- 858 LOMA VISTA STNV CS
County of Los Angeles
DEPARTMENT OF PUBLIC WORKS BUILDING & SAFETY DIVISION
Field Office Address
C fry OF Cc S"e6udOO
STRUCTURAL OBSERVATION REPORT FORM
STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the
approved plans and specifications, at significant construction stages and at completion of the structural system Structural
observation does not include or waive the responsibility for the inspections required by Sections 108, 1701 or other sections
of the Los Angeles County Budding Code (Sections 106.4 5, 1702)
// Report No
This report includes all construction work through tv' — day of Iletel 6elz 2005 Page No. / of /
Project Ad 8s1 Coyle J(si*
Building Permit No.:
oral Otiaervatbn bIlea r
Shuetinal Observer of Rxard (SOR):
Zit itiali1 OV-E
Observer Professional LIcJRog. No.
SOR Phone No.:
(.3%o)VSL-&ro0
Observer Phone No.
OBSERVED STRUCTURAL ELEPA
FOUNDATION
WALL
FRAMES
FLOOR
PORTION OBSERVED, IF NOT WHOLE
».Foothg, Stem Walls,
0 Concrete
0 Steel Moment Frame
O Concrete
Gq a4404 g. Mr
o Mat Formdatkat
0 Maeomy
O Steel Braced Frame
0 Steel Dods
&Ain te %rise - l 2-/G' r
O Caisson, Plies, Grade Beams
*Wood
0 Concrete Moment France
%Wood
0 Retandng Foundation
Hlllebo Speetal Anchors
o Other:
0 Masonry Wall Frame
O Othem:
o Sier>:
0 OBuerm
NOTES: 5*'QQ L-& s T singe S/OL' OF Afar _ a /4-
2 -2.c4 /r1 Lral OP 3ittl3 CtCEz7 flvL Oa pis OLmwS -arc
OBSERVED DEFICIENCIES:
"-oust( f +b-/.(1(r
Qoop D/R7NMAo r ,uAtaa/c. -A/oA6
.i,* -- 6✓/hse.4- uc/aNE
Stht9?2- 7741r✓eFees - ,u/o vE
ricOdwA/S-/t/oive
/ effoE -tuff- Non 6
I DECLARE THAT THE FOLNOING STATEMENTS ARE TRUE TO THE BEST OF MY IONOWLEDGE:
1. I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE
C THE STRUCI'UR&L GeSERVATICN IN ACCORDANCE WITH THE REQUIREMENTS
OF THE OF C L N
2. i. OR ANOTHER ENGINEER OR ARCHTECT WHO I HAVE DESIGNATED ABOVE AND IS UNDER
MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRE) SITE VISITS AT EACH
SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF THE STRUCTURE IS IN GENERAL
CONFORMANCE WITH APPROVED PLANS AND SPECIRCATIONS;
3. ALL DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEM INDICATE) ABOVE
4. IRE�•�•!.TACGIYTaNCE OF THE STRUCTURAL SYSTEMS BY ThalNIY
OF e� GvUNf/ BE WITHHELD UNTIL ALL OBSERVEq
YeAra
DATE
STAMP OF STRUCTURAL
OBSERVER OF RECORD
sod doe - LARUCP Structural Observation Report Fonn (V1 0 - 52000)
Page 1 of 1
12/08/2005 08.26 FAX 310 342 7260
R F INT'L
Ij001
County of Los Angeles
DEPARTMENT OF PUBUC WORKS BUILDING & SAFETY DIVISION
Field Office Address
Col OF Cc Se6urvd d
STRUCTURAL OBSERVATION REPORT FORM
STRUCTURAL OBSERVAI7ON means the wsual obsen20on of the structural system. far general conformance to the
approved plans and specifications, at significant construction stages and at completion of the structural system. Structural
observation does not include or waive the responsibility for the inspecions required by Sections 1013, 1701 or otherseejons
of the Los Angeles County Building Code.(Sechons 106 4.5, 1702)
This report Includes all construction work through ‘711
Project Address: - --
6s-b A,*A Jrsf1?-
&dlding Punult No.
FOUNDATION
"-Footing, Stmn Walls,
G Met Fw°datior
O Cal PIM; Grade Hine
O Robi^ e.g Foundation
thus... 5pedal Anchors
O Others:
Report No.
day of De4311 , 20.4j Page No. / otL
Structural Cp /min of Record ( :
Area-ifI Structural °bradogb omamntt Professional Llear
gNo:&d r✓ res -
rhri
OBSERVED STRUCTURAL ELEMENTS AND zf
THEIR CONNP4
ECTIONS
WALL
O Concrete
O Matmuy
$Wood
O Omer:
FRAMES
O Steel Moninil Franc
O Steel Brayed Frame
O Camels Moment Frame
FLOOR
O Concrete
D Steel Dedi
%Wood
SOR Phone No.:
(/e)sti-6•Sbo
Observer Mire No.:
PORTION OBSERVED, IP NOT WHOLE
Roust' A21.101 /ArC—
write 7 46 - /Y/g/ (
O Masonry Wan Frame
O ODen:
O Others:
NOTED- S/(004 r 4%u4 a de ass of Q c AAP _ 0 K-
? /nr G OP s okra'
ow cons -arc
OBSE -D DEFICIENCIES:
FgAirder-
rats- //owl
1 DECL +r . • WT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY
KNOWLEDGE
1. IA C ENGINEER OR AAyRC:WIEST�REETTAAIINNEED BY THE OWNER TO BE IN RESPONSWLE
t, Wary i n. O C�otJA21YSN ACCORDANCE WITH WE REQUIREMENTS
ow.✓S
2 L- -.TNER Et4WNEER OR ARCHITECT WNO I NAVE DESIGNATED ABOVE AND IS UNDER
n. . Pmr n NAS PERFORMED THE REQUIRED sae VISITS AT EACH
SI. mama
NT CONSTRUCTION STAGE TO VERIFY IF THE STRUCTURE B IN GENERAL
Cc .JUICE WITH APPROVED PLANS AND SPECIFICATIONS:
I A. iENCIES WHICH RE&WN TO SE CORRECTED HAVE BEEN INDICATED ABOVE;
0. 1; EN
pryCE OF THE STRUCTURALA V o BE Wmnm n unitBY _ s FI GUNE5
D.
TY
r\
/2-
sort do. _ ..P Structural Obaervaa0n Revert Form ,V7 0 - 5r200011
DATE
sums OR STRIucrusa
OBSERVER OF RECORD
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