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Rough Grade Compaction Report for 401 Fullerton Avenue, Newport Beach, California by COAST GEOTECHNICAL, hlc., W.O. 509416-02, dated December 6, 2017. Dear Mr. Haddad: In accordance with the request of your contractor, this final soils report has been prepared to address geotechnical observations and testing performed since completion of rough grading. This report addresses requested observations and testing. Copies of our daily reports are maintained in our files. FOUNDATION EXCAVATIONS Foundation excavations for the residence were observed on December 29, 2017. The foundation excavations were found to be acceptable at the time of our final observations. INTERIOR SLAB SUBGRADE AND TRENCH BACKFILLS The residence and garage slab subgrade was observed on February 20, 2019. Probing and testing of the interior residential and garage slab areas indicated acceptable geotechnical conditions for support of the proposed slabs. No request was made to observe subgrade conditions prior to placing concrete. No opinion for the adequacy of subgrade condition is provided. COAST GEOTECHNICAL, INC. Mr. Haddad 2 W.0.509416-03 Final Soils Report April 12 2021 OPIMON It is opinion of COAST GEOTECHNICAL, Inc. that the summarized geotechnical conditions approved by this office are in compliance with approved geotechnical reports and Newport Beach building codes. The final grades appear to conform to approved plans. We appreciate this opportunity to be of service to you. Respectfully Submitted: COAST GEOTECHNICAL, INC. Ming-Tarng Chen RCE 54011 - e "0.54017 * Exp.12131121 .k AJJARINE STRUCTURES 5 T R U C T U R A L E N G I N E E R S 04/25/2022 Client: Hazem Haddad Project: Haddad Residence Interior Guardrail RE: 1/4" 0 Lag Screw's Required Minimum Length To whom it may concern, 9070 Irvine Ce neer Drive, Suite 11S Irvine, CA 92618 T (949) 387-9440 F (949) 387-4887 www.naparinestructures.cam Q The lengths of all 1/4" 0 lag screws on Sections A A, B -B, C -C, and D -D of approved plans (see enclosure) can be 4" Ig. minimum based on our analysis. Please do not hesitate to contact our office for any questions. Sincerely, Ed NaJarine, SE NaAarine Structures cc: File Enclosure: 1. Plans NS Marked 2022.04.25.pdf, 1 page. From: KEVIN A. SCHLEY tn - g716 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 25225 MACKENZIE ST. LAGUNA HILLS, CA 92653 ATTENTION: GRADING ENGINEER, BUILDING DIVISION Date: MAY 16, 2022 GPC No.: Tract/Subdivision/Lot No.: Rough: _Final: x Project Names: NEW RESIDENCE AT 401 FULLERTON AVENUE Owner/Developer: HAZEM HADDAD,5900 SKYLAB,HUNTINGTON BEACH,CA • 714-369-9369 Type of Project: Notes: _ Tract: x Drainage _ Commercial _ Other Industrial Yardage for Project: Notes: _ Cut: _ Borrow: Fill: _ Export: I hereby approve the grading for 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: in conformance with, with the following changes to the approved grading plan. Description of Changes: ��PPDHURCyc/T� L 5073 < tPafqnjgqQ PENEWAL Company: KEVIN SCHLEY & ASSOCIATES DATE �pQ Flame: KEVIN A. SCHLEY (print) (' License No.: 015073 (RCE/LS) FormslCim] Engineers CerttIntion Form 9-13 ___. Milli ___._� ��s I PROJECT 3TATU8 REPORT ERective 02/11/202109 46 1 °t tars R■aar cftUNts n% CA Building Energy Elgdenry S■ntleMs 2013 Residential Campg■rop Oet2015 `�.�" r $ =`s d v k F F . ytt, Energy standards Code Year: 2013 ❑ • Project Name: Haddad Residence ■ Project Type: New Construction SFR Address: 401 Fullerton Avenue ■ City/State/Zip: Newport Beach / CA / 92663 L ■ I Enforcement Agency: City of Newport Beach ■ Easy to Verify @ calcerts.00m Permit Number: X2013-1403 OVERALLSTATUS COMPLETE HERS VERIFIABLE MEASURES: COMPLETE jSEEM;if liTi`0. ce° qa,., •e't S'n re Er ergy Feat rZ� " Certificate Type Compliance ,'7'4' I ; Registered Forth CF1R-PRF-01,-,� t y f a j I r 4 Lai n rr rj +, r;;r 4.:pu Registered Date 2021-02-'O3 1 65,,, 06 Registration R 216-NO46183181600000004400E Number CFIR-SRA-01 2021-02-08 217-N0051582A-000000000-0000 19:41:07 RINFOR1rIAT10, Ifl to fns a pyo �r m f ed`er�a 216-N0461831B-E0100001A-0000 CF2R-ENV-01-E 2021-02-08 HASSAN REZAEI Fenestration Installation 19:41:07 (ALLIED ENGINEERING & FIRE PROTECTION SERVICES) 216-N0461831B-E0200001A-0000 CF2R-ENV-02-E 2021-02-06 HASSAN REZAEI Envelope Air Sealing 19:41:07 (ALLIED ENGINEERING & FIRE PROTECTION SERVICES) 216-NO461831B-E0300001A-0000 CF2R-ENV-03-E 2021-02-08 HASSAN REZAEI Insulation Installation 19:41:07 (ALLIED ENGINEERING & FIRE PROTECTION SERVICES) tars R■aar cftUNts n% CA Building Energy Elgdenry S■ntleMs 2013 Residential Campg■rop Oet2015 `�.