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STRUCTURAL OBSERVATION REPORT FORM <br />STRUCTURAL OBSERVATTON means lhe visual obseNatiotl ol the struclural system, lq general entumance lo tB awroved <br />plans and specitications, al sigrificant construction stages aN al complelion ol the slruclural syslem. Sttuctural obseNation does <br />nol include or waive lhe responsibility fu lhe inspections by Seclion 108, 1701 u other sections of the dg <br />This report includes all construction work through Auoust day of 07 2311- <br />Report No. _ <br />Pag€ l*!e._l_ ol I <br />626)204-1088 <br />626)204-1088 <br />OASERVEO STRUCTURAL ELEMENTS AND THEIR CONNECIIONS <br />E Retaaning FoundatEn, Hilbde <br />Spedal Anctp. <br />fl others: l.lone <br />OBSERVED DEFICIENCIES: Reinforcement for underpin iooting installed per structural dratvings (ssction A). No <br />deficisncies found. Ready to pour concrete 5000 psi (per contractor's .equost). <br />I DECLARE TIIAT THE FOLLOWING SIAIEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE <br />I I AM THE ENGINEER OR ARCHITECT RETAINED AY THE OWNER fO SE tN R€SPONSIBL€ <br />CHARGE FOR THE STRUCTUML OBSERVATION IN ACCORDANCE WITH THE REOUIREMENTS <br />OF THE CITY OF <br />2 I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE OESIGNATEO ABO\r'E ANO IS UNDER <br />MY RESPOiTSBIE CTI,ARCE. HAS PERFORMEO THE REOUIRED SITE VISITS AT EACH <br />SIGNIFICANT COI.ISTRUCTION STAGE IO VERIFY IF THE STRUCTURE IS IN GENERAL <br />CONFORMANCE WITH APPROVED PLANS AND SPECIFICAIIONS ucr\) <br />BAR <br />J 2I 7 <br />EXP cn.3lJ/2019 <br />oF CAL\t3 AIT OEFICIENCIES WHICH REMAIN TO AE CORRECTED HAVE AEEN INOICATED ABOVE <br />1. I RECOMMENO TTIAI ACC€PTANCE OF IHE STRUCTURAL SYSTEMS AY THE C Y OF <br />BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE CORRECTED <br />STAMP OF STRUCTURAI. F}iCTNEER OF RECORI) <br />8.7.tt <br />2840 S. Brislol St.. Santa Ana, CA 92704 - ALOI Santa Ana <br />l5anaurO06crve. ot R.co(d 1SORI <br />*ghrmen Baroonian <br />Frrd(rd ODs..v.boh ped licd by Jft*ssixtd La,Reg. t.lo o{ Obs.rw' <br />lB E B Associates, lnc. ISE 4227 <br />FOUNOATION FRAI,IES FLOOR (ROOF)PORTION OASERVED, IF NOT WHOLE <br />D FoofrB, Stem Walls fl Concrete D Steel Moment Frame E Concrete Slot Culs ABC' - section 'A' only <br />E Mat Foundation ! Masonry E Steel Braced Frame ! steel <br />fl Caisson, Piles, Grade Beams ! wood fl Concrete Moment Frame E wooc <br />E others: <br />Embed <br />@nnoction <br />E Masoflry wall Frame E others: <br />Roof deck <br />conneclionD others: None <br />SICNA'I1]RE DATE <br />I <br />,,n <br />I <br />t= <br />I <br />I