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Home My WebLink AboutE2016-0337 - Miscr. kCITY OF NENV PORTBEACH q�tt�i`.g�fr (sit �3 S �. D�: i3,�e CR �.` 6-§L-.W�• Puri Structural Observation Report /IVIlly ! PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECT!ONS OESERVED (check applicable boxes: Dk'r'(IPVS ry riP,�S F{;fJ�.i.'.5 RAnNi=S ,FifiRACPAS �.NCA ,p E LOCIAi"IOMFj GATE ` BSEKVED OBSERVED ! w2 EMS CHECKED ABOVE A.k'E APPROVED AND WITHOUT DEFIC#ENCicS. OBSERVEC) €.iEFiCIEPli.iFS AND CONt,MENTE: �- 73 - RAL URU+ TL'' Al_ :'c-'eRtd ,T#C714 REaORT'. -fhE s�LuctilrE' writ, .•� _v't}�t t5 wi{t F,p Gryrot•e.t .ci15tTLEcti�r d0Gbmf aws ant] a°? ,.Y._4:. ,l d0iciencias were' orrpclpd. 6 XP( a �A FtJ E ir'C.-,11141. KLg1 A N DLE ."-' WA!ti<F AHA REtIi PPMEN,7 ?0" NEWHT (uonap' `V �P"jl muwl!('�J,wos) vi JS saa!Na8 31aJ I £L58'ZI)8 (199) Z91LOOZ3- #JI7x31Vx 3SS,URi3jx"3A 9 •nu..S juggl ,Clradaw pa1lalau{ SaM Paa sivawwtnbar ❑j) pamhoi agi spa"" uonalnxu( 8mplmq agl'gZ atuJ. IOJ stw'uiarmba3 aleudardda aqi foam 8uT1Taa pua sham paralnsul Ila >a41 Pa!luaA anaq asa'4u2aaA auegS I 099Z6-HDV3flld(Mh 3' xQ VS3W ZIe-, 1-)gfol4 i ,R'a33KOa.0 WOl M of ozoz ,oz `Ilxdv 4,vm V (I") . J'H:)Vgg DNIOI ttiv,S3M ti3JL1a3S J'ir'� Af)S3AI3 .r{�. _-^ :�1►►' 1 aEvrpoRr F CITY OF NEWPORT BEACH >.. _ COMMUNITY DEVELOPMENT DEPARTMENT cN " BLtILDINGDIVISION mew 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 www.newoortheachca.00v 1 (949) 644-3200 Structural Observation Report Pruert ddmss 1 Report Date' // CNB Inspector Nams. CNB Permit #: Building Owner gyms; " — Owners Mailing Address (f (inherent firrmr site); Owners Telephone # CNB Pt.. Check k: Full ,N/am�y// e�AoS Structua(O�trsperver (rS�O)' �7 woo& 1,%IiM r � 1 O4, 150 License yevr-h q . #. P_LEASF INDICATE STRUCT11RA1 Fb FMFNTS AND Cr)NNIFCTInNS nRSFRVFrt rrhnr4 r,.,.....,i DIAPHRAGMS fNDiCATE LOCATION(S) DATE FOUNDATIONS SHEAR WALLS FRAMES Floor/Roo (f_I_ OBSERVED OBSERVED Footings & Slab ❑Concrete r Steel _ �I:I C'anrrete — _ WG u Mat Fourtda5on, Prestressed Concrete - ❑ Masonry _ 1 Concrete ❑ Steel Deck L Caissons, Piles, ❑ Wood or Mani f. L Masonry cl Wood Grade Bens Shear Other ❑ Other:Paris G Other: 0 Other.— � I _ —I ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. ❑ OBSERVED DEFICIENCIES AND COMMENTS: C! REPORT CONTINUED ON ATTACHED PAGE 6 FINAL STRUCTURAL, OBSERVATION REPORT: The structure generally complies with the approved construction documents, and allobserveddeficiencies were corrected: 1 declare tha4 thefollawing statements aretrue to the best of my knowledge: 1. 1 am the licensed design pro?essioral retained by the owner to be in responsible r. charge of the stnicturai obseavafion; 2. 1, or another licensed design professional whom I have designated above and is under � ��'' 9 0 my responsible charge, have performed the required site visits at each significant fp r consWcticm stage to verify that the structure is in general conformance with the F O �9 M approved construction documents; tL 3. 1 unders,and that ail deficiencies which I have documented must be corrected, mior to final aczeptance of the structural systems by the City of Newport Beach, Building Division. \\... TF OF C►01- , _—. _ STAMP OF STRUCTURAL OBSERVE:' SIGNAT" - Sl" :CT'J UO 0{= RECORD DATE''; NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. \ m7 m� \\ Fp E ' \ aP \ ra tq s /p 30 at a V�3�u a b Q� ^zg d e ws�s�Yc Sawv+1 oo Q '71 � _ •�. .F9 �o pc9m4 �+ b ➢�8 �� 9mzw7 C g gR� as �Smy i 9 ��: wiv '- 0 e e eSoS H $`�4c <so➢ �' $i0 i !3!aA:S� R e Bd p Gills a p g g�g,P's Q�GR � Own �4 ire s 9 4 2 _ Y .b fi ffice County of Orange oo °lower street Santa Ana, CA, 92702 OC Public Works 714-607-8888 