City of Burbank
15o N. Third St , Burbank, CA 91502
Community Development Department
Building and Safety Division
Tel. 818.238.5220
Email: [email protected]
August 28, 2024,
2024
SCREENING FORM
For existing wood-frame multi-family buildings with soft, weak, or open front walls The Screening Form is a requirement of Burbank Municipal Code 9-1-16-400 for the retrofit of existing wood- frame multi-family buildings with soft, weak, or open front walls.
The Screening Form is intended to provide additional information to confirm that a building is in the scope of the ordinance and a retrofit is required or if the building is exempt from further evaluation.
The building information provided in the screening form will be reviewed by the City of Burbank to determine whether the seismic retrofit is required, in accordance with Ordinance xx-xxxx and Title 9, Chapter 1, Article 16, Division 4 of the Burbank Municipal Code.
Instructions
The Screening Form must be completed and submitted to the City for review and approval within 12 months of the date of the Notice to Comply. After review of the submitted Screening Form and supporting documentation, if it is determined that the building is already in compliance with the mandatory requirements of Ordinance No. XX-XXXX; the building will be deemed in compliance and removed from the active list and no further retrofit will be required.
Please note that each building on a parcel requires an individual Screening Form to be submitted to the City within the Compliance timeframe set on the Notice to Comply.
Additional information about the Seismic Retrofit Program can be found at:
https://www.burbankca.gov/web/community-development/soft-story ATTACHMENT 3 - 1
City of Burbank
15o N. Third St , Burbank, CA 91502
Community Development Department
Building and Safety Division
Tel. 818.238.5220
Email: [email protected]
August 28, 2024,
2024
SCREENING FORM
For existing wood-frame multi-family buildings with soft, weak, or open front walls.
Section 1: Building & Owner Information
Building Information:
Building Address:
Parcel Number: Year Built:
Living Units:
No. of Stories
above Grade:
Basement: Full Partial None
Owner Information:
Name:
Mailing Address:
City, State: Zip Code:
Phone: Email:
Condominium owners:
Please submit one screening form and one set of contact information for each building. Please list all lot numbers compromising the building here:
ATTACHMENT 3 - 2
City of Burbank
15o N. Third St , Burbank, CA 91502
Community Development Department
Building and Safety Division
Tel. 818.238.5220
Email: [email protected]
August 28, 2024,
2024
SCREENING FORM
For existing wood-frame multi-family buildings with soft, weak, or open front walls.
Section 2: Scope of Determination & Building Type
Yes No Unknown
1. Was the building’s original permit for construction applied for under Building code standards enacted prior to January 1, 1978?
2. Is the building multi-story of wood-frame construction?
3. Does the building have an open wall line(s) or open ground floor parking on the first floor similar to the configuration(s) exhibited on Page 9? See Section 3.
4. Has the building been previously retrofitted? If yes, complete section 4.
If any of the questions 1 through 3 above are marked No: The building may be exempt from compliance with Title 9, Chapter 1, Article 16, Division 4 of the Burbank Municipal Code.
If question 4 is marked Yes: The building may be exempt from compliance with Title 9, Chapter 1, Article 16, Division 4 of the Burbank Municipal Code.
If ALL three of the questions 1 through 3 are marked Yes/Unknown and question 4 is marked No/Unknown:
The building is subject to compliance with Title 9, Chapter 1, Article 16, Division 4 of the Burbank Municipal Code. Complete Section 3 and 5.
ATTACHMENT 3 - 3
City of Burbank
15o N. Third St , Burbank, CA 91502
Community Development Department
Building and Safety Division
Tel. 818.238.5220
Email: [email protected]
August 28, 2024,
2024
SCREENING FORM
For existing wood-frame multi-family buildings with soft, weak, or open front walls.
Must be completed by a Professional Civil or Structural Engineer or Architect licensed by the State of California.
Section 3: Plan/Elevations Sketches & Photographs
In order to determine the status of the building and its compliance with Title 9, Chapter 1, Article 16, Division 4 of the Burbank Municipal Code, the following documents shall be submitted as attachments and reviewed by the Building and Safety Division.
1) Provide a dimensional and scaled floor plan1 of the ground floor.
