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Home My WebLink AboutFEMA Application 1999-6-2 r\tl6,A(C,sS F/LE- #- b2-()OII'j-O/-~ FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE O.M B. No 3067 -con ExpIres July 31,2002 Important: Read the instructions on pages 1 - 7. SECTION A. PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME ~ Mt\t ('IVN- BUILDING STREET ADDRESS (Including Apt, Umt, SUite, and/or Bldg No.) OR PO ROUTE AND BOX NO ~'((.p M IU>/-J ~€.- CITY ZIP CODE 91411 STATE ~PI2.IM~ FIe<.. D 0(2.. PROPERTY DESCRIPTION (Lot and l:llocX Numbers, Tax Parcel Number, Legal DescnptJon. etc) LOr IO'? u;..\l\ L.~I-lDIt--t Z-'f-\!) A-D TIO,..J HI-€... "S l..IDE."'7 II 'Z. -I\~:::; ~E-_ BUILDING USE (e g.. HesldentJal, Non-resldentJal, Addition. Accessory, etc. U e Comments section I(n~ary) . ~':::>l Os,..c\ I M- LA TI1'UDE/LONGITUDE (OPTIONAL) ( #If - #If - ## #If' or ## #####') (oJl--O"( p~ ~c..otZ-D~ HORIZONTAL DA1'UM U NAD 1927 U NAD 1983 . SOURCE. U GPS (Type) U USGS Quad Map U Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORM.-\T:ION 81 NFIP COMMUNITY NAME & COMMUNITY NUMBER 82 COUNTY NAME ?'P12-1 l'--lCl,l= 11:=.'-t;:;l 41 S9i2 LA'/-l& 54 MAP AND PANEL 85 SUfFIX 86 FIRM INDEX B7 FIRM PANEL B8 FLOOD NUM8ER DATE . EFFECTIVElREVISED DATE ZONE(S) 41 0 ~"1 <--It (gfa "F" (0- "z .q,..... 0 . Z- ~q -to 1--J.J2.. ~ 610 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9 U FIS Profile U FIRM, t::l Community DetermIned U Other (Descnbe) 811 IndIcate the elevatIon datum used for the BFE In Bg.,.f:9 NGVD 1929 U NAVD 1988 U Other (Descnbe) 812. Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? ~Ignatlon Date j B3 STATE <A::::.C. cON 89 BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) S(Z 4 UYes UNo SECTION C - BUILDING ELEVAT10N INFORMATION (SURVEY REQUIRED) C1 BUilding elevations are based on UConstructlon Drawmgs* l)gBUlldlng Under Constructlon* UFlnlshed Construction "A new Elevation Certificate wIll be required when constructIon of the budding IS complete. C2. BUilding Diagram Number 2- (Select the bUilding diagram most SimIlar to the bUilding for which thIS certIficate IS bemg completed - see pages 6 and 7 If no dIagram accurately represents the building. provide a sketch or photograph.) C3 ElevatIons - Zones A1-A30. AE, AH, A (With BFE), VEt V1-V30, V (WIth BFE). AR. ARiA. ARiAE. ARlA1-A30. ARlAH. ARlAO Complete Items C3a-1 below aceording to the bUilding diagram specified In Item C2 State the datum used If the datum IS different from the datum used for the BFE In Section B. convert the datum to that used for the BFE Show field measurements and datum conversion calculation Use the space provided or the Comments area of Section D or Section G, as appropnate, to document the datum conversion. Datum l-OC/I><<.- ConverslolllComments AD D 0 '30' \1) ux.At- D-A-IU W\.,-o ~ F-e' N. ~ DA\J "^ . Elevation reference mark used<?"F--lZ- WMM%J..L-p;, Does the elevation reference marl< used appe~1 .ilet~w~~~~' ~o o a) Top of bottom floor (mcludlng basement or endosure) C;\~ ~ ft.(~ 1 i pn,!':;.f.'~J!;j'a~AL. .,.. o b) Top of next hIgher floor ~\~ ..Q....ft...) ~ ; l..A!'~b t'H.J~,t~Y<<OR g ~ ~::';f;:: ~~::,":b;"'ctU,"1 member rJ zones on~) ~ {:- . Ie::~ H.-~T(}[ Q eJ ;:'~~:::,;":'J~,~;ach,ne<y and/b' """,pment J"""'" tkN- _ ft (m) if ,.) ,._.o";;~:;~~' ........1.1.. ....\, ,,..: ~ c ....~""'-Il... . o f) Lowest adjacent grade (LAG) J~rIMP ~ _ ft (m) :: ~ 1 JVU 1~ 1S$4. ! Q g) HIghest adjacent grade (HAG) Il..lL011ARM~ _ ft.(m) OJ '\. JONA THAN A. OAKES./" - . ~,,21r.i1 Q h) No. of permanent openmgs (flood vents) within 1 it above adjacent grade n ::l"""" .~hU~. " Q Q Total area of aU permanent opemngs (flood vents) In C3h \q27\ sq. In ( 1 --) ~ D2e- ? ( 2ro2- SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ThIS r.ertlficatlon IS to be signed and sealed by a land surveyor, engineer, or archItect authonzed by law to certrfy elevation information. I c that the mformatJon In SectJons A, a, and C on thIS certIfICate represents my best efforts to interpret the data avaisb/e. I unaerstand that any false statement may be pUnishable by fine or tmpnsonment under 18 US Code, SectJon 1001 CERTIFIER'S NAME \ A riA _ LICENSE NUMBER -.JQ~I'\~ J+. ~~ orz.