Submission Summary Project Project OCID : OC19-06356 Project Name: 15022-2612 Mesa Drive -Newport Beach Project Description : 15022-2612 Mesa Drive -Newport Beach Map Application SRS.20191217:Record of Survey Enter Issued RS Number: RS 2019-1193 Legal Description: IRVINE SUB LOT BLK 51 POR OF BLK TR 361 Jurisdiction : Cities Cities : Newport Beach Type : Record of Survey Processing Number of Sheets : 1 Application Comments: Location 2612 MESA DR, NEWPORT BEACH: 439-051-06 NOSTREETADDRESS NOSTREETADDRESS, IRVINE NOSTREETADDRESS : 439-051-07 - Primary Job Site. Name Paul Craft Apex Land Surveying, Inc. John C. Manly Contact Phone Email Address Type 20422 Beach Blvd, #225 (714) 488-5006 richard@apes-ls.com Huntington Beach CA Applicant 92948 20422 Beach Blvd, #225 (714) 488-5006 apexlsine(?,�gmail.com Huntington Beach CA Surveyor —Engineer 92948 20422 Beach Blvd, #225 (714) 488-5006 apexlsincogmail.com Huntington Beach CA Owner 92948 FRP No No Yes Printed: 10/11/2019 13:08 PM Page 1 of 3 County of Orange OC Public Works • Attachment Name Reference Maps Map Sheets GPS Horizontal Control Data Sheets Traverse Closures Digital Submittal (AutoCAD) All Other documents — Combined as single research package Declaration By submitting this application, I agree: Main Office 300 N Flower Street Santa Ana, CA, 92702 714-607-8888 File Name RS2019-1193_(15022)-REFERENCES.pdf RS2019-1193_(15022)-l.pdf RS2019-1193_(15022)-CLOSURES_10-11-19.txt 1. To the best of my knowledge that the information I have presented on this form and attached materials is true and correct and the County of Orange makes no representations regarding such information; and 2. To indemnify, defend and hold harmless the County of Orange, its officers, employees and representatives from any claim or litigation arising from or related to the submission of this application or any actions taken on the basis of this application; and 3. That I am subject to the fees, deposits, and charges as identified in the County's current fee schedules as approved by the County of Orange Board of Supervisors; including, any Road Fee Program annual rate adjustments due at the time of permit issuance as authorized per Resolution # 14-053. 4. Applicant shall, at its own expense, defend, indemnify and hold harmless the County of Orange, its officers, agents and employees from any claim, action or proceeding against the County, its officers, agents or employees to attack, set aside, void, or annul any approval of the application or related decision, or the adoption of any environmental documents, findings or other environmental determination, by the County of Orange, its Board of Supervisors, Planning Commission, Zoning Administrator, Subdivision Committee, Director of OC Public Works, or Deputy Director of OC Development Services concerning this application. The County may, at its sole discretion, participate in the defense of any action, at the applicant's expense, but such participation shall not relieve applicant of his/her obligations under this condition. Applicant shall reimburse the County for any court costs and attorney's fees that the County may be required to pay as a result of such action. If litigation is filed challenging the Project, the County may, at its sole discretion, require the Applicant to post a bond, enter into an escrow agreement, obtain an irrevocable letter of credit from a qualified financial institution, or provide other security, to the satisfaction of the County, in anticipation of litigation and possible attorney's fee awards. The County shall promptly notify the applicant of any such claim, action or proceeding. Printed: 10/11/2019 13.08 PM Page 2 of 3 County of Orange