Laserfiche WebLink
City/County of SAxrn A"{A- <br />Jurisdiction <br />Logo <br />Here <br />BUILDING DIVISION LAR UCP, <br />,CA9 <br />T 1231456-7Ap1, F 2341567 -89'12, E-mail @ <br />STRUCTURAL OBSERVATION REPORT FORM <br />STRUCTURAL OBSERVATION means the visual obseNation of the structural system, for general conformance to tha <br />apqoved plans and srycifrcations, al significant construction stages and at completion of the struclural system. Structural <br />obseNation does not include or waive the responsibility for the inspections required by Section 108, 1701 u other sections ot <br />the Code. <br />Report No I <br />This report includes all constructon wo * urougnZl"Ea^y ot @\4 ,2q l? eage No. I ot / <br />P.otcrAddrr..: ZZLL 6- ISf Sf Structu.ll Obs6ry.r of Reco.d (SOR) <br />Ar<-urt *t5fuy SOR Phone No <br />btcll t?'.f'l <br />Building P6rmit No. <br />lo,q5fi7 <br />Struclurtl Oblcrvrtlon D€rtoimad bv:Srae, <-/^ePaz-' <br />Ob.ery9r Prof.3sion6l Llc./Rag. o. <br />EPCc'11-" <br />Ob.ervar Phon. No.:{flrdlrr,r.t <br />OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS <br />FOUNDATION FRAMES FLOOR PORTION OBSERVEO, IF NOT WHOLE <br />XFooung, <br />glEnt1itlti E Concrete O Steel Moment Frame E Concrete e4!.314 GB I S116 <br />F Mst Foundation E Masonry O SteelBraced Frame O St..l Deck Lep+E o ta.f. <br />tr WoodP G.+'6rr+tlG, Grad6 Bcrm.E Concroto Mom€nt FramG O Wood <br />E Rat lnlng Foundltlon <br />Hllblda Sp.clrl Anchor. <br />E Olh6r E lratonry WallFr.mc E Olhers: <br />O Oth.rs E Olhers I <br />OBSERVED DEFICIENCIES:5{oxe' <br />I OECLARE THAT THE FOLLOWNG STATEMENTS ARE IRUE TO THE BEST OF ITY KNOWLEOGE <br />2. I, OR ANOTHER ET{GINEER OR ARCHITECT WHO I HAVE OESIGNATED ABOVE ANO IS UNDER <br />MY RESPONSIBLE CHARGE, HAS PERFORMEO THE REOUIREO SITE VISITS AT EACH <br />SIGNIFICANT COI{STRUCTIOiI STAGE TO VERIFY IF THE STRUCTURE IS IN GENERAL <br />CONFORMANCE WTH APPROVED PLANS A'{O SPECIFICATIONS; <br />IAM THE EI{GINEER OR ARCHITECT RETAIT{EO AY THE OWNER TO BE II.i RESPOI{SISLE <br />CHARGE FOR THE STRUCTURAI OBSERVAION It{ ACCOROANCE WTTH THE REOUIREHENTS <br />oF rHE crrY/coulrrY oF Sarlfl A{} <br />I REC <br />OF <br />3. ALL DE NCIES WHICH REI'AIN TO BE CORRECTEO HAVE BEEN IIIOICATEO ABOVE; <br />4 O THAT AC EPTANCE OF <br />ARE D <br />THE STRUCTURAL SYSTEMS BY THE CITY/COU?iTY <br />BE WITHHELD UNTIL ATL OBSERVED DEFICIENCIES <br />2 tL7lt7 <br />SIGNATURE <br />SIAIIP OF STRUCTURAL <br />OBSERVER OF RECORO <br />No, C06727 <br />Exp.9'30'20 <br /><2 <br />ELI E <br />ctv\L. <br />e <br />qt <br />(, <br />uJd <br />* <br />rnmv <br />* <br />urt <br />FESS <br />OF cA <br />sorf doc - LARUCP Struclural Observalion Report Form (V1 0 - 5/2000) <br />DATE <br />Page 1 of 1