�" CITY OF NEWPORT BEACH Community Development Department I Building Division 100 Civic Center Dr.i P.O. Box 1768 Newport Beach, CA 92658 www.newoortbeachca.aov (949) 644-3200 cALGREEN DOCUMENTATION COMPLIANCE CERTIFICATION ADDRESS: 117 1 u`'F,TDO T< --b PERMIT NO.: X10 K. THIS FORM SHALL BE COMPLETED AND SIGNED PRIOR TO REQUEST FOR FINAL BUILDING INSPECTION. ONE COPY OF THIS FORM SHALL BE SUBMITTED TO THE BUILDING INSPECTOR AT FINAL INSPECTION AND ONE SHALL BE PROVIDED TO THE BUILDING OWNER AS PART OF THE CAL GREEN CERTIFICATION PACKAGE. The following section shall be completed by a person with overall responsibility for the planning and design portion of the project. REQUIRED DOCUMENTATIONS PROVIDED TO THE PROPERTY OWNER(S) E9 -/Franchise Hauler for Construction/Demolition Waste (65% min. reuse of nonhazardous waste) 09"VOC Contents Limitation 09-4ormaldehyde Emissions Limitation t�/T-24 Energy Certificate of Installations (Env., QII, Lighting, Photovoltaic, Mech., Plumb.) l3 T-24 Energy Certificate of Verifications or Acceptance ( Env., QII, Lighting, Photovoltaic, Mech., Plumb., HERS) li�/Operations and Maintenance Manual MOISTURE CONTENT OF BUILDING MATERIAL (RESIDENTIAL CONSTRUCTION ONLY) ZI certify that the moisture content of the wall and floor framing is less than 19 percent as determined in accordance with Section 4.505.3 of CAL Green prior to being enclosed. DECLARATION STATEMENT • 1 certify under penalty of perjury, under the laws of the State of California, the information provided is true and correct. I certify that the installed measures, materials, components, or manufactured devices identified on this certificate conform to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcing agency. Responsible Person's Name: Responsible Person's Signature: I 5- Ili -2o 22 Notes: 1?RcjecT IAAA/A &iFe COAST GEOTECHNICAL, INC. Decmber 6, 2017 Mr. Hazem Haddad 18352 Enterprise Lane Huntington Beach, CA 92648 Reference: W.O. 509416-02 Subject: Rough Grade Compaction Report for 401 Fullerton Avenue, Newport Beach, California 1. Geotechnical Engineering Investigation of Proposed New Residence at 401 Fullerton Avenue, Newport Beach, California; by COAST GEOTECHNICAL, INC., W.O. 509416-01, dated May 12, 2016. Dear Mr. Haddad: Forwarded herewith is the rough grade compaction report for the subject site. The grading operation was conducted from November 28 through December 5, 2017, using the referenced geotechnical report as a guideline. POOL ABANDONMENT A swimming pool was previously abandoned on the property. The pool shell was removed exposing competent native clay. The exposed excavation bottom was scarified, moisture conditioned as needed, and track rolled to a firm compact condition. Subsequent soil backfill was placed in six to eight inch loose lifts, moisture conditioned with a water hose as needed, and compacted to a minimum of 90% relative compaction by rolling with a CAT 975 track loader. This process was followed to final grade. Earthwork was by Tight Quarters, Inc. The approximate pool backfill area and compaction test locations are shown on the Compaction Test Location Plan, Plate 1. PLACEMENT OF FILL Compacted fill material was placed on the subject site to provide adequate support for the proposed structure. The depth of the overexcavation was approximately three to three and one half feet below finish grade. The bottom of the excavations exposed competent native clay. The exposed surface was scarified, watered as needed with a water hose, and compacted to a minimum of 90% relative compaction. COAST GEOTECHNICAL, INC. Mr. Haddad 2 W.O. 509416-02 Rough Grade Compaction Report