OC Public Works Name: Paul D. Craft Date: 10/11/2019 Main Office 300 N Flower Street Santa Ana, CA, 92702 714-607-8888 Printed: 10/11/2019 13:08 PM Page 3 of 3 richard@apex-Is.com From: noreply@salesforce.com on behalf of myOC eServices Email <noreply- myoceservi ces @ ocg ov.co m > Sent: Friday, October 11, 2019 4:08 PM To: richard@apex-Is.com Subject: Your Survey has been submitted to Orange County u PublicWorks 10/11/2019 SRS.20191217 NOSTREETADDRESS Dear Paul Craft, Thank you for a submittal to the Orange County Surveyor's office. For status, please contact Margarita Espinoza at 714-967-0847 or email to Margarita. Espinozaaocpw.ocgov.com Questions concerning reviews, please contact the following staff: For Tracts/Parcels/LLA/Certificate of Compliance/Certificate of Corrections/Annexations, and Monuments/Addressing Li I v. Sand be rq (a)ocpw. ocg ov. co m 714-967-0846 For Record of Survey/Corner Records Steven. Dawson@ocpw.ocgov.com 714-967-0843 Sincerely, Kevin R. Hills, County Surveyor 300 N. Flower Street, Santa Ana, CA 92703 w .ocpublicworks.com 714.667.8800 1 Info@OCPW.ocgov.com 11E P C13'Y�1 INSPECTION 1-800-DE L? GmCoow ongman Construction Michael R Gabriel (Engr) Manly Rsidence/2612 Mesa Dr, Newport Beach Project .'Fame & Add, ess pef Numbcr _X2018-2928 Inspection Typc(s) Reinforced Concrete Inspection Date(s) _1D/29L19 _�[ ] Periodic [ x ] Continuous Describe Inspection Made, includin Locations Observed epoxy installation of �4) #5 dowels embedded a minimum of 4" into concrete for new to existing footing connections at the oun ation per structur owei� 'Ts —per omT--""""`" '"-'__.,M-_.._.. p_p ......__. _ _ __. List Tests Made: Total Inspection'rimr Each Day: List Items Requiring Correction, include uncorrected items previously, listed Holes drilled oversize to allow f( Holes brushed and blown clean Simpson set xp99We—) p-202f- To the best of my knowledge, the work inspected was in accordance with the Building Department approved design drawings, specifications and applicable workmanship provisions of the U.B.C. except as noted above. 10/29/2019 Signed: Date Print Full Name: v vThomas George _._ ._-`._,__. Registration No. NB-0617 Felts: Sf-ot,ao REIRUTY .1 -AINSPFIMMON 1-800-1sil ' " G.C.t, Longman Construction slll�cow' Michael R Gabriel (Engr) t77 7" Manly Rsidence/2612 Mesa Dr, Newport Beach Project Name & Address Permit Number X2018-2928 Inspection Type(s) Reinforced Concrete Inspection Date(s) 11/14/19 ------- Periodic X ]Continuous Describe! Inspection Mac��, � i_ ., .... , OcatlonK Qbsarve epoxy installation of 6 2) #4-dowels emb_dded a minimum of 4° into existing concrete for now to qxJ§!Lnaq!ab connections at the foundation Per structural Plans. Size of dowels and minimum embedment in strictaccordancewith d-etail13 of �S5 List Tests Made: Total Inspection Time Each Day. List Items Requiring Correction, include uncorrected items previously listed Holes drilled oversize to allow for full coating of dowels. Holes brushed and blown clean prior to insertion of dowels . Simpsoii_s6t xp2508/exp 202 To the best of my knowledge, the work inspected was in accordance with the Building Department approved design drawings, specifications and applicable workmanship provisions 1 :he U,B.C. except as noted above. 11/14/2019 Signed: Date Print Full Name: ' vThomas George..