HomeMy WebLinkAboutX2011-2694 - Miscr,Wii -7..% I�¢
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
3300 Newport Boulevard I P.O. Box 1768 1 Newport Beach, CA 92658
www.newiportbeachca.aov 1 (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 Rolu IL eFinA License# vL$ g6S,7
Engineer/Surveyor's Address Z 30 /4 La k f (I.EJP � 7t`d 9 1 t"PA
Job Address 16 `l b / S iw - G v AM33 S
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
from plans:
are IN, are not ❑, per City approved plans. Describe any deviations
I certify that top of slab/floor elevation(s) is ®, is not ❑, per City approved
any deviations from plans: _
2.•-f2..- 13
Date
corm s/5 etbacksandTopo Is IabEl ovati onCert.
Engineer/Surveyor's stamp and
*C.$
CLIENT ^- +Mw..
-
PROJECT NO.
DATE
JOB ADDRESS - -
CITY
-
TECHNICIAN
PROJECT ENGINEER
ti„�➢"�4 4'5� �.,w"... tia 4
�.,.�af,:�a ';w,a \ �"h��'r..➢'V:i 'y.:;
w4dyi .;a:tC,...:1
a"'t`k''RL,Tti `^1,
�i2 E:,w+„}�'w
SUPERINTENDENT ❑ CLIENTSAG)NF❑
-
CONTRACTOR
REPORT NO.
,
ti.,4:i C..+23 `.:> K,.4"a,+..4 w .
PAGE i OF
COMPACTION STANDARD
ASTM A- El- CALIF216
ON SITE@ Y''' AM/PM
TRAVELTIME t ""5 HR
LUNCH—"i4' HR
OFF SITE +1't�-s AM/PM
MILEAGE ��'�
CHARGEABLE TIME4^�HR
AREAHNSPECTED
Fb b ."igR:.'c V4.+➢ p:x'p'`t.`j
�° V�yW `R � Xx ul . tn� i
DESCRIPTION OF FILL MATERIgALL'I SOURCE
-
EDUIPMENT
�Mb+i.Rs"4"k'M�re 'S,,,y rt''r.."� .�i•,. trvw�krl r:, �
.TEST
NO.
TEST
TYPE
LOCATION
ELEVATIONS/DEPTH In).
FIELD
MOIST.
N
DRY
DENS
(PCF)
OPTIMUM
MOIST.
(%)
MAX
DENS,
(PCF)
RELATIVE
COMPACT
(A)
RETEST.
NO,
TEST
FILL
NATURAL
GC = DRIVE CYLINDER SC = SANG CONE NG = NUCLEAR GAUGE
Notice: This rnnnrt he issued ter infdrmatinn"only - test rncuits am suhinct in nvnfirmatinn in a wrinnn r,.rt
COMMENTS '"''
4, V AI
,......,+,ww "-,�W.Y""' �£ l .,F°�
ddV'£../f��.',,syy w,��0.✓'S(^G r J
.✓' ✓�.L.^ '4AP' i'Y�Y _yv4n.'
rvP c�,`➢ d ,rr w.
rl.�C..e *.: ✓' af"'.;/ ¢. -
/ ..�f..
✓iV.,"!."" ..✓w..,yr ✓ c °
C f{.�p,��'^.N�'yd+
n .f'✓'°lnm0.
JP`x^e/.',�l' }-
-y.Aydr�'<fJ'�r rvL..i Ji{s
w+'"u'%: .��q`J �rvA:
ti'`� T'WGrt Jf £Y'�I Lr„
�'f 4- ,✓"�i
.+.'\^'i::
f9� Own. G.. iE;.i�e.J' r^'"
rP""'! i%,: r..w."
"
m
l
S
SIGNATURE 2�J, �N�" DATE Signature acknowledges receipt ofthis report only.
-�" Distribution: White, office; Yellow, client; Goldenrod, contractor; Pink, field file
Harrin ton
Gcot clinical
engineering,
DAILY REPORT A/- /. , v-<-
CLIENT
PROJECT NO.
DATE.
4'. F`+vN .• 4N1 �.:'.,
w✓ S d��f.,✓/
`ww J ..v.' .�^..
JOB AD'fiESS
CITY
TECHNICIAN
PROJECT ENGINEER
,•'�; �'"J �..� 4) 1 �... �
' �%rr �.: 5
,. �1 ��` e
pp
..r°'f �....s%dn?"
PB4<'."..�r
j �;y 4''L/3
�•.._.
SUPERINTENDENT CLIENTS AGENT
r❑
CONTRACTOR
REPORT NO.
Y
PAGE OF
COMPACTION STANDARD
.m^'
ON SITE@HM/PM
TRAVELTIM)E�µf HR
n
LUNCH, v.. HR
ASTM Q CALIF216
❑
OFF SITE @ i »
AMij',(yi
MILEAGE "Y4
CHARGEABLE TIMEIs Q HR
AREA INSPECTED ! p dl?A
DESCRIPTION OF FILL MATERIAL/SOURCE
EQUIPMENT;;9 Je`,/;,.q:r:"
/�
TEST
NO.
TEST
TYPE
LOCATION
I"C � +" fit '•
ELEVATIONS / DEPTH (ft)
FIELD
MOIST.
N
DRY
DENS
(PCF)
OPTIMUM
MOIST.
N
MAX
DENS.
(PCP)
RELATIVE
COMPACT
N
RETEST
NO.
TEST
FILL
NATURAL
"J
(�r�x?.�
E•F
! : r�.c'.
f
1
�,
1'a' 7r R..xa
rr.:;4.�;..,.°`
'n,.....e_
\gyp✓/
%
✓�
a a
(@!`
tlt
n+
�9
t. A.. +J srtiii.".:.
/) y§�
P !
/}r1y@pp
e
�Do=DRIVE CYLINDER SC=SAND CONE INS =NUCLEAR GAUGE
NntiroThis rennrtis isvani for infnrmation colt - tast results are suhiert m confirmation in a written rennrt.
COMMENTS'•,
A'.. r12 YI ..; c' `
✓14=C:.. "
if rT ",%T.�'Ya"'a
(T+✓^ dif r`/{r:: �'r;:7
"U A�•xi6 s:"i«,.? ". '.,fin lar/;:7rF'L,+;. +%7
1 .,fit. ia'"d.t.#'�'
i
' !� n�
kj.t° �Y.°° Jd`V
)
r,;A P,fj
✓, r
..d1/ «.,,...
1/i"f�S "`.�Y�
./ i" T, 7e%! 5y �d. r'.7 iJ:.
t', �
�.�,rta',` <xr .
" I —A ..J� 91
Cv.a%e`7::�i
_"._. "Id
=" AxriA i
OA 9NY
f
�rrvi
✓'
SIGNATURE >+" a i�-�•� .DATE Signature acknowledges receipt of this report only.
Distribution: White, office; Yellow, client; Goldenrod', contractor; Pink, field file
,,-N,