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ORANGE COUNTY
Page_M_
STRUCTURAL OBSERVATION REPORT FORM
Report No._
erahlbull Observation meansthe v ual dw vvfau nlsyalevy for fam"Al... harasses to the removed] Plan and
A ecifita 4®rifam watagea antl attvmplctiwv(Ihe syilem Snu .Fmervavmdoeamtmcladeorwawethe
reapmvhility for the dopeetims L alai ed by 5ectitm log, 1701 mother areduce of Ne care.
This report includes all construction work aircraft, day of R 204_
Project Address
Suuamal Casinos, NRecord
Phone No. of SOR
S AVC fNti ✓tsA
fSOm
Kerman NaraBhi Mani
(818)865-2026
BE imp No
StradmmObemvnion PMmovel
Pm(.'nal Lwaydifro.of
[connect, of Obwve,
Na pipe $ FJ�
by + Kemren NmaBly Aram
Ob - Ooa49$$
(818) 8652ox
AND
FOUNDADON
WALL
rveme
x
xveq
T WHOLE
Pooliv Stem Willa
❑Conerek
❑$feel Mmneto Frame
Concede
[. xo
LJ MG Foadelm"
❑shim
❑S¢el Braced Gem.
Steel
p�pF`N
/- l OVp-2'I
0 Glsmq tile., Game
❑Wood
❑ c,"my Moment Frame
❑Wo.d
fw Boo Ellemcvi
Dam
0 Remining FoAdnamn
00ther
❑ Mammy Wall Frame
❑01hous
Hilliltle5 eclat Awharc
Q others:
❑Others.
Ohmrvedller l...in:
I declare that the following statements arc true to the best of my knowledge: 1 amthe engineer or architect retained by the
owner to be in responsible charge for the structural observation in amordmme with the norwiemems of the County of
Orange.
I, or another mapreceir in architect who l have designated above and is under my responsible charge, has performed the
occurred site chains at each significant construction stage to verify If the stretchers In general conformance with
approved plans and specifications.
2_ All defidenmts which cement to he connected have been indicated above.
3. 1turnaro ndtba more of the aWctwal system' by the County of Orange be withheld until all observed
deficiencies m eporecil f
�pF
Soldered: // _�_ ➢ate
i I qr
Form No. 00-03
Jy'E*pl�d-3 �13 K
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RNA06-012 6-21-II
15 AVAWN HRA MWPOFf COAST
1 DETAIL 3/SW-3 1
XHA fH61H[[PIN6, INQ MOT AgouraCeutl, Su11J Ila. Agoura Hills. G. 913D1 PA 516.1165.2026 Fax VMS IJ19
KNA06-012
6-21-11
u O AVA VISTA, NEWPoM COAST
ATE
DETAIL 2/SW-3
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(AENGINEEMNG. INC. 30101 AAau/a CouM1 Suite 120. Igxm MAq W. 91MI
Ph 810.665R016
fax 615.8651869
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DEPUTY 1 INSPECTION SERVICE INC.
25121 DE SALLE ST, LAGUNA HILLS, CA 92653
1 - 800 - DEPUTY 1 =1 - 800 - 337 - 8891
SPECIAL INSPECTION REPORT
Job, No,
Job Indentification /Atltlress
General Contractor/Atltlress
Sub - Contractor /Address
Structural Engineer / Address
DEPT. OF BLDG. & SAFETY
CITYOF !'dr.rYr/ti
COUNTY OF n"a a r
Date g - ] d/
REINFORCED CONCRETE__ MASONRY_ HI -TENSILE BOLTING CHEMICAL ANCHORS_
PRESTRESSED CONCRETE_ WELDING GYPSUM CONCRETE OTHER f/r
WELDER
RECEIPT NUMBER
WELDER
RECEIPTNUMBER
cameonmornr
DESCRIPTION OF WORK INSPECTED
- G. > 1 t I LJ r
S S-
9 - l /
1 s /
HOURS
SAMPLES
DATE
Reg.
OF -
Timeln
Turn Out
Grout
Mortar
Concrete
Blacks
PNm
Density
Yl.
milnspxrleee based en a minimum of s-a hour,
etlpoll ba neon hour will be hors nab
hour me
minimumdour
or5 bNa9NWortled will hvertion any ection e�nFing post half
ATTORNEY FEES - It any addled at law Oro epmty Is brought A entered or mtemptthe tames onhls contract, the prevailing parts
shall be entitled to reawnebla attorneys teed, wets and necessary diobursdmedtn In Sheldon to any other repel to which such party maybe
entitled
SPECIAL INSPECTION REPORT /
Inspector's Name: Jnn d. Inspector's Signature: .('�r r"-rot
ID. Na. 13 `1 r; has been tiled and It states that the above work to the best of h�e complies with the
provisions of the Uniform Building Coca and meets approved plans and specifications.
