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HomeMy WebLinkAboutX2019-2668 - Misc (2)CITY OF NEWPORT BE, ACH U _ aCGAllY.CfCUNf UYDEVELOPIN3ENTDEPARTIVMNT sw BUILDING DI TISIGN csF R�`'r 100 Civic Center Drive i P.O_ Box 17681 Newport Beach, CA 92658-8915 www.n acv 1 (g¢g) 644_3200 PRE-GRADE MEETING AGREEMENT DATE- _ 3 � 3 Zp JOB ADDRESS: S? 6 SY A&/ 1. The grad -ring plan check number for this site i zaq- uas_ and correspondence. and will be referred to in all reports, certification 2 STOP ORDERS Whenever any work is being done contrary to the provisions of the City Codes, the Chie Official or his authorized representative may order the work stopped by notice in writing served on am Bualdng Persons engaged in the doing or causing such work to be done and any such persons shall forthwith stop suci work until authorized by the Chief Building Official to proceed with the work. 3. The stamped set of approved plans shall be on the job site at all times. 4. NOTIFICATION OP NONCOMPLLANCE If, in the course of fulfilling their responsibilities, the cavil engineer, surveyor, the soils engineer, the engineering geologist or the testing agent finds that the work is not being done it[ conformance with the approved grading plans, the discrepancies shall be reported Immediately in writing to the person in charge of the grading work and to the Building Division. Recommendations far corrective measures, if necessary, shall be submitted to the Building. Division for approval. S. When import or export of materiais is required, haul routes to and from the site shall be approved by the City Traffic Engineer and hauling procedures shall be in accordance with Chapter 15 of the Newport Beach Munieinal Code (NBMC). Contractor shall use Best Management addressed. Practices (SNP's) to insure that all wafer quality issues aka a. Between October 1 and April 30, erosion control BMP measures shall be in plate. During the remainder of the Installed and maintained at all operational storm d Yaw dry season wind erosion BMP's (dust control) shall be Inpaemented. Sediment control $MP's shale be rain Inlets internal to the project. BMP°s to cl sediment hacking shall be implemented and maintained. ®ff-side stormwater from construction activities shall he implemented. Appropriate BMP's fontrom prevent Contamination of A'weather triggered" action plan and the ability to deploy BMP s to protect all exposed portions of the site within 48 -hours when the National Weather Service forecasts a 50% or greater chance of rain. Ail fills shall be Compacted method 1throughout to a manamum of 9ti percent compaction as determined by ASTM test Preliminary soils report, and approved by the soils engineer. Compaction hWm shall be performed according to the B. All trench (enclud-rng Interior and exterior utility trenches) and rataining wail beckFail shall be compacted throughout to a minimum of gti percent relativre Compaction and approved by the soils engineer 9. Whenever work on which ragraared irasp(Drucrc/testing is covered by additional work without first beinr g inspected/ke-sted, the Chief Building Official shall require by written notice that the work be exposed fo examination. The work of exposing and re overing shaft not entail or be subject to expense to the City of Newport Beach and will be the sole expense of the Perniitee. 'ndscaprng or all slopes and pads shelf he in accordance with 'n 6.10:139 of the NEMC. "Wed drainage provaaions shall be used to protect adjoining prepertaes during the grading operation. 12 The permittee or his agent shall notify the Building Division when the grading operation is ready for each of the following inspections: pRE-l,RAOE MEETING When the pennifts is ready to hegira work but not less than two days before any grading or brushing is started. b. DRAINAGE DEVICE INSPECTION After forming of terrace drains, down drains or atter placement of pipe in subdrains, but before any concrete or filter material is placed. C. SPECIAL d, ROUGING When ail rough grading has been completed, the rough grade report shall be provided to the Building Inspector at foundation inspection or sooner based on the Building Inspector's discretion. e FINAL When all work, including installation of all drainage strucilmm and other pt(Octive devices, has been completed and the as -graded plan, p - fissional approvals and the required reports have been submitted. 13. All footing excavations, slab on grade areas and subdrains shall be inspected and approved by the Geotechnical Engineer or Engineering Geologist written approval shall be submitted to the Building Inspector. 14. Prior to the start of grading, all pemianent property comer monuments shall be with the County of Orange shall be ny foundation inspections, proof of recordation of the comer record or record of survey' provided. 15. The undersigned acknowledge a copy of the above and agree to comply with the Grading Code of the City of Newport Beach, the recommendations of the project soils report and any special requirements of the permit 16. Prior to foundation inspection a Line and Grade Certificate Structural Form mut signed ��ri end stambe ped by the surveyor of record and submitted to the building Inspector. 17. All parties listed below must be present for the pregrade meeting unless approved by the building inspector. 18. All duplex construction requires separate utilities (sewer, water, gas, electrical, fire sprinkler risers). OWNER/CONTRACTOR: �KL ( (44pj BY: Au gfttfct ��•Lh9LI� Address: Telephone: R'W-(,AT'7�4LtG DESIGN CIVIL ENGR.:1_ j9Lg* --ice `�lfL'�tk�p ST. (/ ° r 2 Address: 7 I fA2nV W V-tE ! Z44�' Telephone: 7 ` T/3- f-294 GEOTECHNICAL ENGINEER--(�S GEOLOGIST BT. )t Address: ?j'1 S C {Addeess: Telephone: C pen — A� -� 2� Telephone: GRADING CONT :� '✓ (��w lbCOORDINATOR BY: o c Address: o Address: Telephone: i rm ° Telephone: NEWPORT BEACH REPRESENTATIVE: Y Ate! l T-) INSPECTION REQUESTS: (949) 644-3253 Newoort Beach Construction Hours: Monday through Friday: 7:00 a.m. to 6:30 p.m. Saturdays: 8:00 arc,. to 6:00 p.m. No work on Sundays and Holidays FcMMp2gmde meetlng agreement 8-18 Mo CORNER RECORD Agencylndex Document Number 2020-0840 City of NEWPORT BEACH County of ORANGECalifornia Brief Legal Description LOT 35 OF TRACT MAP NO. 884 M.M. 30111-12 CORNER TYPE ® Government Corner ® Control ® Meander �X Property ®R h N. Elevation Units COORDINATES (optional) E. Metric M U.S. Survey Foot. ane o Q Other Horizontal Datum Zone Epoch Date Date of Survey April 1, 2020 Vertical Datum Complies with Public Resources Code §§8801-8819 Complies with Public Resources Code §§8890-8902 PIS Act Ref.: � 878s(d) ® 8771 ® 8773 ® Other: Corner/ FX -11 -eft as found Monument: ® Found and tagged M Established © Reestablished Rebuilt Referenced ® Pre -Construction 17 post -Construction Narrative of corner identified and monument as found, sat, reset, replaced, or removed: 0See sheet #2 for description(s): SURVEYOR'S STATEMENT This Comer Record was prepared by me or under my direction in conformance with the Professional Land Surveyors' Act on April 8. 