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SEISMIC SCREENING CHECKLIST <br />Reviewer Name <br />Total Bldg. Sq. Ft. . <br />Agency <br />Total Lease Sg, Ft.. <br />L6Catign,., <br />HoursofUse <br />1 Ratrofitsince 1976 <br />No further screening required if documentation of retrofit Is provided. <br />2 AO <br />Ty <br />e of Building 8 <br />pe of Con'struIctlon <br />Tilt-Up8aan§ <br />Pre 1933 <br />1933 to 1976 <br />Post 1976 <br />a <br />Score <br />Masonry <br />10 <br />8 <br />1 <br />Reinforced Concrete <br />7 <br />5 <br />1 <br />Wood Frame <br />3 <br />2 <br />1 <br />Steel <br />7 <br />3 <br />1 <br />1 <br />3 .He)g ht„of; Building ;I n. S.tories <br />Max. number of stories allowable for screening is 6. Assign one point <br />per story, La,, 1 min., 6max. <br />Assign points as Indicated for counties as grouped in a, b, & c below <br />(a) 12 points in Los Angeles, West 113 of San Bernardino, <br />Contra Costa, Riverside, Santa Clara, Alameda, Ventura, <br />San Francisco, Merin <br />(b) 9 points in Sonoma, Santa Barbara, San Mateo, <br />Orange, San Diego, Inyo, San Luis Obispo, Napa, Kern, <br />Monterey, Solano, Humboldt, Mendocino <br />(c) 3 points to all other counties not listed above. <br />9✓<! tal Y�! RPR¢P¢i3 � 1 B 14 TEP, <br />YSpI P n0Ww90 tl�pEli#. 9t4ASIR37 Iai; 9�PI rfi <br />fiGH 1�,9 "T .ftl�dit3$2p'i:H� <br />6u gg N7tlSd S fAll R3Si iAt <br />¢I" mud] <br />i4Fi PY41h�1T Nffi <br />All other configurations <br />6 Configuration (Plan View). <br />(1.6) 4 <br />12 <br />9 9 <br />3 <br />7 <br />1 <br />1 3 7 7 7 <br />7 Visible Defects <br />Subjective scoring: 10 points max. assignable for all defects <br />observed. The following list is of typical things to took for. <br />a Dry rot; look for water stains on ceiling tiles and walls. <br />b Damaged foundations; look for large cracks and misalignment <br />c Sagging or shifted beams; look for bowing in center, check for <br />position (parallel) relative to other members <br />d Tilted walls or columns <br />a Corrosion of steel; look for rust, flaking, etc. Check for water stains. <br />f Cracks greater than 1l8" in masonry or concrete <br />g Check for any material that crumbles (wood, plaster, conc., etc) (1-10) <br />TOTAL <br />Total score of 20 or above requires standard seismic certification. <br />Copy of 5olsrec cnecost-eeaea. Js <br />28 <br />