Who can request a seismic retrofit deadline extension?

The owner of a subject building or the owner’s authorized agent may apply for a six-month extension of one or more compliance deadlines.

What must I include with the extension request?

Include supporting documentation related to an accepted reason for the request. The building must already have an assigned Compliance Tier.

Do I need a notary for this seismic retrofit extension request?

No. The form requires the owner or agent to sign and date an affidavit under penalty of perjury, but it does not require notarization.

How do I submit the seismic retrofit extension request?

Email the completed form as a PDF attachment to building@cityofmillvalley.gov with “Request for Extension” in the subject line. The document states a non-refundable $185 processing fee.

Mill Valley, CA · Marin County

No notary required

Wood-Frame Target Story Seismic Retrofit Program Request for Extension of Compliance Deadlines

Building owners or their authorized agents use this application to request a six-month extension of one or more seismic retrofit program compliance deadlines.

What this form is

Mill Valley building owners or their authorized agents can use this application to request a six-month extension of one or more deadlines under the Wood-Frame Target Story Seismic Retrofit Program. The building must already have an assigned Compliance Tier, and the request must include supporting documentation tied to an accepted reason. The form asks for building and owner information, compliance status, the reason for the request, and an owner or agent affidavit.

Who needs it

An owner of a subject building, or the owner’s authorized agent, needs this application to request an extension of a retrofit compliance deadline.

How to submit it

Email the completed form as a PDF attachment to [email protected] with “Request for Extension” in the subject line. The document states a non-refundable $185 processing fee.

About notarization

This document is signed without a notary; the owner or agent signs and dates an affidavit under penalty of perjury, and supporting documentation is required.

How to submit this form

1
Download The Application
Download the Wood-Frame Target Story Seismic Retrofit Program extension request.
2
Complete The Form
Provide building and owner information, your Compliance Tier and status, and the basis for requesting an extension.
3
Gather Supporting Documentation
Include documentation that supports your selected reason for the extension request.
4
Sign And Date
The owner or authorized agent must sign and date the affidavit under penalty of perjury.
5
Email The Request
Email the completed form as a PDF attachment to the Building Department with “Request for Extension” in the subject line.

Frequently asked questions

Who can request a seismic retrofit deadline extension?: The owner of a subject building or the owner’s authorized agent may apply for a six-month extension of one or more compliance deadlines.
What must I include with the extension request?: Include supporting documentation related to an accepted reason for the request. The building must already have an assigned Compliance Tier.
Do I need a notary for this seismic retrofit extension request?: No. The form requires the owner or agent to sign and date an affidavit under penalty of perjury, but it does not require notarization.
How do I submit the seismic retrofit extension request?: Email the completed form as a PDF attachment to [email protected] with “Request for Extension” in the subject line. The document states a non-refundable $185 processing fee.

Need something notarized?

This Wood-Frame Target Story Seismic Retrofit Program Request for Extension of Compliance Deadlines doesn’t need a notary — but if you have another Mill Valley form that does, a commissioned online notary can help.