2020 Signed PowP.L.S. or T-94, N:. L.S. 4653 COUNTY SURVEYOR'S STATEMENT This Corner Record was received APRIL 13, 2020 and examined and filed DECEMBER 15, 2020 Signed —�!j� P.L.S. ocR.C,E, No. 6617 (,a,V Title n, INTc IRV YOR County Surveyor's Comment ePELSG-2018 Pegg 1 ort 0 �4 5�, iAR jl N\A 6'T NO. 66173 OF OA1.Af0� LViV VV•TV N MONUMENT DESCRIPTIONS- MONUMENT NOTES: O 2014 09148 LEAD ANMONUMENT AS NOTED, FLUSH ACCEPTED AS INTERSECTION. [I INDICATES F5. WE O2 FOUND LEAD & TAG, LS. 5848, PER C.R. [I INDICATES SET LEAD AND'fAG L.S. 20140923, PLUSH, ACCEPTED AS C.L. B.Q 4653 ON P.L. PROD 4.00' FROM THE COR. ` O3 FOUND LEAD & TAG, R.C.E. 24668 ON P.L. PROD. ( ) INDICATES RECORD DATA PER 7.00' FROM THE CORNER PER R 1. TRACT NO. 884, M.M. 30111-12. 4U FOUND LEAD & TAG, R.C.E. 24668 RI R.S. 2018-1127. R.S.B. 306/22. PER C.R. 2012.4289. SCALE I"=40' ® POUND LEAD& TAG, R.C.E. 2466$ S.F.N. SEARCHL'D,FOUNDNOTH[NG a PER RI. ®FOUND LEAD & NAIL ON BULLKHEAD, NO TAG _ PER J.S.R. 7312., SET TAG STAMPED L.S. 4653. OFD. CHIS.X ON AND TAG STAMPED BULK] SIE 653 PER JSR 7319, SET LEAD (2890) eq . BASIS OF BEARINGS: spa°,rs;go T5�28 N72qs°,�keegR pEARINGS ARE pASED ON 1'HE jp ti 0h-Af &sa REAR PROPERTY LINE OF RI S.F.N / 728903- BEING N72029'50"W. 6 Fty 2�1 Jas �° S.F.N. J (28,0�� 7 ESTABLISHED (8670) J 28.9 2, 1`1EWp PERRI z ORT BAY 30 / 06122 J N / '/ ra.g1 �/�f`f` — � Rse� 31 JJg / No, 6a� S.F.N." ! ao ` i C'� J JlS 32 JJ ��c� % y nM /;7.94 S.FN SFN 1 / 20' 1 e Tn3 © J (Y l y 3S / y Q; q 1 S / psi c� l 36 / e w 37 'S SRN o .. ��� S.F.N. 1 ^� • r36 �l 4' j +• 20• ! ) 11 S.F.N. 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Box 1768 1 Newport Beach, CA 926588915 www.newportbeachca.gov 1 (949) 644-3200 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 RDU /(/I /�i�/�%/� License # C.5 y(r 53 Engineer/Surveyor'sAddress Z30 t& L*ivf (Lt^j T p2_ JL O9 �j_ _Z" (M* Job Address a 08 W 6AY Setbacks: Sketch a site plan and specify surveyed setbacks (use back page). * Top of slab/floor elevation: 9, r!r * 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 N, are not ❑, per City approved plans. Describe any deviations from plans: I certify that top of slab/floor elevation(s) is 41, is not ❑, per City approved drawings. Describe any deviations from plans: Date Forms/SetbacksandTopofSlabElevationCert. Engineer/Surveyor's stamp and S'/,,pEM q z eje. •%7 LG S _'"rY CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 www.newportbeachca.gov 1 (949) 644-3200 Structural Observation Report Project Address: 808 W. Bay Ave., Newport Beach, CA Report date: 03-18-2021 CNB Inspector Name: CNB Permit#: X2019-2668 Building Owner Name: Owner's Mailing address (if different from site); Owner's Telephone #: CNB Plan Check #: ❑ Concrete O Steel 1900-2019 Full Name of Structural Observer (SO): SO email Address: SO Telephone#: SO License / Reg. #: Raid Ghouli ghouli@rightengineering.net 949-304-8191 C70882 PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED /cherk annlicable hoxesl FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (Floor/Roof) INDICATE LOCATION(S) OBSERVED DATE OBSERVED ❑ Conventional Footings & Slab ❑ Concrete O Steel ❑ Concrete All 03-18-21 0 Mat Foundation, Prestressed Concrete ❑ Masonry ❑ Concrete ❑ Steel Deck All 03-18-21 ❑ Caissons, Piles, Grade Beams 9 Wood or Manuf. Shear Panels ❑ Masonry IRWood .All 03-18-21 ❑ Other: ❑ Other: ❑ Other: ❑ Other: IN ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. ❑ OBSERVED DEFICIENCIES AND COMMENTS: ❑ REPORT CONTINUED ON ATTACHED PAGES. 0 FINAL STRUCTURAL OBSERVATION REPORT: The structure generally complies with thea proved construction documents, and all observed deficiencies were corrected. I declare that the 1. 1 am the licensed L charge of the stru 2. 1, or another licen e my responsible he construction sta e approved const 3. I understand th all final acceptan o Division. . OFSTRUCTURAL true to the best of my knowledge: ass nal. retained by the owner to be in responsible 7ti ; essional whom I have designated above and is under performed the required site visits at each significant at the structure is in general conformance with the have documented must be corrected, prior to ms by the City of Newport Beach, Building 03/18/2021 QROFESSiau No. C70882 Exp. 06/30/21 sl clvl\- �e 9lP OF CA\.IF��� STAMP OF STRUCTURAL OBSERVER STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Fart \Snuctura ObservatianR,p ftaInstructions CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 17681 Newport Beach, CA 92658 vitn,n .n iQ7 3 Ilr,tq(ov 1 (949)644-3200 Structural Observation Report PLEASE INnICATP QTRIICT11RA1 01 CYCYTR Aun RnYHCNJ7nua nPocaworI rw6nw4 ennlfn�6ls Mrd1 FOUNDATIONS SHEARWALLS FRAMES DIAPHRAGMS (FloodRoo INDICATELOCATION(S) OBSERVED DATE OBSERVED 0 Conventional Foctirms & Slab 0 Concrete 0 Steel O Concrete 0 Mal Foundation, Prestressed Concrete 0 Masonry 0 Concrete 0 Steel Deck 0 Caissons, Piles, Grade Beams 0 Wood or Manuf. Shear Panels 0 Masonry ® Wood Roof sheathing sn 9 10/20/2020 0 Other. 0 Odw. 0 Other. 0 Other. O ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. 0 OBSERVED DEFICIENCIES AND COMMENTS: 17 REPORT CONTINUED ON ATTACHED PAGES. 0 FINAL STRUCTURAL OBSERVATION REPORT. The structure generally complies with ithe approved construction documents and all observed deficiencies wow corrected. I declare that the 1. I am the licent charge of the at 2. I, or another Iia my responsible construction at approved const 3. 1 understand thjj final sooapfenq Division. ,,..I1 the beat of my knowledge: retained by the owner to be in responsible i fesslonal whom I have designated above and is under performed the required site visite at each significant at the structure Is in general conformance with the have documented must be corrected, prior to ms by the City of Newport Beach, Building 10/20/2020 � G c � r W No. C70882 ` A Exp. 06/30/21 Cw!� coQ�`� STAMP OF STRUCTURAL OBSERVER SIDUCTUBAL OSMATON GOES NOT WANE ANY REQUIREMENTS FOR BUILDING INSP WIM BY AUIHORQED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Fm.W ow *b M=R WM7Wmbn Project Address: 808 W. Bay Ave., Building Owner Name: CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 www newportbeachca gov 1 (949) 644-3200 Full Name of Structural Observer (SO): Raid Ghouli Structural Observation Report Report date: CNB Inspector Name: Owner's Mailing address (if different from site); Owner's Telephone #: SO email Address: SO Telephone #: ahouliArightengineed ng. net 949-304-8191 CNB Permit #'. CNB Plan Check #: 1900-2019 SO License I Reg. #'. C70882 .rte � Ml rrrr roAI n G1111PHTR AND CONNECTIONS OBSERVED (check applicable boxes) FOUNDATIONS SHEAR WALLS ❑ Concrete C1 Masonry ❑ Wood or Manuf. Shear Panels ❑ Other: FRAMES ❑ Steel ❑ Concrete ❑ Masonry ❑ Other: DIAPHRAGMS (Floor1Roof) ❑Concrete ❑ Steel Deck ® Wood ❑ Other: IN�IUA I e �V r. r rvn�w OBSERVED OBSERVED Third floor 08/18/202( ❑ Conventional Footings & Slab ❑ Mat Foundation, Prestressed Concrete ❑ Caissons, Piles, Grade Beams ❑ Other: i3 ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. ❑ OBSERVED DEFICIENCIES AND COMMENTS: ❑ REPORT CONTINUED ON ATTACHED PAG ❑ FINAL STRUCTURAL OBSERVATION REPORT: The structure generally complies with the approved construction documents, and all observed deficiencies were corrected. I declare that the foil 1. I am the licen. charge of the at 2. 