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Get Structural Observation Form 2009-2024

CITY OF SANTA MONICA BUILDING AND SAFETY DIVISION STRUCTURAL OBSERVATION REPORT FORM Report No. This report includes all work through day of 20 Page No. of PROJECT ADDRESS OWNER LIC. I am the registered engineer or licensed architect who has responsible charge for the structural observation. 2. I have provided structural observation in accordance with the requirements of the City Of Santa Monica. SIGNEDOF 20 AT CA DAY MONTH YEAR CITY X WET SIGNATURE OF REGISTERED CIVIL / STRUCTURAL ENGINEER OR LICENSED ARCHITECT STAMP OF ENGINEER OR ARCHITECT BY AUTHORIZED EMPLOYEES OF BUILDING SAFETY. OR REGISTRATION NO. STRUC. OBS* PHONE NO. DATE OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS -- BUILDING PERMIT NO. LOCATION AND PORTIONS OF BLDG* OBSERVED DEFICIENCIES I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF 1. I or another registered engineer or licensed architect who I have designated above and is under my responsible charge has performed the required site visits at each significant construction stage to verify if the structure is in general conformance with the approved plans and specifications. 3. All deficiencies that I documented have been corrected unless otherwise indicated above. 4. I understand that final acceptance of the structural systems by the Building and Safety Division cannot occur without the correction of all observed deficiencies. 5. I am responsible for the submission of the original of this report to the Building and Safety Division City of Santa Monica* 6. DISTRIBUTION Structural observer to send original to building inspection at 1685 Main Street Rm* 111 Santa Monica 90401 attach the first copy to the approved plans and keep second copy for structural observer s record and distributions to owner and special inspectors. OR REGISTRATION NO. STRUC. OBS* PHONE NO. DATE OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS -- BUILDING PERMIT NO. LOCATION AND PORTIONS OF BLDG* OBSERVED DEFICIENCIES I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF 1. I or another registered engineer or licensed architect who I have designated above and is under my responsible charge has performed the required site visits at each significant construction stage to verify if the structure is in general conformance with the approved plans and specifications. 3. All deficiencies that I documented have been corrected unless otherwise indicated above. 4. I understand that final acceptance of the structural systems by the Building and Safety Division cannot occur without the correction of all observed deficiencies. 3. All deficiencies that I documented have been corrected unless otherwise indicated above. 4. I understand that final acceptance of the structural systems by the Building and Safety Division cannot occur without the correction of all observed deficiencies. 5. I am responsible for the submission of the original of this report to the Building and Safety Division City of Santa Monica* 6. .

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