Fillable Petition For Exemption Form 6-24 2019 (City of Oakland)

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Petition For Exemption Form 6-24 2019 (City of Oakland)

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Planning and Building Department
250 Frank Ogawa Plaza, 2
nd
Floor
Oakland, CA 94612
Petition for Exemption
Oakland Municipal Code Section 15.27.050
Petition-for-Exemption-Form-6-24-2019
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 for Exemption 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 a later Compliance Tier, do not use this form. Use the separate “Petition for Change of Compliance Tier” form.
3. This form might require the certification of a California licensed design professional (architect, civil engineer, or structural
engineer). When required. 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 explanations and examples are provided in a separate document, Petition-for-Exemption-
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 Chapter 15-27: Petition for Exemption
Page 2 of 3
PARCEL NUMBER _________________
Petition-for-Exemption-Form-6-24-2019
PART 2 – WORKSHEET
Yes
No
1. Was the building originally constructed or permitted for construction before January 1, 1991, or
designed based on an adopted version of the 1985 or earlier edition of the Uniform Building Code?
Notes: _______________________________________________________________________________________
If Yes: Continue to Question 2.
If No: The building is tentatively exempt from OMC Chapter 15.27.
• Skip Questions 2 and 3.
• Complete the Owner/Agent portion of Part 3.
• Submit this petition form. Bureau of Building staff are authorized to require additional information as needed.
If approved, the Bureau of Building will confirm the exemption in writing.
Yes
No
2. Does the building contain five or more Dwelling Units?
Notes: _______________________________________________________________________________________
If Yes: Continue to Question 3.
If No: The building is tentatively exempt from OMC Chapter 15.27.
• Skip Question 3.
• Complete the Owner/Agent portion of Part 3.
• Submit this petition form. Bureau of Building staff are authorized to require additional information as needed.
If approved, the Bureau of Building will confirm the exemption in writing.
Question 3 requires the input 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.
Yes
No
3. Does the building have a Wood Frame Target Story?
If No, indicate also which of these conditions is true:
The building has no Target Stories.
The building has one or more Target Stories but none is a Wood Frame Target Story.
Design Professional’s Notes: _____________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
If Yes: The building is subject to OMC Chapter 15.27. Do not submit this petition form.
If No: The building is tentatively exempt from OMC Chapter 15.27.
• Complete all of Part 3.
• Submit this petition form. Bureau of Building staff are authorized to require additional information as needed.
If approved, the Bureau of Building will confirm the exemption in writing.
DEFINITIONS (OMC Section 15.27.150)
Dwelling 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 Chapter 15-27: Petition for Exemption
Page 3 of 3
PARCEL NUMBER _________________
Petition-for-Exemption-Form-6-24-2019
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
Pre-1991 or pre-1985 UBC
Building is subject to OMC Chapter 15.27.
Dwelling Units
Wood Frame Target Story
Building is exempt from OMC Chapter 15.27.
PART 3 – Design Professional &
Owner/Agent Affidavits
BOB Reviewer:
Date:
[Professional Stamp Here]
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Petition For Exemption Form 6-24 2019 (City of Oakland)

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Completed 20 July 2020

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