�l Respectfully Submitted,
Approved by: _� t _ n
It PETRA Pi OF
JOB NO
THEM PRNECi
EGHNLIAN DATE SAY
r %TI
LOCATION
PGTHEM ENGINF�ER GEOLOGIST
2
CONTRACTOR
ronEMBLIN
OWNERS PEPPE9ENiP7IVE
OBSERVATIONS
/q/ _y
'/
a— ny-
Psi lz
j 0KI
ACTIVITY
HOURS
COM i is BOTH)
o imcuN oraoamsi
A EVENED BY (signature) DATE BEcemrz By NLnO Vpom.mI
c.:m...wa....
.aii,a
DiI:. Cost, Bmeassl wmere
DAILY REPORT OF GRADING OBSERVATION
—E.�oc-Psrer-"
99, M ¢A NO,. E(.. 9a F.,,S I BI. CA ate
(949( 494-222 „
. FAx (9{9( A0] 02T0
JOB NO
CLIENT
DAY
DATE
G AUNGPERMITM9.
PACT
GENERAL CATION AND PURPOSE OF
8ENERAL CONTRACTOR ON
GE IT rRUETOP s 9Mn. ONo�M TMMTwA�TOAESMF.fOM.oMEMAM
SOUR C E AND CLAW I F I CATION OF U TIE MATE N A IF
VISITORS
MM.wAT2a�M
AT�atiA.MOE9Ea�PT�M.oE.aA„EMT9M .�,AR
1
� oAREAS
OF ADDITIONAL CONCERINGRETE
PAGE OF
Di DEPi of SLOD. K-saFErr
25121 DE SALLE ST, LAGUNA HILLS, CA WEISS CITY OF
1- BOO - DEPUTY 1=1-800-33T-8891 COUNTY OF
SPECIAL INSPECTION REPORT
Building Permit No. k 4 Jab. No.
Jobindentgicathon/Address f n 1
General Corthacfor/Addresses a
Sub-Contrecrer/Address -tom
Structural Engineer/Address \tA
gEINFORCEO CONCRETE_ MASONRY_ HI-TENSIIEBOLTING CHEMICALANGHORSR
PRESTRESSED CONCRETE_ WELDING GYPSUM CONCRETE_ ULHER
WELD B
RECEIPT NUMBER
WELDER
RECEIPTNUMBER
oAreeTxPemnn
DESCRIPNON OF WORK INSPECTED
Is
HOURS
SAMPLES
DATE
Reg.
OT
Time In
Time Out
Gmu[
MONr
Cnrrttete
BbcL
Prisms
peneXy
All Imrxliona math an e mmunum a
minimum" imrno und me 8
hour memories he anymommumn m.arthear lreellwaw-
old, orbwuie�sel be WhimM temorda half.
ATTORNEYS FEES - t arty seem M we or in equity is bmagmm eMorce or imempt Me wens of this Contras[, the prevailing Petty
wWI he women se hummusble atameys tees, web and necessary disdusements in aMieon roam other fennel to which such PeM maybe
soothe.
SPECIAL INSPECTION REPORT }�
xmctm'e Name: 1, 'd'--.K..1 Inspector's Signature: f
No. �L I tlas loser glee and it snake that the above work to Me best of N4ner knowledge comphos with Me
provlsioas of Me Uniform Building Cooda.tne meek epprpved plans end specifications.
Respectfully Submitee,
Approved by: wm .nsvpmame -
DEPUTY INSPECTION SERVICE INC. DEPT. OF BLDG. a SAFETY
25121 DE SALLE ST, LAGUNA HILLS, CA 92653 CITY OF
1-800- DEPUTY I-1-800-33T-8891 COUNTY OF
SPECIAL INSPECTION REPORT
Building Permit No. QSlhog4C Job. No. Date sire
Job lndenGhoatlon/ _is tiro -<.a :.
General Contractor/Address SuMan,1v IN
Sub - Contractor /Address P K m \
Structural Engineer /Addres ever, Arch.
REINFORCED CONCRETE MASONRY HI-TENSILEBOLTING CHEMICALANCHORS
PRESTRESSED CONCRETE____. WELDING__ GYPSUM CONCRETE_ _ _ OTHER
WELDER RECEIPTNUMBER WELDER
RECEIPTNUMBER
DATE OF INSPEFFYININ
DESCRIPTION OF WORK INSPECTED
HOURS
SAMPLES
DATE
Reg.
SIT
Tlmeln
Time ON
Grout
Mortar
Concrete
Blocka
Pringle
Density
_I
seseei
AllimPanlam hseae en s minimum or
minimum. Any indusalson extending past the noon hour will be thigual as 8
hour 1 or5erwea9111ca ,^ try 1111 Nape hour
ATTORNEYS FEES - If any Acilon at law or m equity is brought to enforce or Imempt fire terms of this Contract, the prevailing pary
shall be entitled to reasonable attorney'* mos, cock and necessary disburearmado in addition to any other relief to which such party maybe
entitled /
n SPECIAL INSPECTION
aRL
InspectoreNeme:�aori Signature s
LDLNoLOM1abenttaethat above work to the best o, fFathererIknowledgecompiles with the
provisions of the Uniform building Code
and meets approved plans and specifications.
- Respectfully Submitted
Approved by Proper Snp.rmtanmm