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608Aldecin PI
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
3300 Newport Boulevard i P.O. Box 1768 i Newport Beach, CA 92658
www.newoortbeachca.aov i (949) 644-3275
SETBACKS AND TOP OF SLAB/FLOOR
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
Michael A. Forkert
License # LS 5662
Engineer/Surveyor's Address 22311 Brookhurst St, Ste 203, H.B. CA 92646
Job Address 608 Aldean Place
Setbacks: Sketch a site plan and specify surveyed setbacks (use back page).
* Top of slab/floor elevation:
* 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 are ®,
from plans:
are not ❑, per City approved plans. Describe any deviations
I certify that top of slab/floor elevation(s) is ❑, is not ❑, per City
any deviations from plans:
11/8/2019
Date
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