What does the screening form ask about?

It requests building and owner information, then asks about the building’s age, rental units, wood-frame target stories, and compliance tier. A design professional may need to complete specified answers.

Who must complete this form?

The owner of each subject building, or the owner’s authorized agent, must complete and submit it. The form is required even if the building has already had voluntary seismic strengthening.

How do I submit the seismic retrofit screening form?

Email the completed form as a PDF attachment to building@cityofmillvalley.gov with “Screening Form Submittal” in the subject line. The form lists December 15, 2024, as the submission date.

Mill Valley, CA · Marin County

No notary required

Wood-Frame Target Story Seismic Retrofit Program Screening Form

Property owners or their authorized agents complete this form to screen a building for Mill Valley’s wood-frame target story seismic retrofit program.

What this form is

Mill Valley requires the owner of each subject building, or the owner’s authorized agent, to complete and submit this screening form, even if the building was already voluntarily strengthened. It asks for property and owner details and answers about the building’s age, rental units, target stories, and compliance tier. Depending on the answers, a California-licensed architect or civil engineer must complete part of the form.

Who needs it

Owners of subject buildings, or their authorized agents, must submit the form; a licensed design professional completes specified sections when the answers require it.

How to submit it

Email the completed form as a PDF attachment to [email protected] with “Screening Form Submittal” in the subject line. The form lists December 15, 2024, as the submission date.

About notarization

This form is signed without a notary; Sections 5 and 6 contain certifications under penalty of perjury, and the applicable signer signs and dates the section.

How to submit this form

1
Download The Form
Download the Wood-Frame Target Story Seismic Retrofit Program Screening Form and its separate instructions.
2
Complete Building Information
Fill in the property and owner details, answer the screening questions, and complete the applicable owner or agent statement.
3
Gather Professional Information
If the form’s answers require it, have a California-licensed architect or civil engineer complete the specified sections.
4
Email The Form
Email the completed form as a PDF attachment to [email protected] with “Screening Form Submittal” in the subject line.

Frequently asked questions

What does the screening form ask about?: It requests building and owner information, then asks about the building’s age, rental units, wood-frame target stories, and compliance tier. A design professional may need to complete specified answers.
Who must complete this form?: The owner of each subject building, or the owner’s authorized agent, must complete and submit it. The form is required even if the building has already had voluntary seismic strengthening.
Do I need a notary for the seismic retrofit screening form?: No. The form is signed without a notary, though Sections 5 and 6 contain certifications under penalty of perjury and require the applicable signer’s signature and date.
How do I submit the seismic retrofit screening form?: Email the completed form as a PDF attachment to [email protected] with “Screening Form Submittal” in the subject line. The form lists December 15, 2024, as the submission date.

Need something notarized?

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