Hayward, CA · Alameda County
Seismic Screening Form
Building owners use this form to provide Hayward with screening information about residential buildings that may be covered by the city’s mandatory seismic screening requirements.
What this form is
The form collects parcel, property, owner or agent contact, and building information for screening under Hayward Municipal Code Chapter 9, Article 7. Owners answer questions about each building’s age, dwelling units, stories, and potential target stories, and provide supporting materials where needed. When the screening questions require it, a California-licensed design professional completes and certifies parts of the form.
Who needs it
Owners of buildings that might be subject to Hayward’s mandatory seismic screening requirements use this form to submit parcel and building screening information.
How to submit it
The form says to email it as a PDF attachment to [email protected] with “Seismic Screening Form” in the subject line, or submit a hard copy by mail or in person to the Building Division, 777 B Street, Hayward, CA 94541.
About notarization
This document is signed without a notary; the owner or agent and, when required, design professional certify under penalty of perjury, but no notarial act is requested.
How to submit this form
- 1
Download The Form
Download the Seismic Screening Form PDF.
- 2
Complete Property Information
Enter the parcel, property, owner or agent contact, and building screening information requested on the form.
- 3
Gather Supporting Materials
Include additional Part 3 sheets and supporting materials if needed; the form identifies documentation that may support exemption answers.
- 4
Submit To The Building Division
Email the PDF to [email protected] with the required subject line, or deliver a hard copy by mail or in person to the listed address.
Frequently asked questions
- Do I need a notary for the Seismic Screening Form?
- No. The form has no notary block; the owner or agent and, when required, design professional certify under penalty of perjury.
- How do I submit the Seismic Screening Form?
- Email a PDF to [email protected] with “Seismic Screening Form” in the subject line, or submit a hard copy by mail or in person to the Building Division at 777 B Street.
- What information does the form ask for?
- It asks for parcel and contact information and building details, including construction year, dwelling units, stories, and screening information about target stories.
- When does a design professional complete part of the form?
- The form says a California-licensed design professional must complete specified Part 3 questions and the remaining screening information and Part 4 when the answers to Questions 1, 2, and 3 are all Yes.