- Registration No, NB-0617 ,,OP.M Sl-OL90 o" e CITY OF NEWPORT BEACH u s COMMUNITY DEVELOPMENT DEPARTMENT a r9rrF�pH,r BUILDING DIVISION 100 Civic Center Drive I P.Q. Box 17681 Newport Beach, CA 92658-8915 www.newportbeachca.gov 1 (949) 644-3200 Structural Observation Report Prole iAddre;ess'. Report Date CNB inspector Name: CNB Penny #: BuOing Chvner Name, Owner's Mailing Address (if drtterent flnm site); Owner's Telephone lf: CNB Plan Check p: Full Name of StZdUrW Obseivt, i t SO E-mail Address: $o Tehone#: I SO License f Reg. #: ;I "": 8, l ink r��-t 4144G _ q PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNFCTInNti nRSFRvFn rrhwrL nnnterahln hnvec\ FOUNDATIONS -- SHEAR WALLS FRAMES DIAPHRAGMS Floor1Rootj INDICATE LOCATION(S) OBSERVED DATE OBSERVED Conventional Faotings & Slab Mat Foundation, Prestressed Concrete i 1Caissons, Piles, Grade Beams 0 Other: 7 Concrete 10 Masonry C n Woad or Manufi. I Shear Panels ' Other: -- G' Steel ❑ Concrete C; Masonry ❑ Other: 7] Concrete ❑ Steel Deck ❑Wood ❑ Other: - -� ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. —� I ❑ OBSERVED DEFICIENCIES AND COMMENTS: i REPORT CONTINUED ON ATTACHED PAGES. 0 FINAL STRUCTURAL OBSERVATION REPORT: The structure generally complies with the approved construction documents, and all observed deficiencies were corrected. I declare that the following statements are true to the best of my knowledge: 1. I am the licensed design professional retained by the owner to be in responsible charge of the structural observation; j 2. 1, or another licensed design professional whom I have designated above and is under my responsible charge, have performed the required site visits at each significant conshucbon stage to verify that the structure is in general conformance with the approved construction documents; 1 1 understand that all deficiencies which I have documented must be corrected, prior to final acceptance of the structural systems by the City of Newport Beach, Building DMsmn- -i- --- O11/• / -ly Sv^ RE. G�� Sl RL„T ' ?kLEiBESiVEi1 OF RECORD DAT, E 1 um�a5imam eM?bmn:aHmke;vn&Inn�mmimes 6 x e ,o� rgt/CT�QP� 4P STAMP OF STRUCTURAL OBSERVER NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Flo 1V CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT Cgi�r}0.NP BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 www.newportbeachca.gov 1 (949) 644-3200 Structural Observation Report Proje es�: 0/0 Report Date: P /7 ^ rtf CNB Inspector Name: CNB Permit #: Building O��e!/rr N/ame: Owners Mailing Address (if different from site); Owners Telephone #: CNB Plan Check #: Full Name of Stru ural Observer (SO): W"gt- GAP1Zl�L SO E-mail Address: , m tr�hlrn� wf• SO Telephone #: °I4 SO License / Reg. #: oqoq PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED check annficable boxes FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (Floor/Roof) INDICATE LOCATION(S) OBSERVED DATE OBSERVED ❑ Conventional Footings & Stab ❑ Concrete ❑ Steel ❑ Concrete ❑ Mat Foundation, Prestressed Concrete ❑ Masonry ❑ Concrete ❑ Steel Deck ❑ Caissons, Piles, Grade Beams ❑ Wood or Manuf. Shear Panels ❑ Masonry Wood C7a L — 7_ Z T Y/ ❑ Other. ❑ Other: ❑ Other ❑Other. ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. ❑ OBSERVED DEFICIENCIES AND COMMENTS: ❑ REPORT CONTINUED ON ATTACHED PAGES. ❑ FINAL STRUCTURAL OBSERVATION REPORT: The structure generally complies with the approved construction documents, and all observed deficiencies were corrected. I declare that the following statements are true to the best of my knowledge: 1. I am the licensed design professional retained by the owner to be in responsible charge of the structural observation; 2. 1, or another licensed design professional whom I have designated above and is under my responsible charge, have performed the required site visits at each significant construction stage to verify that the structure is in general conformance with the approved construction documents; 3. 