1, or another licr my responsible construction sU approved consti 3. 1 understand th final acceptan Division. true to the best of my knowledge: ti ofess'' nal retained by the owner to be in responsible Q�q OPES �y, i ti essional whom I have designated above and is under �� O i performed the required site visits at each significant " Q that the structure is in general conformance with the p No. C70882 _ BrIts, Exp. 06/30/21 have documented must be corrected, prior to s ms by the City of Newport Beach, Building sry CIV I\ - 7F OF CAV\E 8/18/2020 STAMP OF STRUCTURAL OBSERVEF STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEA( ParnuSvvawdO6servuiunRepon&Insvuc�iom o� , s CITY OF NEWPORT BEACH .` I COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION cr, o,zN,P' 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 www.newDortbeachca.gov 1 (949) 644-3200 Structural Observation Report Project Address: Report date: CNB Inspector Name: CNB Permit#: B08 W. Bay Ave. Newport Beach. CA n7/93/9n9n Building Owner Name: Full Name of Structural Obsewer (SO): Raid Ghouli FOUNDATIONS ❑ Conventional Footings 8 Slab ❑ Mat Foundation, Prestressed Concre ❑ Caissons, Piles, Grade Beams ❑ Other: SHEAR WALLS ❑ Concrete ❑ Masonry ❑ Wood or Manuf. Shear Panels ❑ Other: Owner's Mailing address (f different from site); Owner's Telephone #: CNB Plan Check #: SO email Address: SO Telephone #: ghouli@rightengineerina.net oao3ne_r FRAMES UTAPHHAGIN5 INDICATE LOCATIC (Floor/Roofl OBSERVED ❑ Steel ❑ Concrete ❑ Concrete ❑ Steel Deck ❑ Masonry 9 Wood Second floor ❑ Other: ❑ Other: 9 ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. ❑ OBSERVED DEFICIENCIES AND COMMENTS: ❑ FINAL STRUCTURAL OBSERVATION REPORT: I declare that the following elements true to the best of my knowledge: 1, I am the licensed design profess' nal retained by the owner to be in responsible charge of the stru ural observati ; 2. I, or another lice ed design essional whom I have designated above and is under my responsible arge, performed the required site visits at each significant construction sta e t rlfy tivt the structure is in general conformance with the approved const n docume ts; 3. 1 understand th all defici ' have documented must be corrected, prior to final acceptan o I I s ms by the City of Newport Beach, Building Division. . 7/23/2020 SO License / Reg. #: 07/23/2020 ❑ REPORT CONTINUED ON ATTACHED PAGES. No. C70882 Exp. 08/30/21 OF a IAMP Ur Sr KUCTURAL OBSERVER nAlvc An. Aeuumemcm I s run eua.UINU INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Forms%Slmoum ObsemalionRepon&Innruclions CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 www.newportbeachca.gov 1 (949) 644-3200 Structural Observation Report Project Address: 808 W. Bay Ave., Newport Beach, CA Report date: 06/02/2020 CNB Inspector Name: CNB Permit #: X2019-2668 Building Owner Name: Owner's Mailing address (if different from site); Owner's Telephone M CNB Plan Check #: ❑ Steel ❑ Concrete 1900-2019 Full Name of Structural Observer (SO): SO email Address: SO Telephone #: SO License / Reg. #: Raid Ghouli ghouli@rightengineering.net 949-304-8191 C70882 PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTif)NS ORSFRVFn rrhar4 nnnlirnhla hnvacl FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (Floor/Roof) INDICATE LOCATION(S) OBSERVED DATE OBSERVED ❑ Conventional Footings & Slab ❑ Concrete ❑ Steel ❑ Concrete R Mat Foundation, Prestressed Concrete ❑ Masonry ❑ Concrete ❑ Steel Deck M at Slabs 06/02/2020 ❑ Caissons, Piles, Grade Beams ❑ Wood or Manuf. Shear Panels ❑ Masonry ❑ Wood ❑ Other: ❑ Other: ❑ Other: ❑ Other: 9 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 atementstrV true to the best of my knowledge: am the licenseesign professnal retained by the owner to be in responsible C harge of the stru d dural observati' ; 2. I, or another liven ed design p essional whom I have designated above and is under my responsible harge, performed the required site visits at each significant construction sta e t rify that the structure is in general conformance with the approved const on documents; 3. 1 understand th all defici have documented must be corrected, prior to final acceptan o truc I s ms by the City of Newport Beach, Building Division. 6/2/2020 SIGNATURE OF STRUCTURAL OBSERVER OF RECORD _ DATE ESS No. C70882 Exp. 06/30/21 C/VtV �F SOF CAl1F�/ STAMP OF STRUCTURAL OBSERVER STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Proms\StmctumlObservetioaepon&rnstmctions CITE' OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION' 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 www.new ortbeachcagov 1(949)644-3200 Struoturai Observation Report j Project Address: 808 W. Bay Ave., Newport Beach, CA Report date: 05/14/2020 CNB Inspector Name: CNB Permit#: x2019-2668 Building Owner Name: Owners Mailing address (if different from site); Owner's Telephone #: CNB Plan Check #: ❑ Steel ❑ Concrete footing and grade beams 1900-2019 Full Name of Structural Observer (SO): So omail Address: SO Telephone #: SO License/ Reg. #: !.laid Ghoul! I ghouli@rightengineering.net 949-304-8191 070882 PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED !cheek annlinahle hnYesl FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (Floor/Roof) INDICATE LOCATION(S) OBSERVED DATE OBSERVED E Conventional _ Footings &Slab ❑ Concrete ❑ Steel ❑ Concrete footing and grade beams 05/14/2020 ❑Mat Foundation, Prestressed Concrete ❑ Masonry ❑ Concrete ❑ Steel Deck C] Caissons, Piles, _ Grade Beams ❑ Wood or Manuf. Shear Panels ❑ Masonry ❑ Wood i ❑ Other: ❑ Other: ❑ Other: ❑ Other: 2 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 foll 1. I am the Ream charge of the at 2. 1, or another lice my responsible construction sh approved consti 3. 1 understand the final acceptan Division. true to the best of my knowledge: retained by the owner to be in responsible .pffessior,al whom I have designated above and is under a performed the required site visits at each significant th,Pi the structure is in general conformance with the have documented must be corrected, prior to ms by the City of Newport Beach, Building 5/14/2020 No. C70882 Exp. 06/30/21 f CIV Iv Off` R or CAllf� STAMP OF STRUCTURAL OBSERVER STRUCTURAL OBSER VATIC''! 