FLOOD ZONE- 5410 & 5412 W Kedge Ave - Plan

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CITY OF SANTA ANA ELEVATION CERTIFICATE Planning and Building Agency IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGE 1-11 Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.: FOR INSURAIW ""L&E 5410 W Kedge Avenue, Unit #2 Polic NuF„Q :PERMIT ISSUAN City: Santa Ana State: CA ZIP Code: 92704 Company NAIC Number: SECTION G — COMMUNITY INFORMATION (RECOMMENDED FOR COMMUNITY OF 6JAIttfid&PLETION, The local official who is authorized by law or ordinance to administer the community's floodplain managem nt ordinance can complete Section A, B, C, E, G, or H of this Elevation Certificate. Complete the applicable item(s) and sign below whim! G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by state law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.a. ❑ A local official completed Section E for a building located in Zone A (without a BFE), Zone AO, or Zone AR/AO, or when item E5 is completed for a building located in Zone AO. G2.b. ❑ A local official completed Section H for insurance purposes. G3. ❑ In the Comments area of Section G, the local official describes specific corrections to the information in Sections A, B, E and H. G4. ❑ The following information (Items G5—G11) is provided for community floodplain management purposes. G5. Permit Number: G6. Date Permit Issued: G7. Date Certificate of Compliance/Occupancy Issued: G8. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G9.a. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum: G9.b. Elevation of bottom of as -built lowest horizontal structural member: ❑ feet ❑ meters Datum: G10.a. BFE (or depth in Zone AO) of flooding at the building site: ❑ feet ❑ meters Datum: G10.b. Community's minimum elevation (or depth in Zone AO) requirement for the lowest floor or lowest horizontal structural member: ❑ feet ❑ meters Datum: G11. Variance issued? ❑ Yes ❑ No If yes, attach documentation and describe in the Comments area. The local official who provides information in Section G must sign here. I have completed the information in Section G and certify that it is correct to the best of my knowledge. If applicable, I have also provided specific corrections in the Comments area of this section. Local Official's Name: Title: NFIP Community Name: Telephone: Ext.: Email: Address: City: State: ZIP Code: Signature: Date: Comments (including type of equipment and location, per C2.e; description of any attachments; and corrections to specific information in Sections A, B, D, E, or H): No FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 5 of 8