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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.aov 1 (949) 644-3200
�/((*- Structural Observation Report
Project Address:
Report Date: J U N E 14, 1 921
CNB Inspector Name:
CNB Permit #:
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Building Owner Name:
Owner's Mailing Address (if different from site);
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Owner's Telephone #:
CNB Plan Check #:
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Full Name of Structural Observer (SO):
SO E-mail Address:
SO Telephone #:
SO License / Reg. #:
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PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check anDlicable boxes)
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Roof)
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
❑ Conventional
Footings 8 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:
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❑ ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. 6 C l Lr l,(,_Cf-
❑ OBSERVED DEFICIENCIES AND COMMENTS: N 0 N L5-
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❑ 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. 1 am the licensed design professional retained by the owner to be in responsible
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charge of the structural observation;
2. 1, 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 ;
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approved const n documents;
1 1 understand,$gal efficiencies which I have documented must be corrected, prior to
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final acce nce the structur ystems by the City of Newport Beach, Building
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STAMP OF STRUCTURAL OBSERVER
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WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH.
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