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' � °�,�;T � Permit No. Comm — 18-2125 � � �` ��
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County of Los Angeles
, � ` DEPARTMENT OF PUBLIC WORKS BUILDING 8� SAFETY DIVISION
PUBLIC WORKS
Los Angeles Regional Uniform Code Program
STRUCTURAL OBSERVATION REPORT FORM
STRUCTURAL OBSERVATION means the visual observation of the structura/system, for genera/conformance to the
approved p/ans and specifications, at signi�cant construction sfages and at comp/etion of the structural system.
Structural observation does not include or waive the responsibility for the inspections required by Section 108, 1704 or
other sections of the Los Ange/es County Building Code. (Sections 106.4.5, 1709)
Report No.
This report includes all construction work through_ 19TH _day of_ �ANUARY _ 2o2t _Page No.�of�_
Project Address: 2gg SANTA ANITA AVENUE, Structural Observer of Record (SOR): SOR Phone No.:
ARCADIA, CA 91006 K Fi h r 818-874-1445
Building Permit No.: Structural Observation Observr Professional Lic./Reg. No.: Observer Phone No.:
Comm-18-2125 performed by: KUft FISCIIe S5432 818-874-1445
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR ELEMENTS/CONNECTION
OBSERVATION LOCATION
0 Footing, Stem Walis ❑ Concrete ❑ Steel Moment Frame ❑ Concrete
SEE FOLLOWING
❑ Mat Foundation ❑ Masonry ❑ Steel Braced Frame ❑ Steel Deck pAGE FOR
❑ Caisson, Piles, ❑ Wood ❑ Concrete Moment ❑ Wood LOCATIONS OF
Grade Beams Frame WALLS AND
❑Retaining Foundation ❑ Others: � Masonry Wall ❑ Others: COLUMNS
Hillside Special Anchors Frame OBSERVED.
❑Others: ❑ Others:
NOTED DEFICIENCIES with the proposed corresponding corrective actions with respect to general
conformance with the approved plans or in the load path: (A final report by the structural observer which states that
all observed deficiencies have been resolved is required before acceptance of the work by the building officials.)
No observed deficiencies within the items listed above.
I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE:
1. I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE
CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE
REQUIREMENTS OF THE COUNTY OF LOS ANGELES.
QR�F ESS/�N
2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS q
UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT ���`'��M F �SC `F2
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN ! � �J� �F� Z
GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; ''�' �'
'�� No. 55432 �
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED \�* *
ABOVE; RP P
��Tq STR���v ��
4. 1 RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY ���F CF�A�AF��
OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE ��
CORRECTED.
2021/01/19
(STAMP OF STRUCTURAL OBSERVER)
SIGNATURE OF STRUCTURAL OBSERVER DATE
Version 1.0(2008 LACBC) Jan. 10 2008