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