1 understand that all deficiencies which I have documented must be corrected, prior to final acceptance of the structural systems by the City of Newport Beach, Building L �49 SIGF F RECORD DATE OF CA0 STAMP OF STRUCTURAL OBSERVER STRUCTURAL OBSER!/ATION DOFS NOT WANE ANY RFOIIIRFnFNTS Fm Run nimr. IMSPFrTInN RV AtrmnDITFn F DI My =F nF TMF In V nc u..l .c— rwmr�5lrvnunN)I. TvdnnNa�ronAlmuuni,xu CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 www.newportbeachca.gov 1 (949) 644-3200 BUILDING HEIGHT CERTIFICATION Project Street Address: 2612 Mesa Drive, Newport Beach, CA Building Permit Number(s): # As the surveyor of record for the project at the above address, I hereby certify that I have reviewed the City of Newport Beach approved plan and original topographic survey and based the elevations listed below on those plans. Elevations shall include an allowance for roofing material thickness if not yet installed. Provide each critical ridge and flat roof, or roof deck railing elevations indicated on the approved plans. Use the format below on the back of this form if additional space is necessary or further explanation is needed. Provide original copy to the inspector before roof framing inspection. All elevation points are based on: O NAVD88 O NGVD29 O Assumed Please provide the following elevation information for the highest roof ridges, flat roofs, or parapets/guardrails. Additional elevation points may be requested by the Building Inspector. RIDGES (3:12 slope or greater) Approved elevation point of ridge is c O' and actual elevation point is1.10 l Approved elevation point of ridge is 10 .3' and actual elevation point is -78. 1$ V Approved elevation point of ridge is S31 -0' and actual elevation point is al Approved elevation point of ridge is and actual elevation point is Approved elevation point of ridge is and actual elevation point is Approved elevation point of ridge is and actual elevation point is Approved elevation point of ridge is and actual elevation point is FLAT ROOFS, PARAPETS AND GUARDRAILS Approved elevation point of flat roof or parapet is and actual elevation point is Approved elevation point of flat roof or parapet is and actual elevation point is Approved elevation point of flat roof or parapet is and actual elevation point is Approved elevation point of flat roof or parapet is and actual elevation point is Approved elevation point of flat roof or parapet is and actual elevation point is I certify that the above height measurements are correct and the above project: is IS in compliance with the City -approved plans. OIS NOT in compliance with the City -approved plans (Provide explanation). describe any deviation from the City -approved plans 04,,' IroZ2 Surveyor or Civil Engineer's* signature and (Wet stamp and signature required) * License number of 33965 or lower 1 6k:of this form. J �1 I '1 7NZo Date Fo \Building Height Certification 11/02/16 R � Q N IN FLAT ROOF = � J� i D.S. E�----------- x._______ ® > 12 VENT N (N) RIDGE 8 4.12 240A6V. 610 AV@ N.G. ABV. 61,0' AVG_ N_6. I (E 4 :12 (E) �.DGE E= 2 y� a D.S.-. PROPd ED NEW ADDITION J i Eh15TIN6 TO REMAIN ROOF PLAN no NORTH a 51-ALE: 1/5" = 1'-0" 7Q�WIPOkT r �n } " a� "�. cy4 Fo aANvr ��G<:IVfiD BY COMMUNITY CITY OF NEWPORT BEACH o r,'4FNT COMMUNITY DEVELOPMENT DEPARTMENT M'' 91 BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 CITY www.newportbeachca.gov 1 (949) 644-3200 Z lz`llvPORT Three Year Construction Time Limit Extension Building Official Application Project �/�r�Receipt No Address:---- 2- ......... ._- -----/� Permit ^/ O Original Permit Q Extension Fee: Date Fee Paid: No.: ��-Z�Z`, Issued Date: V 1� �c.