60'3 NC7 FIAIhE!1!.Y RrQUIREMENM FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Forms\Sime�umxlhuwaionaepunStn�n a :•..e �EVJPORr CITY OF NEWPORT BEACH CONI'MUNITY DEVELOPMENT DEPARTMENT = BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 WWW.newoortbeachca.gov 1 (949) 644-3200 Structural Observation Report Pmlect Address: 808 W. Bay Ave., New ort Beach, CA Report date: 04/13/2020 CNB Inspector Name: ' CNB Permit #: X.A 01 c) , Building Owner Name: Owner's Mailing address (H different from site); Owner's Telephone #: CNB Plan Check # ❑ Concrete Cl Steel 1900-2019 Full Name of Structural observer (SO): SO email Address: SO Telephone #, SO License (Reg #.' Raid Ghouli ghouli@rightengineering.net 949-304-8191 C70882 PLEASE INDICATE STRUCTURAL FL FMFNTS ANO CONNFCTIONS OBSERVED !checkannlicahle howasl FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (FloorlRoof) INDICATE LOCATION(S) OBSERVED DATE OBSERVED 2 Conventional Footings 8 Slab ❑ Concrete Cl Steel ❑ Concrete Pad's 04/13/20 ❑ Mat Foundation, Prestressed Concrete ❑ Masonry ❑ Concrete ❑ Steel Deck ❑ Caissons, Piles, Grade Beams ❑ Wood Or Manuf. Shear Panels ❑ Masonry ❑ Wood ❑ Other: ❑ Other. ❑ Other. ❑ Other. B 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-0eclare that the following 1, I am the licensed deli charge of the stm ural 2. I, or another licen ed de my responsible harge construction sta e t approved const on d 3 1 understand lh all def final acceptan o Division. J true to the best of my knowledge: retained by the owner to be in responsible pdFessional whom I have designated above and is under a performed the required site visits at each significant that the structure is in general conformance with the have documented must be corrected, prior to ms by the City of Newport Beach, Building 4/13/20 No. C70882 Exp. 06/30/21 CryIV �� F OF CAUt� STAMP OF STRUCTURAL OBSF.HVL.R �NA7URE 0 F STRUCTURAL OBSERVER OF RECORD _ _.,. DATE ----- STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. J CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915 www.newportbeachce.gov 1 (949) 644-3200 BUILDING HEIGHT CERTIFICATION Project Street Address: S o t W my 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: ® NAVD88 0 NGVD29 0 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 Insj�)ector. RIDGES (3:11 slope or greater) 1. Approved elevation point of ridge is 3 g •00 and actual elevation point is 37•Q L —. 2. Approved elevation point of ridge is and'attual elevation point is 3. Approved elevation point of ridge is and actual elevation point is FLAT ROOFS, PAARRA,PETS AND GUARDRAILS 1. Approved elevation point of flat or'a pet is 32.3 and actual elevation point is 3 ZA . 2. Approved elevation point of flat roof or parapet is and actual elevation point is 3. Approved elevation point of flat roof or parapet i3 and actual elevation point is O S �E I certify that the above height measurements are correct and the above project: �pEM4 ®�` p IS in compliance with the City -approved plans. O IS NOT in compliance with the City -approved plans (Provide explanation) .o Please describe any deviation from the City -approved plans on the back of this form. Surveyor or Civil Engirber's" 4 signature and seal (wet stamp and signature required) * License number of 33965 or lower F m 1B gdingaoigbt Cerdficadan 11102/16 Date CITY O, NEWPORT k !1wcolseIs a 1 e o jE DE•"TMSI pr loo aWc Cerftr 2 Beach 1' 1 1:L M 1 " d sysum 1 117:1 ■°i i 1 51 YES • ■ 1. WMEMAdW - I ■ 12 Backflow P iS7aleQ El 13. SyStSM kOtRW per Marsrfa *XOM g0a=63M pK " - _=e=_ _. • _ FIRE SPRINKLER NFPA. 130 SYSTEM FINAL APPROVED: PERMIT,* - ooI K BY: DATE' 3%9.72 rms Fre SvAn of NEPA 3305vx@m-FlNAL Qi istRBIDEMiAL05 'O' BEACH CO3DIUN=DEVEWPAMENTDEPARTMENT BUnDINGDIVINON too Civic CenterDrive I PA BoxWw4poft Beadi,:c wwwxw��gov`j (949) ver r FM SPRLSTELER PWA 13D SYMh CORRECTIONS AND FIRE SPRINKLER NFPA 136 SYSTEM ROUGH INSPECTION APPROVED: \ �� PERMrrt r -2®z ( - 60 i tA BY, - W DATE IIQI_Zi Wrmc�fire Sprinkler NEPA liO SysiEm-Paugh lnspecdon CfietWist OS/Ir%NIS i _ FriserTC�s4icx5on endLoca6oT n Aacruvst -- a. Drarn valve Q LL Baddbw deme (single dm*) Q c, Bell acts device Q CL &sspectoes test valve Q e, Rser siad per approved plans 2 " Pressise Test a System s=ated at oPg pressure frx 2 limas / Q b. Pressure gauge bs @ Q 3_ Saradder Heads Shall not be 6rstaled in the itftras Prior to the gffMs fxirw cenrerrted'ci office ftemeoiav�st olrxssl / a Installation acid spacing of t rnpaary test plugs / P`7 Q 4 picka a- Maui instar per pian PKQ Q b- Hangers par d movement rw All CPVC pi{rag steal be installed by persons rvfrn isve been Q cerffiaf by me mara&achaer far ter of CPUC p d Piping protected from d3nQ 5. Bel a- VA*V kmbded per code ❑ b. Boxes t>staled at proper orations Q NOTE CPVO p[asifc p(pe b the garage shaft cwt be exposed. Sprirzkfers that are ISted as `tlu ck Response' or'ResWdnW must be used. CORRECTIONS AND FIRE SPRINKLER NFPA 136 SYSTEM ROUGH INSPECTION APPROVED: \ �� PERMrrt r -2®z ( - 60 i tA BY, - W DATE IIQI_Zi Wrmc�fire Sprinkler NEPA liO SysiEm-Paugh lnspecdon CfietWist OS/Ir%NIS 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 CIVIL ENGINEER'S CERTIFICATION FORM From: Forkert Engineering & Surveying, Inc. 22311 Brookhurst St, Ste 203 Huntington Beach, CA 92646 ATTENTION: GRADING ENGINEER, BUILDING DIVISION Date: April 4, 2022 GPC No.: 1900-2019 Tract/Subdivision/Lot No.: Rough: _Final: x Project Names: 808 W Bay Ave Owner/Developer: Mr. Todd Jackson Type of Project: _Tract: Drainage _ Commercial x Other Industrial Yardage for Project: 0 Cut: _ Borrow: 55 Fill: _ Export: Notes: Single Family Residence Notes: I hereby approve the grading or this project in accordance with my responsibilities under the City Grading Code. I have inspected the project and hereby certify that all areas exhibit positive surface flow to public ways or City approved drainage devices. The grading has been completed: x in conformance with, with the following changes to the approved grading plan. Description of Changes: Company: Forkert Engineering & Surveying, Inc. Name: Thomas Ruiz (pliMl License No.: RCE 58627 CITY OF NEWPORT BE, ACH U _ aCGAllY.CfCUNf UYDEVELOPIN3ENTDEPARTIVMNT sw BUILDING DI TISIGN csF R�`'r 100 Civic Center Drive i P.O_ Box 17681 Newport Beach, CA 92658-8915 www.n acv 1 (g¢g) 644_3200 PRE-GRADE MEETING AGREEMENT DATE- _ 3 � 3 Zp JOB ADDRESS: S? 6 SY A&/ 1. The grad -ring plan check number for this site i zaq- uas_ and correspondence. and will be referred to in all reports, certification 2 STOP ORDERS Whenever any work is being done contrary to the provisions of the City Codes, the Chie Official or his authorized representative may order the work stopped by notice in writing served on am Bualdng Persons engaged in the doing or causing such work to be done and any such persons shall forthwith stop suci work until authorized by the Chief Building Official to proceed with the work. 3. The stamped set of approved plans shall be on the job site at all times. 