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Jurisdiction <br />Logo <br />Here <br />CityTCounty of 4,-'rvLr t A A <br />STRUCTURAL OBSERVN <br />STRUCTURAL OBSERVATION means the visual observation of the structural syslem, for general conformance to the <br />approved plans and specifications, at significant construction stages and at completion of the structural system. Structural <br />obseNation does not include or waive the responsibility for the inspections required by Section 108, 1701 or other sections ot <br />th" C"d" <br />Report No <br />This report includes all construction work through '3'a day of ,zol1 eageNo. I of f <br />OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS <br />LARUCP,',' .-,,. ..,.,. , <br />ProJ.ct Addr...:L!!!€ lsl tl'Squct ui.l Ob..rv.r ot R.cord (SOR) <br />k". .411,7, i2y <br />SOR Phono No.: <br />/SIdrsr lsol <br />Bulldlng P.rmlt No.: <br />Drq,q17 <br />Structural Obseruatlon porformcd by: <br />fir,*o-, ffaa1zlov <br />Obrcrvar Proflltlonrl Llc./R.9. No,:sE 03!2 <br />FOUNDATION WALL FRAMES FLOOR PORTION OBSERVED, IF NOT WHOLE <br />E footri$StEqt ns,E Concrote E StoolMomont Fr.mo E Concrote ls* r"q.r - 3c**o.ot3*7 <br />E M.t Foundetlon E Masonry E Ste.l Br.c.d Fr.m.E Stoel Deck (b+-a n/i*. z. t3.3 <br />g -CiFrorr, r{cc Grade B€a tr Wood E ConcratG Momont Fram6 E wood r>. b)' <br />E R.t!lnlng Foundatlon <br />Hlll!ld6 Spoclal Anchors <br />O Other:E Masonry Wall Frame E Others <br />O Others E Others <br />OBSERVED OEFICIENCIES: <br />.i\r a1't t- <br />I DECLARE THAT THE FOLLOWNG STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEOGEI <br />I AT' THE ENGINEER OR ARCHITECT RETAINEO AY THE OWNER TO BE IN RESPONSIBLE <br />CI{ARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDAI\ICE WTTH THE REOUIREMENTS <br />or rxq6jfcouurv or SAryrA A^rA <br />I. OR ANOTHER ENGINEER OR ARCI{ITECT WHO I HAVE OESIGNATEO ABOVE AND IS UNOER <br />MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH <br />SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF THE STRUCTURE IS IN GENERAL <br />CONFORMANCE wlTH APPROVEO PLANS ANO SPECIFICATIOT{S; <br />ARE CORRECTED qlz <br />SIGNATURE <br />3. ALL OEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INOICATED AAOVE; <br />,.. I RECOTTiTEND THAT ACCEPTANCE OF Tr{E STRUCTURAL SYSTEITS BY THE CdTCOUXTVoF .A \'1-A ALrA BE WTTHHELD UNTIL ILL osseaveo oelEtENctEs <br />STA'''P OF STRUCTURAL <br />OBSERVER OF RECORO <br />Erp.6-j0-19 <br />UC <br />+ <br />( <br />+ <br />ISS/ <br />(5p <br />ff clr <br />sorf.doc - LARUCP Structural Observalion Report Form (V1 0 - 5/2000) <br />.,,14 <br />DATE <br />Page 1 of 1 <br />BUILDING DIVISION <br />, cA 9_-_ <br />r 1231456-7891 , F 2341567-8912, E-mail: _@_ <br />,\oiL <br />'Ob&rvrr Phona l{o.: <br />5 A4!-( q_ <br />1