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Structural Observation Report Form <br />PublicWorks <br />a <br />STRUCTURAL OBSERVATION means the visual observation of the struclural system, for general <br />conformance to the approved plans and specifications, at significant construction stages and at <br />completion of the structural system. Structural observation does not include or waive the responsibility for <br />the inspections required by Section 'l 10, 1704 oJ olh€I s ctioll gl lhe Cqqe. <br />This report includes all construction work through 1ru .? .- Reoort No. f <br />days of $NE , zd!. eage No:l-;[:-!- <br />OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS <br />Remarks: <br />F.to f APprlc AGL €. SLAA REieL AcgU_ DoE Io_Er€LS rr ,.JO, f, .r. <br />o Et_ <br />I DECLARE THAT THE FOLLOWING ARE TRUE TO THE BEST OF MY KNOWLEOGE <br />'1. I am the enginoer or architect retained by the owner to bs in responsible charge for <br />the structural obseryation in accordance with the r€quirem€nts of the County of <br />Orange.2. l, or another Engineer or Architect who I have designated above and is under my <br />responsible charge, has performed the required site visits at each significant <br />crnstruction stage to verify if the structure is in general conformance with <br />approved plans and specificationsi <br />ST <br />OBSERVER OF RECORD <br />PROJECT ADDRESS:/,oc N. oRAd(,.€ &D. SA,..rt q 4*rA <br />STRUCTURAL O <br />RECORD (SOR): <br />BSERVER <br />A. 6,r <br />OF <br />rcH <br />SOR PHONE NO.:qoq Sbgqq tq <br />Building Permit No Strucluraf Observation <br />performed by: A. beltcll <br />Observer Professional Lic./Reg <br />No.: CBts,?9? <br />Observ€r Phone No.aqoq sb:. lqtq <br />FOUNDATION WALL FRAMES FLOOR <br />PORT]ON <br />OBSERVED, IF NOT <br />WHOLE <br />X FootinS, Stem Walls tr <br />Concrete <br />El Steel Moment <br />Frame <br />E Concrete ,A\rirotr GoLTs( Mat Foundation tr <br />Masonry <br />E Steel Braced Frame tl Steel <br />Oeck 'A*tcifoA c-ooS <br />! Caisson, Piles, Grade <br />Beams <br />D Wood D Concrete Moment <br />Frame <br />fl Wood . E,,REN. DEPTN <br />f] R€taining Foundation <br />Hillside Special Anchors <br />I other:E Masonry Wall <br />Frame <br />E Others <br />E Olhers E Others <br />EIP MARCII 3,, A <br />I <br />cN <br />c 8 3 3 4 7 <br />* <br />SS <br />300 N. Flo.t€r Strest, Santa Ana, CA 92703 <br />P.O. Box 4048, Santa Ana, CA 92702-4M8 <br />Revised 10/m15 <br />TE <br />www.ocplanning.net <br />P:714.667.8888 I F: 714.667.8885 <br />ocpcustornercarg@ocA,y.ocgov.com <br />I <br />I