4. NOTIFICATION OP NONCOMPLLANCE If, in the course of fulfilling their responsibilities, the cavil engineer, surveyor, the soils engineer, the engineering geologist or the testing agent finds that the work is not being done it[ conformance with the approved grading plans, the discrepancies shall be reported Immediately in writing to the person in charge of the grading work and to the Building Division. Recommendations far corrective measures, if necessary, shall be submitted to the Building. Division for approval. S. When import or export of materiais is required, haul routes to and from the site shall be approved by the City Traffic Engineer and hauling procedures shall be in accordance with Chapter 15 of the Newport Beach Munieinal Code (NBMC). Contractor shall use Best Management addressed. Practices (SNP's) to insure that all wafer quality issues aka a. Between October 1 and April 30, erosion control BMP measures shall be in plate. During the remainder of the Installed and maintained at all operational storm d Yaw dry season wind erosion BMP's (dust control) shall be Inpaemented. Sediment control $MP's shale be rain Inlets internal to the project. BMP°s to cl sediment hacking shall be implemented and maintained. ®ff-side stormwater from construction activities shall he implemented. Appropriate BMP's fontrom prevent Contamination of A'weather triggered" action plan and the ability to deploy BMP s to protect all exposed portions of the site within 48 -hours when the National Weather Service forecasts a 50% or greater chance of rain. Ail fills shall be Compacted method 1throughout to a manamum of 9ti percent compaction as determined by ASTM test Preliminary soils report, and approved by the soils engineer. Compaction hWm shall be performed according to the B. All trench (enclud-rng Interior and exterior utility trenches) and rataining wail beckFail shall be compacted throughout to a minimum of gti percent relativre Compaction and approved by the soils engineer 9. Whenever work on which ragraared irasp(Drucrc/testing is covered by additional work without first beinr g inspected/ke-sted, the Chief Building Official shall require by written notice that the work be exposed fo examination. The work of exposing and re overing shaft not entail or be subject to expense to the City of Newport Beach and will be the sole expense of the Perniitee. 'ndscaprng or all slopes and pads shelf he in accordance with 'n 6.10:139 of the NEMC. "Wed drainage provaaions shall be used to protect adjoining prepertaes during the grading operation. 12 The permittee or his agent shall notify the Building Division when the grading operation is ready for each of the following inspections: pRE-l,RAOE MEETING When the pennifts is ready to hegira work but not less than two days before any grading or brushing is started. b. DRAINAGE DEVICE INSPECTION After forming of terrace drains, down drains or atter placement of pipe in subdrains, but before any concrete or filter material is placed. C. SPECIAL d, ROUGING When ail rough grading has been completed, the rough grade report shall be provided to the Building Inspector at foundation inspection or sooner based on the Building Inspector's discretion. e FINAL When all work, including installation of all drainage strucilmm and other pt(Octive devices, has been completed and the as -graded plan, p - fissional approvals and the required reports have been submitted. 13. All footing excavations, slab on grade areas and subdrains shall be inspected and approved by the Geotechnical Engineer or Engineering Geologist written approval shall be submitted to the Building Inspector. 14. Prior to the start of grading, all pemianent property comer monuments shall be with the County of Orange shall be ny foundation inspections, proof of recordation of the comer record or record of survey' provided. 15. The undersigned acknowledge a copy of the above and agree to comply with the Grading Code of the City of Newport Beach, the recommendations of the project soils report and any special requirements of the permit 16. Prior to foundation inspection a Line and Grade Certificate Structural Form mut signed ��ri end stambe ped by the surveyor of record and submitted to the building Inspector. 17. All parties listed below must be present for the pregrade meeting unless approved by the building inspector. 18. All duplex construction requires separate utilities (sewer, water, gas, electrical, fire sprinkler risers). OWNER/CONTRACTOR: �KL ( (44pj BY: Au gfttfct ��•Lh9LI� Address: Telephone: R'W-(,AT'7�4LtG DESIGN CIVIL ENGR.:1_ j9Lg* --ice `�lfL'�tk�p ST. (/ ° r 2 Address: 7 I fA2nV W V-tE ! Z44�' Telephone: 7 ` T/3- f-294 GEOTECHNICAL ENGINEER--(�S GEOLOGIST BT. )t Address: ?j'1 S C {Addeess: Telephone: C pen — A� -� 2� Telephone: GRADING CONT :� '✓ (��w lbCOORDINATOR BY: o c Address: o Address: Telephone: i rm ° Telephone: NEWPORT BEACH REPRESENTATIVE: Y Ate! l T-) INSPECTION REQUESTS: (949) 644-3253 Newoort Beach Construction Hours: Monday through Friday: 7:00 a.m. to 6:30 p.m. Saturdays: 8:00 arc,. to 6:00 p.m. No work on Sundays and Holidays FcMMp2gmde meetlng agreement 8-18 Mo CORNER RECORD Agencylndex Document Number 2020-0840 City of NEWPORT BEACH County of ORANGECalifornia Brief Legal Description LOT 35 OF TRACT MAP NO. 884 M.M. 30111-12 CORNER TYPE ® Government Corner ® Control ® Meander �X Property ®R h N. Elevation Units COORDINATES (optional) E. Metric M U.S. Survey Foot. ane o Q Other Horizontal Datum Zone Epoch Date Date of Survey April 1, 2020 Vertical Datum Complies with Public Resources Code §§8801-8819 Complies with Public Resources Code §§8890-8902 PIS Act Ref.: � 878s(d) ® 8771 ® 8773 ® Other: Corner/ FX -11 -eft as found Monument: ® Found and tagged M Established © Reestablished Rebuilt Referenced ® Pre -Construction 17 post -Construction Narrative of corner identified and monument as found, sat, reset, replaced, or removed: 0See sheet #2 for description(s): SURVEYOR'S STATEMENT This Comer Record was prepared by me or under my direction in conformance with the Professional Land Surveyors' Act on April 8. 2020 Signed PowP.L.S. or T-94, N:. L.S. 4653 COUNTY SURVEYOR'S STATEMENT This Corner Record was received APRIL 13, 2020 and examined and filed DECEMBER 15, 2020 Signed —�!j� P.L.S. ocR.C,E, No. 6617 (,a,V Title n, INTc IRV YOR County Surveyor's Comment ePELSG-2018 Pegg 1 ort 0 �4 5�, iAR jl N\A 6'T NO. 66173 OF OA1.Af0� LViV VV•TV N MONUMENT DESCRIPTIONS- MONUMENT NOTES: O 2014 09148 LEAD ANMONUMENT AS NOTED, FLUSH ACCEPTED AS INTERSECTION. [I INDICATES F5. WE O2 FOUND LEAD & TAG, LS. 5848, PER C.R. [I INDICATES SET LEAD AND'fAG L.S. 20140923, PLUSH, ACCEPTED AS C.L. B.Q 4653 ON P.L. PROD 4.00' FROM THE COR. ` O3 FOUND LEAD & TAG, R.C.E. 24668 ON P.L. PROD. ( ) INDICATES RECORD DATA PER 7.00' FROM THE CORNER PER R 1. TRACT NO. 884, M.M. 30111-12. 4U FOUND LEAD & TAG, R.C.E. 24668 RI R.S. 2018-1127. R.S.B. 306/22. PER C.R. 2012.4289. SCALE I"=40' ® POUND LEAD& TAG, R.C.E. 2466$ S.F.N. SEARCHL'D,FOUNDNOTH[NG a PER RI. ®FOUND LEAD & NAIL ON BULLKHEAD, NO TAG _ PER J.S.R. 7312., SET TAG STAMPED L.S. 4653. OFD. CHIS.X ON AND TAG STAMPED BULK] SIE 653 PER JSR 7319, SET LEAD (2890) eq . BASIS OF BEARINGS: spa°,rs;go T5�28 N72qs°,�keegR pEARINGS ARE pASED ON 1'HE jp ti 0h-Af &sa REAR PROPERTY LINE OF RI S.F.N / 728903- BEING N72029'50"W. 6 Fty 2�1 Jas �° S.F.N. J (28,0�� 7 ESTABLISHED (8670) J 28.9 2, 1`1EWp PERRI z ORT BAY 30 / 06122 J N / '/ ra.g1 �/�f`f` — � Rse� 31 JJg / No, 6a� S.F.N." ! ao ` i C'� J JlS 32 JJ ��c� % y nM /;7.94 S.FN SFN 1 / 20' 1 e Tn3 © J (Y l y 3S / y Q; q 1 S / psi c� l 36 / e w 37 'S SRN o .. ��� S.F.N. 1 ^� • r36 �l 4' j +• 20• ! ) 11 S.F.N. 