December 6, 2017 Subsequent fills were moisture conditioned, thoroughly mixed, placed in six to eight inch loose lifts and compacted to a minimum of 90% relative compaction. This process was followed to final grade. Limits of grading are shown on the attached Plate 1. Equipment used for compacting the fill soils consisted of a CAT 975 track loader. Earthwork was by Tight Quarters Demolition and Grading. TESTING Maximum density optimum moisture relationship determinations were performed for each soil type encountered during grading operations. Test results were as follows: Laboratory Standard: (ASTM: D-1557) 4 -inch diameter mold; 1/30 ft3 volume; 5 layers at 25 blows per layer; 10 lb. hammer dropped 18 inches ;dall$3g RIPt?. i -.-`Sid ie 1©nj g R OM110S.a t _ '+r°� "U ( ?}Tyu§Ze �}kyuh l 11.5 s fie' . '#' �`ajL `x h -1 ul� i ' 1} -14R" 125.0 I Import Brown Sandy Clay II Brown Sandy Clay 13.0 120.0 III Brown Sandy Silty Clay 12.0 124.0 IV Import Brown Sand 11.0 126.0 Compaction tests were performed a minimum of every two feet and/or 500 cubic yards of compacted fill soils placed. These tests were performed in accordance with ASTM test methods. The test results are summarized in Table 1. The approximate test locations are shown on Plate 1. FOUNDATIONS ON COMPACTED FILL The proposed structures may be supported by continuous spread footings or isolated pads placed a minimum depth of 24 inches below lowest adjacent grade, utilizing an allowable bearing value of 1,500 pounds per square foot. This value is for dead plus live load and may be increased 1/3 for total including seismic and wind loads where allowed by code. The footing width shall be at least 15 inches for a proposed two-story residence and at least 18 inches for a proposed three- story residence. Where isolated pads are used, they shall be tied into adjacent foundations with grade beams in at least two directions. It is recommended that all footings be reinforced with a minimum of four No. 5 bars (2 top and 2 bottom). The structural engineer's reinforcing requirements should be followed if more stringent. Footing excavations shall be observed by a representative of COAST GEOTECHNICAL, INC. prior to placement of steel or concrete to verify competent soil conditions. If unacceptable soil conditions are exposed mitigation will be recommended. COAST GEOTECHNICAL, INC. Mr. Haddad 3 W.O. 509416-02 Roujzh Grade Compaction Report December 6 2017 FOUNDATIONS ON NATIVE SOILS Secondary structures may be supported by continuous spread footings or isolated pads placed a minimum depth of 24 inches below lowest adjacent grade and bearing 12 inches into competent native material, whichever is deeper. Foundations bearing into native material may utilize an allowable bearing value of 1,500 pounds per square foot. This value is for dead plus live load and may be increased 1/3 for total including seismic and wind loads where allowed by code. Where isolated pads are used, they shall be tied into adjacent foundations with grade beams in at least two directions. It is recommended that all footings be reinforced with a minimum of four No. 5 bars (2 top and 2 bottom). The structural engineer's reinforcing requirements should be followed if more stringent. Footing excavations shall be observed by a representative of COAST GEOTECHNICAL, INC. prior to placement of steel or concrete to verify competent soil conditions. If unacceptable soil conditions are exposed mitigation will be recommended. LATERAL DESIGN Lateral restraint at the base of footings and on slabs may be assumed to be the product of the dead load and a coefficient of friction of .30. Passive pressure on the face of footings may also be used to resist lateral forces. A passive pressure of zero at the surface of finished grade, increasing at the rate of 300 pounds per square foot of depth to a maximum value of 3,000 pounds per square foot, may be used for compacted fill and native soils at this site. If passive pressure and friction are combined when evaluating the lateral resistance, then the value of the passive pressure should be limited to 2/3 of the values given above. SEISMIC