Fillable ESHP-Project-Description Form - Project Description_121418m

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ESHP-Project-Description Form - Project Description_121418m

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The ESHP-Project-Description Form - Project Description_121418m form is 2 pages long and contains:

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  • 6 check-boxes
  • 19 other fields

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File type: PDF

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Page1of2
E
ARTHQUAKE
S
AFE
H
OMES
P
ROGRAM
(ESHP)
ProjectDescription
CompleteandsubmitthisformwithyourDesignReviewPackagetotheESHPOfficeattheaddressabove.
Afterpreliminaryreview,ESHPwillforwardyourPermitApplicationtothePlanningandBuildingDepartment.
ThePermitApplicantwillbenotifiedonceapprovedtoproceedwithplancheckandpermitapprovals.
1.
VisibleExteriorChanges:
Willanyvisibleexteriorchangesresultfromthisretrofitprojectoranyother
concurrent,non‐seismicactivities?
NO YES*
*Describeanyvisibleexteriorchangesbelowandensurethattheyareclearlydepictedintheschematics
anddrawings.Statewhetheranyrelevantrepairorreplacementwillbeperformedin‐kindand/or
whethervisiblechangeswillbereversible.
2.RequiredSeismicActivities:
Confirmthattherequiredmeasuresareincludedinyourscopeofwork.*

Foundationanchors Woodstructuralpanels Framingclips
*Ifanyoftheabovearenotapplicabletoyourproject,explainwhy:
3. OptionalSeismicActivities:
Indicateanddescribeanyadditionalseismicmeasuresincludedinyour
scopeofwork.
NONE Anchoringofwaterheatertank 
Othermitigationofstructuralornon‐structuralseismicsafetyhazardsasdescribedbelow.
D
EPARTMENT OF
H
OUSING AND
C
OMMUNITY
D
EVELOPMENT
R
ESIDENTIAL
L
ENDING AND
R
EHABILITATION
S
ERVICES
250
FRANK
H.
OGAWA
PLAZA,
SUITE
5313
OAKLAND,
CALIFORNIA
94612-2034
ResidentialLending@oaklandnet.com

/238‐3598
S
ITE
A
DDRESS
:  
P
ROPERTY
O
WNER
: P
HONE
: 
P
ERMIT
A
PPLICANT
: 
P
HONE
:

Rev 5/30/19
Page2of2
4. Non‐SeismicActivities:
Willanynon‐seismicworkbeconductedatthesametimeastheretrofit?
NO YES*
*Clearlydescribenon‐seismicworktobeconductedconcurrentlywiththeretrofitunderaseparate
permit.Ifthebuildingismorethan45yearsold,includePlans,Schematics,andPhotographsforEHP
Reviewasaseparateattachment.
5. PermitApplicantCertification:
Mysignaturebelowconfirmsthefollowing:
Thedescriptionaboveincludesallworkthatwillbeconductedduringorconcurrentlywiththe
seismicretrofitofthisproperty.
Ifanynon‐seismicornon‐reimbursableworkisplanned,itwillbecoveredunderseparatepermit(s).
AnychangestothisscopeofworkwillbesubmittedtotheESHPOfficeusingarevisedversionof
thisformandupdatedplans/drawings/picturesasisappropriatebeforeanyunapprovedactivities
begin.NoadditionalactivitieswillbeconducteduntildesignrevisionsareapprovedbyFEMAand
ESHP.
I/weunderstandthatanyactivitiesconductedwithoutESHPapprovalpriortoESHPreimbursement
andprojectclose‐outmayresultinpreviouslyeligiblecostsbeingdeniedreimbursement.

SignatureofPermitApplicant Date
ESHPSTAFFUSEONLY
DateReceived:________________ESHPRehabAdvisor:______________________________Ext:_________
Approved?Y/NDate:_________________ApplicationSubmitted:_________________
Comments:_______________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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ESHP-Project-Description Form - Project Description_121418m

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Completed 27 February 2020

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