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Box 1768 1 Newport Beach, CA 926588915 www.newportbeachca.gov 1 (949) 644-3200 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 RDU /(/I /�i�/�%/� License # C.5 y(r 53 Engineer/Surveyor'sAddress Z30 t& L*ivf (Lt^j T p2_ JL O9 �j_ _Z" (M* Job Address a 08 W 6AY Setbacks: Sketch a site plan and specify surveyed setbacks (use back page). * Top of slab/floor elevation: 9, r!r * 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 N, are not ❑, per City approved plans. Describe any deviations from plans: I certify that top of slab/floor elevation(s) is 41, is not ❑, per City approved drawings. Describe any deviations from plans: Date Forms/SetbacksandTopofSlabElevationCert. Engineer/Surveyor's stamp and S'/,,pEM q z eje. •%7 LG S _'"rY CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 www.newportbeachca.gov 1 (949) 644-3200 Structural Observation Report Project Address: 808 W. Bay Ave., Newport Beach, CA Report date: 03-18-2021 CNB Inspector Name: CNB Permit#: X2019-2668 Building Owner Name: Owner's Mailing address (if different from site); Owner's Telephone #: CNB Plan Check #: ❑ Concrete O Steel 1900-2019 Full Name of Structural Observer (SO): SO email Address: SO Telephone#: SO License / Reg. #: Raid Ghouli ghouli@rightengineering.net 949-304-8191 C70882 PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED /cherk annlicable hoxesl FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (Floor/Roof) INDICATE LOCATION(S) OBSERVED DATE OBSERVED ❑ Conventional Footings & Slab ❑ Concrete O Steel ❑ Concrete All 03-18-21 0 Mat Foundation, Prestressed Concrete ❑ Masonry ❑ Concrete ❑ Steel Deck All 03-18-21 ❑ Caissons, Piles, Grade Beams 9 Wood or Manuf. Shear Panels ❑ Masonry IRWood .All 03-18-21 ❑ Other: ❑ Other: ❑ Other: ❑ Other: IN ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. ❑ OBSERVED DEFICIENCIES AND COMMENTS: ❑ REPORT CONTINUED ON ATTACHED PAGES. 0 FINAL STRUCTURAL OBSERVATION REPORT: The structure generally complies with thea proved construction documents, and all observed deficiencies were corrected. I declare that the 1. 1 am the licensed L charge of the stru 2. 1, or another licen e my responsible he construction sta e approved const 3. I understand th all final acceptan o Division. . OFSTRUCTURAL true to the best of my knowledge: ass nal. retained by the owner to be in responsible 7ti ; essional whom I have designated above and is under performed the required site visits at each significant at the structure is in general conformance with the have documented must be corrected, prior to ms by the City of Newport Beach, Building 03/18/2021 QROFESSiau No. C70882 Exp. 06/30/21 sl clvl\- �e 9lP OF CA\.IF��� STAMP OF STRUCTURAL OBSERVER STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Fart \Snuctura ObservatianR,p ftaInstructions CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 17681 Newport Beach, CA 92658 vitn,n .n iQ7 3 Ilr,tq(ov 1 (949)644-3200 Structural Observation Report PLEASE INnICATP QTRIICT11RA1 01 CYCYTR Aun RnYHCNJ7nua nPocaworI rw6nw4 ennlfn�6ls Mrd1 FOUNDATIONS SHEARWALLS FRAMES DIAPHRAGMS (FloodRoo INDICATELOCATION(S) OBSERVED DATE OBSERVED 0 Conventional Foctirms & Slab 0 Concrete 0 Steel O Concrete 0 Mal Foundation, Prestressed Concrete 0 Masonry 0 Concrete 0 Steel Deck 0 Caissons, Piles, Grade Beams 0 Wood or Manuf. Shear Panels 0 Masonry ® Wood Roof sheathing sn 9 10/20/2020 0 Other. 0 Odw. 0 Other. 0 Other. O ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. 0 OBSERVED DEFICIENCIES AND COMMENTS: 17 REPORT CONTINUED ON ATTACHED PAGES. 0 FINAL STRUCTURAL OBSERVATION REPORT. The structure generally complies with ithe approved construction documents and all observed deficiencies wow corrected. I declare that the 1. I am the licent charge of the at 2. I, or another Iia my responsible construction at approved const 3. 1 understand thjj final sooapfenq Division. ,,..I1 the beat of my knowledge: retained by the owner to be in responsible i fesslonal whom I have designated above and is under performed the required site visite at each significant at the structure Is in general conformance with the have documented must be corrected, prior to ms by the City of Newport Beach, Building 10/20/2020 � G c � r W No. C70882 ` A Exp. 06/30/21 Cw!� coQ�`� STAMP OF STRUCTURAL OBSERVER SIDUCTUBAL OSMATON GOES NOT WANE ANY REQUIREMENTS FOR BUILDING INSP WIM BY AUIHORQED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Fm.W ow *b M=R WM7Wmbn Project Address: 808 W. Bay Ave., Building Owner Name: CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 www newportbeachca gov 1 (949) 644-3200 Full Name of Structural Observer (SO): Raid Ghouli Structural Observation Report Report date: CNB Inspector Name: Owner's Mailing address (if different from site); Owner's Telephone #: SO email Address: SO Telephone #: ahouliArightengineed ng. net 949-304-8191 CNB Permit #'. CNB Plan Check #: 1900-2019 SO License I Reg. #'. C70882 .rte � Ml rrrr roAI n G1111PHTR AND CONNECTIONS OBSERVED (check applicable boxes) FOUNDATIONS SHEAR WALLS ❑ Concrete C1 Masonry ❑ Wood or Manuf. Shear Panels ❑ Other: FRAMES ❑ Steel ❑ Concrete ❑ Masonry ❑ Other: DIAPHRAGMS (Floor1Roof) ❑Concrete ❑ Steel Deck ® Wood ❑ Other: IN�IUA I e �V r. r rvn�w OBSERVED OBSERVED Third floor 08/18/202( ❑ Conventional Footings & Slab ❑ Mat Foundation, Prestressed Concrete ❑ Caissons, Piles, Grade Beams ❑ Other: i3 ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. ❑ OBSERVED DEFICIENCIES AND COMMENTS: ❑ REPORT CONTINUED ON ATTACHED PAG ❑ FINAL STRUCTURAL OBSERVATION REPORT: The structure generally complies with the approved construction documents, and all observed deficiencies were corrected. I declare that the foil 1. I am the licen. charge of the at 2. 1, or another licr my responsible construction sU approved consti 3. 1 understand th final acceptan Division. true to the best of my knowledge: ti ofess'' nal retained by the owner to be in responsible Q�q OPES �y, i ti essional whom I have designated above and is under �� O i performed the required site visits at each significant " Q that the structure is in general conformance with the p No. C70882 _ BrIts, Exp. 06/30/21 have documented must be corrected, prior to s ms by the City of Newport Beach, Building sry CIV I\ - 7F OF CAV\E 8/18/2020 STAMP OF STRUCTURAL OBSERVEF STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEA( ParnuSvvawdO6servuiunRepon&Insvuc�iom o� , s CITY OF NEWPORT BEACH .