DESIGN Based on the 2013 CBC the following seismic design parameters are provided. These seismic design values were determined utilizing latitude 33.620927 and longitude -117.917968 and calculations from the US GS ground motion parameter calculator. A site class D was assigned to site earth materials. • Site Class = D • Mapped 0.2 Second Spectral Response Acceleration, Ss = 1.703g • Mapped One Second Spectral Response Acceleration S1= 0.628g • Site Coefficient from Table 1613A.3.3(1), Fa =1.0 • Site Coefficient from Table 1613A.3.3(2), Fv = 1.5 • Maximum Design Spectral Response Acceleration for short period, SMs = 1.703g • Maximum Design Spectral Response Acceleration for one -second period, Sm, = 0.942g • 5% Design Spectral Response Acceleration for short period, SDs = 1.135g 0 5% Design Spectral Response Acceleration for one -second period, SDi = 0.628g COAST GEOTECHNICAL, INC. Mr. Haddad 4 W.O. 509416-02 Rough Grade Compaction Report December 6, 2017 EXPANSIVE SOILS Results of expansion tests indicate that the near surface soils have a medium expansion potential. The medium recommendations on the accompanying "Expansive Soil Recommendations", in the referenced report, maybe utilized in design of foundations and concrete slabs. FLOOR SLABS Where conventional foundation and slab on grade is utilized, the slab shall be supported on engineered fill compacted to a minimum of 90% relative compaction. For design of slab on grade a computed effective plasticity index of 24 may be utilized. From a geotechnical standpoint, concrete slabs on grade shall have a minimum five -inch actual thickness reinforced with #4 bars at 12 -inches on center each way. Structural design may be more stringent. Subgrade soil should be kept moist prior to casting the slab. However, if the soils at grade become disturbed during construction, they should be brought to approximately two to three percent over optimum moisture content and rolled to a firm, unyielding condition prior to placing concrete. The capillary break material shall comply with the requirements of the local jurisdiction and shall be a minimum of four inches in thickness and shall consist of four inches of gravel (1/2 inch or larger, clean aggregate). A heavy filter fabric must be placed over the gravels prior to placement of the recommended vapor barrier to minimize puncturing of the vapor barrier. Additionally, a vibratory plate should be used over the gravels prior to placement of the recommended filter fabric to smooth out any sharp protuberances and consolidate the gravels. Slab areas should be underlain by a vapor retarder consisting of an engineered plastic film (as described by ASTM:E-1745). hi areas where a moisture sensitive floor covering will be used and/or where moisture infiltration is not desirable, a vapor barrier with a permeance of less than 0.01perms (consistent with ACI 302.211-06) such as 15 mil. Stego Wrap Vapor Barrier, or equivalent, should be considered, and a qualified water proofing specialist should be consulted. The vapor barrier should be underlain by the above described capillary break materials and filter cloth. The capillary break materials should be compacted to a uniform condition prior to placement of the recommended filter cloth and vapor barrier. The vapor barrier should be properly lapped and sealed. POOL DESIGN Any future pool and spa shall be designed as free standing and supported by compacted native soil where stated settlements can be tolerated. Pool excavation bottoms shall be observed by a representative of COAST GETOECHNICAL INC., prior to processing. Processing of pool excavation bottoms shall consist, at a minimum, of scarification of the exposed native soils, moisture conditioning, and compaction to a minimum of 90% relative compaction. COAST GEOTECHNICAL, INC. Mr. Haddad 5 W.O. 509416-02 Rough Grade Compaction Report December 6, 2017 Pool walls shall be designed to support the water, having a density of 62.4 pounds per cubic foot without bearing from adjacent soil. The walls should be able to support the adjacent soil when the pool is empty. The earth pressure may be calculated as