Laserfiche WebLink
ELEVATION CERTIFICATE <br />IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION <br />CITY OF SANTA ANA <br />Planning and Building Agency <br />Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.: <br />FOR <br />INSURAIW VbVL&E <br />5410 W Kedge Avenue, Unit #2 <br />Polic <br />NuF„Q :PERMIT ISSUAN <br />City: Santa Ana State: CA ZIP Code: 92704 <br />Company <br />NAIC Number: <br />SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQU <br />IALqjJer ID: <br />C1. Building elevations are based on: ® Construction Drawings* ❑ Building Under Construction Finished Construction <br />*A new Elevation Certificate will be required when construction of the building is complete. <br />C2. Elevations — Zones Al—A30, AE, AH, AO, A (with BFE), VE, VI—V30, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO, <br />A99. Complete Items C2.a—h below according to the Building Diagram specified in Item A7. In Puerto Rico only, enter meters. <br />Benchmark Utilized: SA-223-70 (ELE: 56.212 ft, 2005) Vertical Datum: NAVD88 <br />Indicate elevation datum used for the elevations in items a) through h) below. <br />❑ NGVD 1929 ® NAVD 1988 ❑ Other: <br />Datum used for building elevations must be the same as that used for the BFE. Conversion factor used? ❑ Yes ® No <br />If Yes, describe the source of the conversion factor in the Section D Comments area. <br />Check the measurement used: <br />a) Top of bottom floor (including basement, crawlspace, or enclosure floor): 57.20 ® feet ❑ meters <br />b) Top of the next higher floor (see Instructions): N/A ❑ feet ❑ meters <br />c) Bottom of the lowest horizontal structural member (see Instructions): N/A ❑ feet ❑ meters <br />d) Attached garage (top of slab): N/A ❑ feet ❑ meters <br />e) Lowest elevation of Machinery and Equipment (M&E) servicing the building <br />(describe type of M&E and location in Section D Comments area): N/A ® feet ❑ meters <br />f) Lowest Adjacent Grade (LAG) next to building: ❑ Natural ® Finished 55.83 ® feet ❑ meters <br />g) Highest Adjacent Grade (HAG) next to building: ❑ Natural ® Finished 56.69 ® feet ❑ meters <br />h) Finished LAG at lowest elevation of attached deck or stairs, including structural <br />support: N/A ❑ feet ❑ meters <br />SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION <br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by state law to certify elevation <br />information. / certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any <br />false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. <br />Were latitude and longitude in Section A provided by a licensed land surveyor? ❑ Yes ® No <br />❑ Check here if attachments and describe in the Comments area. <br />Certifier's Name: Lan Pham License Number: C29595 <br />Title: Chief Engineer <br />Q�pFESS/ON <br />Company Name: Lan & Associates O �N. Pyq q�Fy <br />Address: 13139 Harbor Boulevard CO <br />No. 29595 rn W <br />City: Garden Grove State: CA ZIP Code: 92843 cc Exp: 3/31/27 M <br />Telephone: (714) 414-9215 Ext.: Email: lanpham9@hotmail.com <br />s cnm <br />lglE OF CA1.\E��� <br />Signature: -- Date: 04/15/2025 <br />Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. <br />Comments (including source of conversion factor in C2; type of equipment and location per C2.e; and description of any attachments): <br />No <br />FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 3 of 8 <br />