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O , m CITE' OF NEWPORT BEACH
r,
u f i COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
"O" T 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:
8 Sunset Cv., Newport Coast, CA
Report Date:
?1) -
CNB Inspector Name
CNB Permit #:
Building Owner Name:
Owner's Mailing Address (if different from site);
Owner's Telephone #:
CNB Plan Check #:
�r ..II
5 wms il#A
Full Name of Structural Observer (SO):
SO E-m it Address:
- 4v-e
SO Telephone #:.
SO License / Reg. #:
Tin
/V7 e �, ." ,
PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check applicable boxes)
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Roof)
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
V
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:
❑ Other:
❑ Other:
❑ Other:
ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑
OBSERVED DEFICIENCIES
AND COMMENTS:
CI REPORT CONTINUED ON ATTACHED PAGES.
❑ FINAL STRUCTURAL OBSERVATION REPORT:
The structure gener Ily 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 t Fjp structural systems by the City of Newport Beach, Building
Division. /
j
No' 64424
EKP- 06.30--u
STAMP OF STRUCTURAL OBSERVER
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH.
FamvsASm,mm1l0bservo,innRepnnfi lns,mnimrs
Project Name &
Permit Number
Cyr/
Report of Special Inspection
Golden Building Solutions -#8 Sunset Cove -
X2020-2323
InspectionType(s) Epoxy Inspection
Inspection Date(§) 02-27-2021 periodic ❑� Continuous
Describe Inspection Made, including locations:
Epoxy Inspection
Observed the installation of apprx. 40+ - #4 dowels into existing patio
slab/addition and slabs for 3 bathrooms, all located on the lower level.
#4 dowels set in Simpson "Set-XP" Epoxy per ESR - 2508. Expiration dates:
6/21 & 12/22. Verified hole depths and proper cleaning with compressed air and
nylon brush was completed prior to epoxy. Locations shown on Sht S-1; Dtls 2;
3; 4; 5; 9/SD-2. No detail on plans for bathrooms. Bathrooms 18"-24" oc around
perimeter of existing slab. 4 1/2" embedment met.
Slab Ftg Conn- Dtl. 5/SD-2;(2) #4 dwls TAB into exist ftg Min.4 1/2" embed. met.
Ext. Ftg. Slab - #4 @ 32" oc. 6" embedment met.
New Pad Ftgs -Dtl 9/SD-2 #4 dowel - 6" embed. met;
Ext Ftg. Slab - #4 @ 16" oc. 4 1/2 "- 6" embed met.
Work per plan
List Tests Made
Total Inspection Time Each Day:
List Items Requiring Correction, Include Uncorrected Items Previously Listed:
To the best of my knowledge, the work inspected was in accordance with the Building Department
approved design drawings, specifications and applicable workmanship provisions of the IBC except as
noted above. pp n
A _ �1� ., � 02-27-2021
Print Full Name: U Tracy Barr Registration No. NB-071 1
FORM st-oz, 2014
0