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aEW PART
0, ;� CITY OF NEWPORT BEACH
F
ut r„ COMMUNITY DEVELOPMENT DEPARTMENT
cq `oaN 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
Structural Observation Report
Project Address:
Report Dat :
CNB Inspector Name:
CNB Permit #:
Building er Na e:
Owner's Mailing A dress (if different from site);
Owners Telephone #:
CNB Plan Check
Full Name of Stru tural Observer (SO):
SO E-mail Address:
SO Telephone #:
SO Li nse/II Reg. #:
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PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED (check applicable boxes)
FOUNDATIONS
SHEAR WALLS
FRAMES
DIAPHRAGMS
(Floor/Roo
INDICATE LOCATION(S)
OBSERVED
DATE
OBSERVED
❑
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:
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/
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❑
ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES.
❑
OBSERVED DEFICIENCIES AND COMMENTS:
Ile
❑ REPORT CONTINUED ON ATTACHED PAGES.
T
FINAL STRUCTURAL OBSERVATION REPORT:
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:
QPOFESSIpy
1. I am the licensed design professional retained by the owner to be in responsible P�0 ER B. Kyp F�F�
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 61402
construction stage to verify that the structure is in general Conformance with the t 06530-2021
approved construction documents;
3. 1 understand that all deficiencies which I have documented must be corrected, prior to CI ILfinal
P
Divso 1tance�Of the structural
systems by the City of Newport Bea, Building V i FC.%'oz
STAMP OF STRUCTURAL OBSERVER
STRUCTURAL OBSERVATION DOES AQT,WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CRY OF NEWPORT REACN
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