an equivalent fluid pressure of 100 pounds per cubic foot for level backfill, plus the lateral pressure due to any superimposed surcharge when the pool is empty. Expansion joints shall be placed between the pool and deck. The client is advised that non -conventional swimming pools/spas, with zero or infinity edge construction, are sensitive to settlements, which could cause the pool/spa edge to not function as designed. If this risk is unacceptable to the client then alternate support of the pool/spa with a foundation system that reduces differential settlements should be considered. Typically foundations placed into bedrock are utilized. All pool utility lines shall be backfilled with soils compacted to a minimum of 90% relative compaction. Where pool lines are sensitive to the use of compaction equipment the trenches shall be backfilled with one sack slurry. COAST GEOTECHNICAL, INC. shall verify the backfill of all trenches. Pool decking shall be cast free of the swimming pool structure and access openings. The free space shall be filled with flexible water stop materials. The client is advised that due to the expansive nature of site soils that some horizontal and vertical movement between the pool and pool decking will occur over time. The pool foundation excavation shall be observed and approved by COAST GEOTECHNICAL, INC. prior to the placement of reinforcement. These recommendations are subject to change based on the review of pool plans. UTILITY LINE BACKFILLS All utility line backfills, both interior and exterior, shall be compacted to a minimum of 90% relative compaction and shall require testing at a maximum of two -foot vertical intervals. COAST GEOTECHNICAL, INC. shall be present during backfill placement and compaction to verify compliance. VOYMITIMOMM Hardscape subgrade areas shall exhibit a minimum of 90% relative compaction to a depth of at least one foot. Deeper removal and recompaction may be required if unacceptable conditions are encountered. These areas require testing just prior to placing concrete. Due to the expansive nature of the on-site soils, a cutoff wall, extending a minimum of twelve inches below the lowest adjacent grade, is highly recommended where hardscape is adjacent to planter and landscape areas. If no significant load is associated with the edge of the slab, the width of the cutoff wall may be limited to eight inches. 601111").1 T.Y IM I M Typical on-site soils showed a soluble sulfate content of 438 ppm. Based on the Table 4.3.1 of ACI 318-05 this is a moderate exposure to sulfates, concrete with Type II cement with a COAST GEOTECHNICAL, INC. Mr. Haddad 6 W.O. 509416-02 Rough Grade Compaction Report December 6, 2017 maximum water cementitious materials ratio of 0.5 and a minimum compressive strength of 41000 psi. The structural engineers design criteria may be more stringent. Concrete shall be placed in accordance with appropriate codes. DRAINAGE Positive drainage should be planned for the site. Drainage should be directed away from structures via non -erodible conduits to suitable disposal areas. The structure should utilize roof gutters and down spouts tied directly to yard drainage. Unlined flowerbeds, planters, and lawns should not be constructed against the perimeter of the structure. If such landscaping (against the perimeter of a structure) is planned, it should be properly drained and lined or provided with an underground moisture barrier. Irrigation should be kept to a minimum. Section 1804.3 of the 2013 CBC recommends five percent slope away from structures for landscape areas within ten feet of the residence. Hardscape areas shall be sloped a minimum of two percent where within ten feet of the residence unless allowed otherwise by the building official. Minimum drainage shall be one percent for hardscape areas and two percent for all other areas. We do not recommend the use of bottomless trench drains to conform with infiltration best management practice (BMP) such as infiltration trenches, infiltration basins, dry wells, permeable pavements or similar systems designed primarily to percolate water into the subsurface