�"�� $ /--' 7"— PETITIONER/PROPERTY OWNER INFORMATION Name (Must be payer of fees): Company Name: - Street Address: / City: (j State: Zip Code: 1e Email Phone: CO/I -Arm- ,n if o/n � � �( -Z�Z— (o� 2-9 PROJECT INFORMATION Length of extension requested: l� New end date if request is approved: 2 Q/ Previous Extension(s) Granted? (Y(N)) Yes, How Many?: Description of Work Under Permit: Reason for j (Attach Supporting Documents as Needed) Extension/�. _ _-- Request (kz fA. ! (1Q C -_ � S G��1�-:>k� CY1 ..._1'.U'Sl!�t<_UPS--- I HEREBY CERTIFY THAT THE ABOVE STATEMENT IS TRUE. ......... - - - Petitioner's at e. �.� Relationship to- Property Owner: Date: 4! �Y )rci,4} e- 5 /Z6 rz FOR STAFF USE ONLY Department Action: Approved ❑ Denied — -- - _.__ _.......... ........ - Conditions sttw-��Z�.ZZ of Approval �'�-�f� 8" U-tt,.�zS-rj:A! "-QL[lLS1,4/1Z. i Comments: Building Inspector Name: p Signatur Dat : Reviewed: - - --- - . ........ ... _.... _ ...._--- ----- ----- --_ - - Building Official Name: Signature. Date: Approval: / / - I c-�•i �= 1 I�nz- o S 3 t 2 BuildingOfficial3YearExtension Valid Until 04/22/2025 Ordinance 2022-8 / NBMC 15.02.095 Shelton, Chad From: Jill Manly <jill@jabulaniyoga.com> Sent: May 26, 2022 9:12 PM To: Shelton, Chad Cc: Neil Longman Subject: Re: 2612 mesa dr [EXTERNAL EMAIL] DO NOT CLICK links or attachments unless you recognize the sender and know the content is safe. Hi Chad, Thank you for your email and voicemail. I am moving my son into Quantico, Virginia for military service and I am just now checking vm and email. I do authorize Jeff Longman to handle the paperwork for the extension with the City in my absence. Thank you, Jill Apperson Owner 2612 Mesa Dr On May 26, 2022, at 4:19 PM, Shelton, Chad <CShelton@newportbeachca.gov> wrote: Hey Jill, I just left you a voicemail regarding the extension paperwork for 2612 Mesa Dr. If you could please email me a letter authorizing Jeff Longman to handle the extension paperwork that would be greatly appreciated, as I need to turn this into the building official by end of day tomorrow. Thank You, Chad Shelton Newport Beach Building Department CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 www.newportbeachca.gov 1 (949) 644-3200 SETBACKS AND TOP OF SLAWFLOOR ELEVATION CERTIFICATE The purpose of this certificate is to insure that the structure is located properly on site per the approved drawings. This certificate also verifies the top of slab/floor elevation noted on the approved drawings. After the top of slab/floor elevation is verified to match the elevation specified on the approved drawings, the contractor and inspector can measure the height of the structure to the top of slab/floor to verify that it is equal or less than the dimension shown on building sections and elevations. This form must be filled out by a registered surveyor or civil engineer authorized to perform surveys. The survey must be done after the concrete forms are in place or preferable after the concrete slab is poured or raised floor is built, but prior to starting wall framing. Engineer/Surveyor's Name Paul D. Craft License # P.L.S. 8516 Engineer/Surveyor's Address 8512 Oxley Circle, Huntington Beach, CA 92646 Job Address 2612 Mesa Drive, Newport Beach, CA Setbacks: Sketch a site plan and specify surveyed setbacks (use back page). * Top of slab/floor elevation: (05.'so (02.50 1 (00,180 * If slab/floor elevation varies, sketch a plan or section through slab on the back page and specify the elevations. Use same datum used in the survey of record. I certify that the setbacks from plans: are 0, are not ❑, per City approved plans. Describe any deviations I certify that top of slab/floor elevation(s) any deviations from plans: II �P Date Jl`l" l Z Forms/SetbacksandTopofSlabElevalionCert. is 19, is not ❑, per City approved drawings. Describe stamp and N