ
/ ,Z 0 otian0 t- k.l. ,
Ll, ,L 00fL
0Y3-0 _ oz!
Full Name of Structural Observer (SO):
SO E-mail Address:
SO Telephone #:
SO License / Reg. #:
Basil Ammar! / Gouvis Engineering.
bammar!@gouvisgmup.com
949-2797410
C52030
PLEASE INDICATE STRUCTIIRAI FI FMFNTS AND mNNFCTIflNR nRRFRVFII 1rher4 annli�ehln hnvnal
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Roof)
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
C% Conventional
Footings & Slab
❑ Concrete
❑ Steel
❑ Concrete
Structural observation for footings
6-18-21
❑ Mat Foundation,
Prestressed Concrete
❑ Masonry
❑ Concret
❑ Steel De
❑ Caissons, Piles,
Grade Beams
or Manuf.
Panels
ZOtohoe
❑ Me my
❑ Wo
❑ 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.
'r�'C�il ,!i 0
6-18-21
QpOFESS/p
� y �PWAIq� Fy
� m No. C052030 9 �
Exp. 1PJ31/22
9rFCF CA��F
STAMP OF STRUCTURAL OBSERVER
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH.
Forms\St=c lObservatlonRepun&Imtmdiom
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
MUNICIPAL OPERATIONS DIVISION
592 SUPERIOR AVENUE
NEWPORT BEACH CA 92663
19491644-3055
Demolition Hauler Certification and Deposit Form
Owner Name:
Property Address:
Permittee Name:
Permit Number:
Franchised Hauler:
Phone:,
Permittee L_j�, I hereby certify that I have contracted with the above -mentioned City Franchised Solid
must initial Waste or Demolition Contractor. I also certify that I understand I must contact the
Municipal Operations Department at (949) 644-3064 no less than 24 hours or more
than 72 hours prior to my intent to commence demolition activities. Municipal
Operations staff will inspect demolition site and verify usage of franchised hauler.
City of Newport Beach Municipal Code indicates: A demolition permit deposit, as determined by the Public
Works Director, shall be paid at the time of submitting the demolition permit. Said deposit shall be returned
to the permittee, at the conclusion of the demolition project assuming permittee follows applicable laws.
REFUND TO:
Name: 0,
: r
City, State, Zip:
Permittee 1, (Permittee) hereby certify that I understand that a City Franchised Hauler must
must sign be used to transport all construction and demolition debris generated as a result of
and date the demolition referenced above. I agree that the deposit will be forfeited if 1) a City
franchised hauler is not used to haul construction and demolition debris from this
project or 2)1 fail to notify the Municipal Operations Division at (949) 644-3064
no less than 24 hours or more than 72 hours in advance of my intent to
commence demolition activities.
XI I I Date
For eltlg
sty �5e Issued By
For MOD Notification Date: _
Staff Use
Hauler:
Distribution: White: Municipal Operations Yellow: Refund
.J4A✓�7
For Finance Use Only
Date 1 f
Demo Date:
❑Release Deposit []Forfeit Deposit
Goldenrod: Finance Pink: Applicant.
Revised September 2019 `
BDJ Consulting, Inc.
A California Corporation
1062 Campanile
Newport Beach
CA 92660
CONSULTING, INC.
Cell (714) 863-9180
btsog22@9mai1.c0m
H ❑ F ❑
Observation Report and Observation Agreement
Name //^ �— / !711 /o 'ir
r'WV1
I Samples: X
Description of Work Observed:
nnrt=• - J 1
P✓7r o - n 0" ! — Jln
/, 3 .A Ill & vdq�-K6
i=ae�a
� e
By this signature on the this Observation Report I acknowledge
that BDJ Consulting, Inc. performed the above observation.
Approved by:
Certification or aompimnee
t t theWe n of this observation we have, obseryled all f h
We hereby caddy dla. a o a show,
spunted work, unless otherwise noted To the bat,four knowledge and belief, we have found
this wade to comply win the aPPmwd plas,.spedfeati,ns, antl aMceble seetim(s) of gs
Unll4nn Building Coda, a applicable to the bWity wtwe the Pulled is prated. This report
cannot be construed to be a reammatlagoe of work of any natwe to be Performed. The
pedmmaixe of our observation s rvicesis subset m thehours and mndNons as desodbed on
the averse side of this Observation Rmod. The cum a or a succamr in interest shell hold
hm,lme BOJ Consulting, Inc.�i end all legal proceedings of any nature whatsoewen that
Is mkated to MSLftr nl9tlBQ
S� nature 0 Qgissttered observer
2
Specialty No. Agency
WHITE -OFFICE COPY, CANARY -ACCOUNTING COPY, PINK -OBSERVERS COPY, BOTTOM WHITE-JOBSITE COPY