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Structural Observation Report Form <br />PublicWorks <br />J <br />STRUCTURAL OBSERVATION means the visual observation of the structural 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 insoections required by Section 1 10, 1704 or other sections of the Code. <br />rhis report rncrudes ar constructon work throush 8th o"y. ot SEPT ,!3i31|3" *i-r--r- <br />PROJECT ADDRESS: <br />1 108 W, ORANGE ROAD, SANTA ANA, CA <br />STRUCTURAL OBSERVER OF <br />RECORo (soR):B. BAICH <br />SOR PHONE NO,: <br />909 568 9919 <br />Building Permit No.Structural Observation <br />performed by: B. BAICH <br />Observer Professronal Lic /ReoNo C 83.347 <br />Observer Phone No <br />909 568 9919 <br />OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS <br />FOUNDATION WALL FRAMES FLOOR <br />PORTION <br />OBSERVED, IF NOT <br />WHOLE <br />E Footing, Stem Walls E <br />Concrete <br />E Steel Moment <br />Frame <br />E Concrete FINAL OBSERVATION: <br />SEISMIC ELEMENTS <br />TIES, STRAPS. <br />SW NAILING <br />HOLD DOWNS <br />ROOF DIAPHRAGM, <br />ETC, <br />E Mat Foundation E <br />Masonry <br />El Steel Braced Frame E Steel <br />Deck <br />fl Caisson, Piles, Grade <br />Beams <br />m Wood E Concrete Moment <br />Frame <br />m Wood <br />E Retaining Foundation <br />Hillside Special Anchors <br />E other:Masonry Wall <br />Frame <br />E Others <br />E Others n Others <br />Remarks <br />NO DEFICIENCIES <br />c 8337 <br />I DECLARE THAT THE FOLLOWING ARE TRUE TO THE BEST OF MY KNOWLEOGE <br />1. I am ule engineer or architect retained by the owner to be in responsible charge for <br />the structural observation in acrordanc€ with the requirements of the County ot <br />Orange. <br />2. l, or another Engineer or Architecl who I have designated above and is under my <br />responsible charge, has performed the required site visits at each significant <br />construction stage to verify if the structure is in general conformance with <br />approved plans and specifications, <br />09/08/18 <br />SIGNATURE <br />S'I'AMP OF STRUCTURAI- <br />OBSERVER OF REC]ORI) <br />300 N. Flotr€r Slreet, Sanla Ana, CA 92703 <br />P.O. Box 4048, Santa Ana. CA 92702-4048 <br />Revised'10/20'15 <br />DATE <br />www. ocplanning. net <br />P:714.667.8888 I F: 714.657.8885 <br />ocpCustomercare@ocpw.ocgov.com <br />I <br />I <br />I <br />I <br />I