soils. Due to the physical characteristics of the site earth materials, infiltration of waters into the subsurface earth materials has a risk of adversely affecting below grade structures, building foundations and slabs, and hardscape improvements. From a geotechnical viewpoint surface drainage should be directed to the street. The WQMP requirement shall be addressed by the Civil Engineer. POST -GRADING SERVICES During construction of the residence, it is recommended, and at times required by the regulatory agency, the following be observed and/or tested by the geotechnical engineer: • Excavation of footings • Backfill of interior slab areas • Backfill of interior trenches • Backfill of exterior utility trenches • Hardscape subgrade It is the responsibility of the developer to schedule the required observations and testing. COAST GEOTECHNICAL, INC. Mr. Haddad 7 W.O. 509416-02 Rough Grade Compaction Report December 6. 2017 REGULATORY COMPLIANCE I hereby certify that the subject grading was observed by a representative from this office, and the work was done in full compliance with the Grading Ordinance of the City of Newport Beach and in accordance with the best accepted practices of the applicable chapter of the California Building Code. All cuts, fills or processing of original ground under the purview of this report have been completed under the observation of and with selective testing by COAST GEOTECHNICAL, Inc., and found to be in compliance with the Grading Code of the City of Newport Beach. The completed work has been observed by COAST GEOTECHNICAL, Inc., and is considered adequate for the development. Our findings were made and recommendations prepared in accordance with generally accepted professional engineering practices, and no further warranty is implied nor made. This report is subject to review by the controlling authorities for this project. We appreciate this opportunity to be of service to you. Respectfully submitted: COAST GEOTECHNICAL, INC. W— , v Lg- aru€ RCE 54011 No. 54011 Exp. 12131/19 COAST GEOTECHNICAL, INC. Mr. Haddad 8 W.O. 509416-02 Rough Grade Compaction Report December 6 2017 COMPACTION TEST RESULTS TABLE U.� esf tx�Lo6aiac�n rd� ''pct tfsed � �tt�n�en��s 0; We�t'�t �i at"i` E' E iCAM WE 1 Pad Area 7.58.0 11.4 114.6 I 91.7 11/28/17 2 Pad Area 5.0-5.5 13.5 113.6 I 90.9 11/28/17 3 Pad Area 2.53.0 11.9 114.1 I 91.3 11/28/17 4 Pad Area 3.0-3.5 17.1 112.0 II 93.3 11/29/17 5 Pad Area 3.0-3.5 15.8 110.9 II 92.4 11/29/17 6 Pad Area 2.0-2.5 13.5 114.3 II 92.2 11/30/17 7 Pad Area 2.0-2.5 13.9 113.7 III 91.7 11/30/17 8 Pad Area 1.52.0 13.1 114.5 IU 92.4 11/30/17 9 Pad Area 1.0-1.5 14.5 114.0 III 91.9 11/30/17 10 Pad Area 3.0-3.5 17.1 110.4 lI 92.0 12/1/17 11 Pad Area 3.0-3.5 19.5 108.7 lI 90.6 12/1/17 12 Pad Area 1.52.0 16.7 110.6 11 92.2 12/1/17 13 Pad Area 1.52.0 15.5 111.6 II 92.6 12/1/17 14 Pad Area F.G 8.6 117.6 IV 93.3 12/5/17 15 Pad Area F.G. 9.2 118.0 IV 93.6 12/5/17 16 Pad Area F.G. 10.7 117.5 rV 93.3 12/5/17 F. G.- Finish Grade COMPACTION TEST LOCATION PLAN Scale: 1" = 20' •g s • x Approximate 4 Compaction Test Location = �' m i IQ D Z r N 9a@ii ; I9 fie'- iat li IZ P12 Approximate m {3€'3'ei cs 8a Limits of 9 e Grading C 0110 V • 1 p .o '+oma .�,� �;, �� ��'" ++�-. va � � �-�'d:.s• §r� ,v.,, x � x x ' FUL4 RTON AVENUE x Rough Grading Compaction Report Work Order 509416-02 401 Fullerton Avenue Newport Beach, California Plate No. 1 COAST GEOTECHNICAL, INC. CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. 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 RUN 14/WIVA License #- LAT'(6S3 Engineer/Surveyor's Address 2,30& LA -k E FO (L( -3T- PA, iF VOt !.A c w L*4-< CA, Job Address Ye / r=vu 01D/'V Setbacks: Sketch a site plan and specify surveyed setbacks (use back page). * Top of slab/floor elevation: Pt-- 9 2 .OG * 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 t4, are not ❑, per City approved plans. Describe any deviations from plans: I certify that top of slab/floor elevation(s) is a, is not ❑, per City approved drawings. Describe any deviations from plans: Date Forms/Setbacksand`ropofS labElevationCeit. 4 /Y Aa -&Y 1 wLLet-W