Fillable Change Of Compliance Tier Form 5-21 2019 (City of Oakland)

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Change Of Compliance Tier Form 5-21 2019 (City of Oakland)

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Planning and Building Department
250 Frank Ogawa Plaza, 2
nd
Floor
Oakland, CA 94612
Petition for Change of Compliance Tier
Oakland Municipal Code Section 15.27.050
OMC 15.27 Change of Compliance Tier Form 5-21-2019
This petition form is provided for owners of buildings that might be subject to Oakland Municipal Code (OMC) Chapter 15.27: Mandatory
Seismic Evaluation and Retrofit of Certain Multi-Unit Residential Buildings. The form is authorized by Section 15.27.050. Bureau of
Building staff are authorized to require additional information as needed.
Instructions
1. Submit this form:
• As a PDF attachment, by email to MandatorySoftStoryRetrofit@oaklandca.gov, with “Petition form submittal” in
the subject line, or
• As a hardcopy by U.S. mail or in person to:
Mandatory Soft Story Retrofit Program
250 Frank H. Ogawa Plaza Suite 2340
Oakland, CA 94612
2. To request exemption from OMC Chapter 15.27, do not use this form. Use the separate Petition for Exemption.
3. This form requires the certification of a California licensed design professional (architect, civil engineer, or structural
engineer). It is the building owner’s responsibility to engage a qualified design professional.
4. Terms shown in bold, italic font are defined in OMC Section 15.27.150. The definitions are provided after Part 2 below.
5. Additional line-by-line instructions and examples are provided in a separate document, Petition Instructions, available at
https://www.oaklandca.gov/topics/SSRetrofit.
PARCEL NUMBER
PROPERTY ADDRESS
OWNER(S)
Yes
No
Does this petition replace or supplement a previously submitted petition for the same building?
PART 1 – CONTACT INFORMATION
Owner telephone
Owner email
Authorized agent (optional)
Agent telephone
Agent email
Agent mailing address
CONDOMINIUM OWNERS: Submit only one form with one set of contact information for each building. List all parcel
numbers comprising the building here:
OMC Chap
ter 15-27: Petition for Change of Compliance Tier
Page 2 of 3
PARCELNUMBER
OMC 15.27 Change of Compliance Tier Form 5-21-2019
PART 2 – WORKSHEET
Current Compliance Tier:
Tier 1-NR
Tier 1-LB
Tier 2
Tier 3
Number of Dwelling Units:
5 to 19 20 or more
Yes
No
1. Answer only if the Current Compliance Tier is Tier 1-NR: Are you submitting documentation
to show that you or the previous owners complied with the Mandatory Screening Ordinance (OMC
Section 15.26.230) on or before July 28, 2011?
If Yes: Continue to question 2.
If No: The building is assigned to Compliance Tier 1-NR. Skip to CONCLUSION.
2. Does the building contain a legally permitted, non-vacant Business or Mercantile occupancy in a
Wood Frame Target Story?
If Yes: Enter the date the non-vacant B or M occupancy was observed: _______________. The
building is tentatively assigned to Compliance Tier 3. Skip to CONCLUSION.
If No: Continue to question 3.
3. Does the building contain at least one legally permitted Dwelling Unit) in a Wood Frame Target
Story?
If Yes: The building is assigned to Compliance Tier 3. Skip to CONCLUSION.
If No: Continue to question 4.
4. Does the building contain 5 to 19 Dwelling Units?
If Yes: The building is assigned to Compliance Tier 2. Continue to CONCLUSION.
If No: The building is assigned to Compliance Tier 1-LB. Continue to CONCLUSION.
CONCLUSION: Check the Proposed Compliance Tier indicated by the responses to questions 1 – 4:
Tier 1-NR
Tier 1-LB Tier 2 Tier 3
If the Proposed Compliance Tier is the same as the Current Compliance Tier: Do not submit this petition form.
If the Proposed Compliance Tier is different from the Current Compliance Tier: Complete Part 3 and submit this
petition form. The Bureau of Building will confirm the change in writing.
DEFIN
ITIONS (OMC Section 15.27.150)
Dwellin
g Unit. A Dwelling Unit shall include any individual residential unit in a building with R-1 or R-2 occupancy, as well
as any guest room, with or without a kitchen, in either a tourist or residential hotel or motel but shall not include a
housekeeping room. Any unit occupied as a Dwelling Unit, whether approved or not approved for such use, shall be
counted as a Dwelling Unit.
Target
Story. A Target Story shall mean either (1) a basement story or underfloor area that extends above grade at any
point or (2) any story above grade, where the wall configuration of such basement, underfloor area, or story is substantially
more vulnerable to earthquake damage than the wall configuration of the story above, except that a story is not a target story
if it is the topmost story or if the difference in vulnerability is primarily due to the story above being a penthouse or an attic
with a pitched roof.
Wood Frame
Target Story. A Wood Frame Target Story means a Target Story in which a significant portion of lateral or
torsional story strength or story stiffness is provided by wood frame walls.
OMC Chap
ter 15-27: Petition for Change of Compliance Tier
Page 3 of 3
PARCELNUMBER
OMC 15.27 Change of Compliance Tier Form 5-21-2019
PART 3 – DESIGN PROFESSIONAL & OWNER AFFIDAVIT
DESIGN PROFESSIONAL
Under penalty of perjury, I certify that the information provided in Part 2 of this petition is based on information provided by
the Owner/Agent identified below, on my personal review of the building and its records, or on review by others acting
under my direct supervision, and is correct to the best of my knowledge.
Date stamped and signed
Name
Firm name (optional)
Telephone
Email
OWNER /
AGENT
Under penalty of perjury, I certify that the information provided in Part 1 of this petition is correct to the best of my
knowledge.
Owner
Agent
Signature
Date
FOR BUREAU OF BUILDING USE ONLY
Form appears incomplete, or more information is needed regarding:
The form appears complete and is assumed correct based on
Design Professional and Owner/Agent Affidavits.
PART 2 – Worksheet
Mandatory Screening Compliance Form
Compliance Tier remains as assigned.
Business or Mercantile occupancy in WFTS
Dwelling unit in WFTS
Compliance Tier is tentatively changed as proposed.
Number of Dwelling Units
PART 3 – Design Professional &
Owner/Agent Affidavits
BOB Reviewer:
Date:
[Professional Stamp Here]
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Change Of Compliance Tier Form 5-21 2019 (City of Oakland)

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Completed 20 July 2020

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