-E.. L. e;. ~"Z..loS TITLE COMPANY NAME ~J2.~E~""lo~ ~ ~E..."((1'tZ... .f'~E.... ~p."'(eF-.-A2,...-J..~ ...j. ?ve-vE'T'~ (~ ADDRESS CITY STATE \ ZlP CODE .:p 0 ~ z..S"2-i :CChfAJcL 0fL '9,4o"L SIGNA1'URE 1;0\._ tJ 1\ n fl,.) DATE TELEPHONE -----...I~ J-"r \....>> L 4- n 02... S4-I - 4'bS -4st5 IMPORTANT In these spaces, copy the corresponding information from Section A BUILDING STREET ADDRESS (IncludIng Apt , Unit, Suite, and/or Bldg No) OR P 0 ROUTE AND BOX NO ~q~ ~ ~L. CITY STATE ZIP CODE ~ -?f> a..l ~ ~ ~c.t'l 0Y2- 9.'"14'11 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both Sides of thiS Elevation Certificate for (1) community offiCial, (2) Insurance agent/company, and (3) bUlldmg owner COMMENTS uT'( oF -:>P2.c ~ f=t EU.." ~M..A.'2.<<.. D~I~ ~ A c.t+t ~r-~ ~ v~ lA--J. ~ _ ~ P 0'= l\tE ~ AT I\te M,.. DPOI ~ (1f: ~ uftP;. ~~ .a ~ ?~ co<2.~ ~ ~ 1t...l.\'€:A.-::.E:c...TtO....... ~ 0,l):!:- 4- ~\l>1-I- ~ c...cr'-( DA"iUM c:,l'2.."O\ ~t-MA DA'i\JM 'Sl~ \ ~A110l-\ '5ttV\U1J. ~~ ~ ~)J.\,{E:.f2..~ iZ> ~e-.~.A. [)'\-iU f(\ I_I Check here If attachments SECTION E _ BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E 1 through E4 If the Elevation Certificate IS Intended for use as supporting Informatton for a LOMA or LOMR-F, Section C must be completed E1 BUIlding Diagram Number (Serect the bUIlding diagram most Similar to the bUilding for which thiS certificate IS being completed - Sl;le p~ge_s 6 and 7 If no dlaltram _a_c~~rat~y r~l?resents the bUlldmg, prOVide a sketch or photograph) E2 The top of the bottom floor (including basement or enclosure)ofthe bliiTding IS 1-1-1 ft (m) ~1_11l' (cm) I_I above or 1-1 below (check one) the highest adjacent grade (Use natural grade, If available) E3 For BUilding Diagrams 6-8 With openrngs (see page 7), the next higher floor or elevated floor (elevatton b) of the building IS 1_1_1 fl(m) 1_1_11n (cm) above the highest adjacent grade Complete Items C3 hand C3 Ion front of form E4 For Zone AO only If no flood depth number IS available, IS the top of the bottom floor elevated In accordance With the community's f100dplafn manaQement ordmance? 1_1 Yes 1_1 No I_I Unknown The local offiCial must certify thiS Information In Section G SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authOrIZed representative who completes Secttons A, B, C (Items C3 hand C3 I only), and E for Zone A (Without a FEMA-Issued or communrty-Issued BFE) or Zone AO must sign here The statements In SectJons A, a, C, and E are correct to the best of my knowledge PRO....t:r\ I i OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ~F9!" Jnsu,an~ ~mpany-Use:;;i~r:: ~ PCIlICY Numper ~?~i~~~~ Auut(cSS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS I_I Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offiCial who IS authonzed by law or ordinance to administer the communrty's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate Complete the applicable Item(s) and sign below G1 I-I The Information In Section C was taken from other documentation that has been Signed and embossed by a licensed surveyor, engineer, or architect who IS authOrized by state or local law to certtfy elevation information (Indicate the source and date of the elevation data In the Comments area below) G2 1-1 A community offiCial completed Section E for a building located In Zone A (Without a FEMA-Issued or community-Issued BFE) or Zone AO G3 I_I The followmg Information (Items G4-G9) IS proVIded for community floodplain management purposes G4 PERMIT NUMBER I G5 DATE PERMIT ISSUED I G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7 ThiS permIt has been Issued for I_I New Constructton I_I Substanttallmprovement G8 Elevation of as-built lowest floor (including basement) of the bUlldmg IS G9 BFE or (II) Zone AO) depth of floodIng at the bUildIng sIte IS LOCAL OFFICiAl'S NAME _ ft (m)Datum _ ft (m) Datum TITLE COMMUNITY NAME SIGNATURE TELEPHONE DATE COMMENTS '-_I Check here If attachments RI=PI A("'I=~ AI I PRI=\Ilnll~ I=nlTlnN~ I=I=MA I=nrm R1- ':(1 1111 nn