The plan shall include the following:
a. A dotted outline of the floor above the ground floor i. include the locations and dimensions of balconies, cantilevers, and setbacks b. Provide labels identifying areas of different use or occupancy c. Indicate north with an arrow and show street names lining the property
2) Provide elevations1 of the perimeter walls indicating size of openings and total length of wall (openings shall include windows, doors, etc.)
a. Indicate wall material (e.g. wood frame, steel frame, concrete, block or brick)
3) Provide photos2 of all perimeter walls
a. Label each elevation depicted in the photo (e.g. north, south, east, west) b. Please provide a date the photo was taken
Upon review of the documents listed above, the Building and Safety Division may require additional information.
Note: 1Documents to be in 8 ½ x11 or 11x17 format only. 2For elevations visible from the street using Google Street View, snapshots will be accepted as long as the entire wall face is visible and not blocked by any obstructions.
ATTACHMENT 3 - 4
City of Burbank
15o N. Third St , Burbank, CA 91502
Community Development Department
Building and Safety Division
Tel. 818.238.5220
Email: [email protected]
August 28, 2024,
2024
SCREENING FORM
For existing wood-frame multi-family buildings with soft, weak, or open front walls.
Section 4: Previous Retrofit
Has a previous seismic retrofit been completed? Yes No
Does the previous completed seismic retrofit meet or exceed the requirements of Title 9, Chapter 1, Article 16, Division 4 of the Burbank Municipal Code? Yes No
If yes, please provide the permit number: Date of Retrofit:
Please attach supporting documentation to include drawings and supporting calculations for review by the Community Building and Safety Division .
List Attachments Below:
ATTACHMENT 3 - 5
City of Burbank
15o N. Third St , Burbank, CA 91502
Community Development Department
Building and Safety Division
Tel. 818.238.5220
Email: [email protected]
August 28, 2024,
2024
SCREENING FORM
For existing wood-frame multi-family buildings with soft, weak, or open front walls.
Section 5: Building Determination, Design Professional Statement, Owner Acknowledgment Building Status of Compliance with Title 9, Chapter 1, Article 16, Division 4 of the Burbank Municipal Code
(Please check 1 box only):
Non- Exempt – In Section 2, questions 1 through 3 are marked Yes/Unknown and question 4 is marked No/Unknown.
Building is to be retrofitted in accordance with
Title 9, Chapter 1, Article 16, Division 4 of the Burbank Municipal Code.
Exempt – In Section 2, any of questions 1 through 3 are marked No or question 4 is marked Yes. Building is not subject to compliance with the ordinance due to the information provided in Sections 2 or all soft, weak, open wall li nes have been p revious retrofitted in compliance with Title 9, C hapter 1, Artic le 16, Division 4 of the Burbank Municipal Code as indicated in Section 4.
Under penalty of Perjury, I certify that the information provided in this screening form is based on my personal review of the building and its records, and is correct to the best of my knowledge.
Date Signed
Engineer, Architect, or Building Owner Name
Telephone
5.2 Owner Acknowledgment
I have reviewed this form and understand the conclusions of this screening form.
Signature Date
ATTACHMENT 3 - 6
City of Burbank
15o N. Third St , Burbank, CA 91502
Community Development Department
Building and Safety Division
Tel. 818.238.5220
Email: [email protected]
August 28, 2024,
2024
SCREENING FORM
For existing wood-frame multi-family buildings with soft, weak, or open front walls.
FOR BUILDING AND SAFETY DIVISION & DEVELOPMENT DIVISION USE ONLY
The Screening Form appears to be complete and is acceptable to the City of Burbank as presented.
The following sections of the Form are incomplete (see below):
Section 1: Building & Owner Information
Section 2: Scope of Determination & Building Type
Section 3: Plan / Elevation Sketches & Photographs
Section 4: Previous Retrofit
Section 5: Statement and Owner Acknowledgment
List additional information that is needed:
Building and Safety Division Reviewer:
Date
ATTACHMENT 3 - 7
City of Burbank
15o N. Third St , Burbank, CA 91502
Community Development Department
Building and Safety Division
Tel. 818.238.5220
Email: [email protected]
August 28, 2024,
2024
SCREENING FORM
Soft, Weak, or Open-Front Building Configurations:
ATTACHMENT 3 - 8