` I COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION cr, o,zN,P' 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 www.newDortbeachca.gov 1 (949) 644-3200 Structural Observation Report Project Address: Report date: CNB Inspector Name: CNB Permit#: B08 W. Bay Ave. Newport Beach. CA n7/93/9n9n Building Owner Name: Full Name of Structural Obsewer (SO): Raid Ghouli FOUNDATIONS ❑ Conventional Footings 8 Slab ❑ Mat Foundation, Prestressed Concre ❑ Caissons, Piles, Grade Beams ❑ Other: SHEAR WALLS ❑ Concrete ❑ Masonry ❑ Wood or Manuf. Shear Panels ❑ Other: Owner's Mailing address (f different from site); Owner's Telephone #: CNB Plan Check #: SO email Address: SO Telephone #: ghouli@rightengineerina.net oao3ne_r FRAMES UTAPHHAGIN5 INDICATE LOCATIC (Floor/Roofl OBSERVED ❑ Steel ❑ Concrete ❑ Concrete ❑ Steel Deck ❑ Masonry 9 Wood Second floor ❑ Other: ❑ Other: 9 ITEMS CHECKED ABOVE ARE APPROVED AND WITHOUT DEFICIENCIES. ❑ OBSERVED DEFICIENCIES AND COMMENTS: ❑ FINAL STRUCTURAL OBSERVATION REPORT: I declare that the following elements true to the best of my knowledge: 1, I am the licensed design profess' nal retained by the owner to be in responsible charge of the stru ural observati ; 2. I, or another lice ed design essional whom I have designated above and is under my responsible arge, performed the required site visits at each significant construction sta e t rlfy tivt the structure is in general conformance with the approved const n docume ts; 3. 1 understand th all defici ' have documented must be corrected, prior to final acceptan o I I s ms by the City of Newport Beach, Building Division. . 7/23/2020 SO License / Reg. #: 07/23/2020 ❑ REPORT CONTINUED ON ATTACHED PAGES. No. C70882 Exp. 08/30/21 OF a IAMP Ur Sr KUCTURAL OBSERVER nAlvc An. Aeuumemcm I s run eua.UINU INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Forms%Slmoum ObsemalionRepon&Innruclions CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 www.newportbeachca.gov 1 (949) 644-3200 Structural Observation Report Project Address: 808 W. Bay Ave., Newport Beach, CA Report date: 06/02/2020 CNB Inspector Name: CNB Permit #: X2019-2668 Building Owner Name: Owner's Mailing address (if different from site); Owner's Telephone M CNB Plan Check #: ❑ Steel ❑ Concrete 1900-2019 Full Name of Structural Observer (SO): SO email Address: SO Telephone #: SO License / Reg. #: Raid Ghouli ghouli@rightengineering.net 949-304-8191 C70882 PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTif)NS ORSFRVFn rrhar4 nnnlirnhla hnvacl FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (Floor/Roof) INDICATE LOCATION(S) OBSERVED DATE OBSERVED ❑ Conventional Footings & Slab ❑ Concrete ❑ Steel ❑ Concrete R Mat Foundation, Prestressed Concrete ❑ Masonry ❑ Concrete ❑ Steel Deck M at Slabs 06/02/2020 ❑ Caissons, Piles, Grade Beams ❑ Wood or Manuf. Shear Panels ❑ Masonry ❑ Wood ❑ Other: ❑ Other: ❑ Other: ❑ Other: 9 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 atementstrV true to the best of my knowledge: am the licenseesign professnal retained by the owner to be in responsible C harge of the stru d dural observati' ; 2. I, or another liven ed design p essional whom I have designated above and is under my responsible harge, performed the required site visits at each significant construction sta e t rify that the structure is in general conformance with the approved const on documents; 3. 1 understand th all defici have documented must be corrected, prior to final acceptan o truc I s ms by the City of Newport Beach, Building Division. 6/2/2020 SIGNATURE OF STRUCTURAL OBSERVER OF RECORD _ DATE ESS No. C70882 Exp. 06/30/21 C/VtV �F SOF CAl1F�/ STAMP OF STRUCTURAL OBSERVER STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Proms\StmctumlObservetioaepon&rnstmctions CITE' OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION' 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 www.new ortbeachcagov 1(949)644-3200 Struoturai Observation Report j Project Address: 808 W. Bay Ave., Newport Beach, CA Report date: 05/14/2020 CNB Inspector Name: CNB Permit#: x2019-2668 Building Owner Name: Owners Mailing address (if different from site); Owner's Telephone #: CNB Plan Check #: ❑ Steel ❑ Concrete footing and grade beams 1900-2019 Full Name of Structural Observer (SO): So omail Address: SO Telephone #: SO License/ Reg. #: !.laid Ghoul! I ghouli@rightengineering.net 949-304-8191 070882 PLEASE INDICATE STRUCTURAL ELEMENTS AND CONNECTIONS OBSERVED !cheek annlinahle hnYesl FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (Floor/Roof) INDICATE LOCATION(S) OBSERVED DATE OBSERVED E Conventional _ Footings &Slab ❑ Concrete ❑ Steel ❑ Concrete footing and grade beams 05/14/2020 ❑Mat Foundation, Prestressed Concrete ❑ Masonry ❑ Concrete ❑ Steel Deck C] Caissons, Piles, _ Grade Beams ❑ Wood or Manuf. Shear Panels ❑ Masonry ❑ Wood i ❑ Other: ❑ Other: ❑ Other: ❑ Other: 2 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 foll 1. I am the Ream charge of the at 2. 1, or another lice my responsible construction sh approved consti 3. 1 understand the final acceptan Division. true to the best of my knowledge: retained by the owner to be in responsible .pffessior,al whom I have designated above and is under a performed the required site visits at each significant th,Pi the structure is in general conformance with the have documented must be corrected, prior to ms by the City of Newport Beach, Building 5/14/2020 No. C70882 Exp. 06/30/21 f CIV Iv Off` R or CAllf� STAMP OF STRUCTURAL OBSERVER STRUCTURAL OBSER VATIC''! 60'3 NC7 FIAIhE!1!.Y RrQUIREMENM FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. Forms\Sime�umxlhuwaionaepunStn�n a :•..e �EVJPORr CITY OF NEWPORT BEACH CONI'MUNITY DEVELOPMENT DEPARTMENT = BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658 WWW.newoortbeachca.gov 1 (949) 644-3200 Structural Observation Report Pmlect Address: 808 W. Bay Ave., New ort Beach, CA Report date: 04/13/2020 CNB Inspector Name: ' CNB Permit #: X.A 01 c) , Building Owner Name: Owner's Mailing address (H different from site); Owner's Telephone #: CNB Plan Check # ❑ Concrete Cl Steel 1900-2019 Full Name of Structural observer (SO): SO email Address: SO Telephone #, SO License (Reg #.' Raid Ghouli ghouli@rightengineering.net 949-304-8191 C70882 PLEASE INDICATE STRUCTURAL FL FMFNTS ANO CONNFCTIONS OBSERVED !checkannlicahle howasl FOUNDATIONS SHEAR WALLS FRAMES DIAPHRAGMS (FloorlRoof) INDICATE LOCATION(S) OBSERVED DATE OBSERVED 2 Conventional Footings 8 Slab ❑ Concrete Cl Steel ❑ Concrete Pad's 04/13/20 ❑ Mat Foundation, Prestressed Concrete ❑ Masonry ❑ Concrete ❑ Steel Deck ❑ Caissons, Piles, Grade Beams ❑ Wood Or Manuf. Shear Panels ❑ Masonry ❑ Wood ❑ Other: ❑ Other. ❑ Other. ❑ Other. B 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-0eclare that the following 1, I am the licensed deli charge of the stm ural 2. I, or another licen ed de my responsible harge construction sta e t approved const on d 3 1 understand lh all def final acceptan o Division. J true to the best of my knowledge: retained by the owner to be in responsible pdFessional whom I have designated above and is under a performed the required site visits at each significant that the structure is in general conformance with the have documented must be corrected, prior to ms by the City of Newport Beach, Building 4/13/20 No. C70882 Exp. 06/30/21 CryIV �� F OF CAUt� STAMP OF STRUCTURAL OBSF.HVL.R �NA7URE 0 F STRUCTURAL OBSERVER OF RECORD _ _.,. DATE ----- STRUCTURAL OBSERVATION DOES NOT WAIVE ANY REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THE CITY OF NEWPORT BEACH. J CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915 www.newportbeachce.gov 1 (949) 644-3200 BUILDING HEIGHT CERTIFICATION Project Street Address: S o t W my 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: ® NAVD88 0 NGVD29 0 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 Insj�)ector. RIDGES (3:11 slope or greater) 1. Approved elevation point of ridge is 3 g •00 and actual elevation point is 37•Q L —. 