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CITY OF SANTA ANA <br />ELEVATION CERTIFICATE Planning and Building Agency <br />IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGE 1-11 <br />Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.: <br />FOR <br />INSURANW ""L&E <br />5410 W Kedge Avenue, Unit #2 <br />Polic <br />Nu a F, f� PERMIT ISSUAN <br />City: Santa Ana State: CA ZIP Code: 92704 <br />Company <br />NAIC Number: <br />SECTION H — BUILDING'S FIRST FLOOR HEIGHT INFORMATION FORA <br />Lam% <br />(SURVEY NOT REQUIRED) (FOR INSURANCE PURPOSES ONL <br />)Date: <br />The property owner, owner's authorized representative, or local floodplain management official may comp) <br />to determine the building's first floor height for insurance purposes. Sections A, B, and I must also be completed. Enter heights to the <br />nearest tenth of a foot (nearest tenth of a meter in Puerto Rico). Reference the Foundation Type Diagrams (at the end of Section H <br />Instructions) and the appropriate Building Diagrams (at the end of Section I Instructions) to complete this section. <br />H1. Provide the height of the top of the floor (as indicated in Foundation Type Diagrams) above the Lowest Adjacent Grade (LAG): <br />a) For Building Diagrams 1A, 1B, 3, and 5-8. Top of bottom ❑ feet ❑ meters ❑ above the LAG <br />floor (include above -grade floors only for buildings with <br />crawlspaces or enclosure floors) is: <br />b) For Building Diagrams 2A, 213, 4, and 6-9. Top of next ❑ feet ❑ meters ❑ above the LAG <br />higher floor (i.e., the floor above basement, crawlspace, or <br />enclosure floor) is: <br />H2. Is all Machinery and Equipment servicing the building (as listed in Item H2 instructions) elevated to or above the floor indicated by the <br />H2 arrow (shown in the Foundation Type Diagrams at end of Section H instructions) for the appropriate Building Diagram? <br />❑ Yes ❑ No <br />SECTION I — PROPERTY OWNER (OR OWNER'S AUTHORIZED REPRESENTATIVE) CERTIFICATION <br />The property owner or owner's authorized representative who completes Sections A, B, and H must sign here. The statements in Sections <br />A, B, and H are correct to the best of my knowledge. Note: If the local floodplain management official completed Section H, they should <br />indicate in Item G2.b and sign Section G. <br />❑ Check here if attachments are provided (including required photos) and describe each attachment in the Comments area. <br />Property Owner or Owner's Authorized Representative Name: <br />Address: <br />City: State: ZIP Code: <br />Telephone: Ext.: Email: <br />Signature: Date: <br />Comments: <br />=E <br />FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 6 of 8 <br />