2. Approved elevation point of ridge is and'attual elevation point is 3. Approved elevation point of ridge is and actual elevation point is FLAT ROOFS, PAARRA,PETS AND GUARDRAILS 1. Approved elevation point of flat or'a pet is 32.3 and actual elevation point is 3 ZA . 2. Approved elevation point of flat roof or parapet is and actual elevation point is 3. Approved elevation point of flat roof or parapet i3 and actual elevation point is O S �E I certify that the above height measurements are correct and the above project: �pEM4 ®�` p IS in compliance with the City -approved plans. O IS NOT in compliance with the City -approved plans (Provide explanation) .o Please describe any deviation from the City -approved plans on the back of this form. Surveyor or Civil Engirber's" 4 signature and seal (wet stamp and signature required) * License number of 33965 or lower F m 1B gdingaoigbt Cerdficadan 11102/16 Date CITY O, NEWPORT k !1wcolseIs a 1 e o jE DE•"TMSI pr loo aWc Cerftr 2 Beach 1' 1 1:L M 1 " d sysum 1 117:1 ■°i i 1 51 YES • ■ 1. WMEMAdW - I ■ 12 Backflow P iS7aleQ El 13. SyStSM kOtRW per Marsrfa *XOM g0a=63M pK " - _=e=_ _. • _ FIRE SPRINKLER NFPA. 130 SYSTEM FINAL APPROVED: PERMIT,* - ooI K BY: DATE' 3%9.72 rms Fre SvAn of NEPA 3305vx@m-FlNAL Qi istRBIDEMiAL05 'O' BEACH CO3DIUN=DEVEWPAMENTDEPARTMENT BUnDINGDIVINON too Civic CenterDrive I PA BoxWw4poft Beadi,:c wwwxw��gov`j (949) ver r FM SPRLSTELER PWA 13D SYMh CORRECTIONS AND FIRE SPRINKLER NFPA 136 SYSTEM ROUGH INSPECTION APPROVED: \ �� PERMrrt r -2®z ( - 60 i tA BY, - W DATE IIQI_Zi Wrmc�fire Sprinkler NEPA liO SysiEm-Paugh lnspecdon CfietWist OS/Ir%NIS i _ FriserTC�s4icx5on endLoca6oT n Aacruvst -- a. Drarn valve Q LL Baddbw deme (single dm*) Q c, Bell acts device Q CL &sspectoes test valve Q e, Rser siad per approved plans 2 " Pressise Test a System s=ated at oPg pressure frx 2 limas / Q b. Pressure gauge bs @ Q 3_ Saradder Heads Shall not be 6rstaled in the itftras Prior to the gffMs fxirw cenrerrted'ci office ftemeoiav�st olrxssl / a Installation acid spacing of t rnpaary test plugs / P`7 Q 4 picka a- Maui instar per pian PKQ Q b- Hangers par d movement rw All CPVC pi{rag steal be installed by persons rvfrn isve been Q cerffiaf by me mara&achaer far ter of CPUC p d Piping protected from d3nQ 5. Bel a- VA*V kmbded per code ❑ b. Boxes t>staled at proper orations Q NOTE CPVO p[asifc p(pe b the garage shaft cwt be exposed. Sprirzkfers that are ISted as `tlu ck Response' or'ResWdnW must be used. CORRECTIONS AND FIRE SPRINKLER NFPA 136 SYSTEM ROUGH INSPECTION APPROVED: \ �� PERMrrt r -2®z ( - 60 i tA BY, - W DATE IIQI_Zi Wrmc�fire Sprinkler NEPA liO SysiEm-Paugh lnspecdon CfietWist OS/Ir%NIS 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 CIVIL ENGINEER'S CERTIFICATION FORM From: Forkert Engineering & Surveying, Inc. 22311 Brookhurst St, Ste 203 Huntington Beach, CA 92646 ATTENTION: GRADING ENGINEER, BUILDING DIVISION Date: April 4, 2022 GPC No.: 1900-2019 Tract/Subdivision/Lot No.: Rough: _Final: x Project Names: 808 W Bay Ave Owner/Developer: Mr. Todd Jackson Type of Project: _Tract: Drainage _ Commercial x Other Industrial Yardage for Project: 0 Cut: _ Borrow: 55 Fill: _ Export: Notes: Single Family Residence Notes: I hereby approve the grading or this project in accordance with my responsibilities under the City Grading Code. I have inspected the project and hereby certify that all areas exhibit positive surface flow to public ways or City approved drainage devices. The grading has been completed: x in conformance with, with the following changes to the approved grading plan. Description of Changes: Company: Forkert Engineering & Surveying, Inc. Name: Thomas Ruiz (pliMl License No.: RCE 58627 CERTIFICATE OF COMPLETION CUSTOMER NAME: Jason Gonterman DATE: 04-18-2022 ADDRESS (EQUIPMENT INSTALLATION): 808 W Bay Ave CITY: Newport Beach STATE: CA LP: 92663 TYPE OF EQUIPMENT, SYSTEM, INSTALLATION: Waupaca Excelevator Hydraulic ® HALL DOORS COMPLY 3X5 CODE (ELEVATORS WITH SWING TYPE DOOR ® PHONE IN ELEVATOR CAB IS ACTIVE AND WORKING PROPERLY © OWNERICONTRACTOR M SAT1sFIEO WITH THE LOOK 8 OPERATION OF THE ELEVATORIDUMBWAITER ® KEYS RECEIVED: YES ®NO ❑ NUMBER OF KEYS ® TRAINING FOR SAFE OPERATION HAS BEEN PERFORMED Emergency Battery Lowering- System operation has been demonstrated. ® A FULL SET OF PRINTS RAs IMEN LEFT IN CONTR01„LFR ® COMPLETION PHOTOS TAKEN ® OPTIONAL PLANNED MAINTENANCE AVAILABILITY EXPLAINED ® FMERC-EN Y BATTERY LOWERING -EXPLAINED FOR WEIN POWER OUTAGE ❑ REQUEST FOR INSTALLATION OR EQUIPMENT CHANGE _The folmaing fieidlahop changes to the P.OJContract are requested. We agree that McKinley Equipment will modify the P.OJContract and invoice these changes for time and materials. (mm. EQUIPMENT WILL BE RELEASED FOR OPERATION UPON FINAL PAYMENT ONLY.) FINAL PAYMENT OWED: 0 YES ❑ NO AMOUNT RECEIVED: $ $3,379.70 Customer Name: Todd Jackson Date: 04-18-2022 Representative Name (Prim) 4g Todd Jackson Title: Homeowner customer Represenlasve sowum AfCWRY Represenfauve Signature 949-697-0746 Eai Ussrftm..., `aLRi a�.��L�Y7 ELlVATQN eewanwA.T�eeu Jason@gontermanconstruction.com End User&maff: 17611 Armstrong Avenue • Irvine, California 92614-5760 (949)261-9222 • (800)229-7275 • FAX (949)250-7301 CERTIFICATE OF COMPLETION CUSTOMER NAME: Jason Gonterman DATE: 04-18-2022 ADDRESS (EQUIPMENT INSTALLATION): 808 W Bay Ave CITY: Newport Beach STATE: CA LP: 92663 TYPE OF EQUIPMENT, SYSTEM, INSTALLATION: Waupaca Excelevator Hydraulic ® HALL DOORS COMPLY 3X5 CODE (ELEVATORS WITH SWING TYPE DOOR ® PHONE IN ELEVATOR CAB IS ACTIVE AND WORKING PROPERLY © OWNERICONTRACTOR M SAT1sFIEO WITH THE LOOK 8 OPERATION OF THE ELEVATORIDUMBWAITER ® KEYS RECEIVED: YES ®NO ❑ NUMBER OF KEYS ® TRAINING FOR SAFE OPERATION HAS BEEN PERFORMED Emergency Battery Lowering- System operation has been demonstrated. ® A FULL SET OF PRINTS RAs IMEN LEFT IN CONTR01„LFR ® COMPLETION PHOTOS TAKEN ® OPTIONAL PLANNED MAINTENANCE AVAILABILITY EXPLAINED ® FMERC-EN Y BATTERY LOWERING -EXPLAINED FOR WEIN POWER OUTAGE ❑ REQUEST FOR INSTALLATION OR EQUIPMENT CHANGE _The folmaing fieidlahop changes to the P.OJContract are requested. We agree that McKinley Equipment will modify the P.OJContract and invoice these changes for time and materials. (mm. EQUIPMENT WILL BE RELEASED FOR OPERATION UPON FINAL PAYMENT ONLY.) FINAL PAYMENT OWED: 0 YES ❑ NO AMOUNT RECEIVED: $ $3,379.70 Customer Name: Todd Jackson Date: 04-18-2022 Representative Name (Prim) 4g Todd Jackson Title: Homeowner customer Represenlasve sowum AfCWRY Represenfauve Signature 949-697-0746 Eai Ussrftm..., `aLRi a�.��L�Y7 ELlVATQN eewanwA.T�eeu Jason@gontermanconstruction.com End User&maff: 17611 Armstrong Avenue • Irvine, California 92614-5760 (949)261-9222 • (800)229-7275 • FAX (949)250-7301 NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE AND INSTRUCTIONS 2019 EDITION