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NT: In these spaces,copy the.t o esponding Information from Section A For insurance Company use: F ING STREET ADDRESS(Including Apt.,Unit,Suite,andlor Bldg.No OR P.O.ROUTE AND BOX NO. Policy Number 800 W. MOSSDALE ROAD X CIT' STATE _ ZIP CODE Company NAIC Number LATHROP CA 95330 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. COMMENTS PORTABLE OFFICE BUILDING WITH TELEPHONE & ELECTRIC UTILITIES LOWEST ELECTRICAL PORTION IS BOTTOM OF ELECTRICAL PANEL. ELECTRICAL OUTT FTS_26 H ELECTRICAL RANE.T. 97 R I I Check here it attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE),complete Items E1.through E5. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,Section C must be completed. Et.Building Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed– see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) E2.The top of the bottom floor(including basement or enclosure)of the building is 1-1-1 ft. (m)1-1-1 in.(cm) 1-1 above or L-1 below (check one)the highest adjacent grade. (Use natural grade,if available.) E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is 1—I—I ft-(m)1-1—lin. (an)above the highest adjacent grade. Complete Items C3.h and C3.11 on front of form. E4.The top of the platform of machinery andfor equipment servicing the building is 1-1-1 ft.(m)1-1-1 In.(cm)1-1 above or 1-1 below (check one)the highest adjacent grade. (Use natural grade,H available.) E5.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 11 Yes 1_1 No I I Unknown The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners authorized representative who completes Sections A.B,C(Items C3.h and C3.i only),and E for Zone A (without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements in Sections A,B, C, and E are correct to the best ofany knowled e. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME AG–CON–BUILDING OWNER ADDRESS - CITY STATE ZIP CODE 700 W MOSSDALE ROAD LATHROP CA 95330 ,SIGNATURE\ f� S JUNE 10 2003 TEi t5%9oil T606-8197 COMMENTS )y I—I Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can compfelllbb Sections A,B.C(or E),and G of this Elevation Certificate. Complete the applicable items)and sign below. G1. The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor; engineer,or architect who is authorized by state or local law to certify elevation information. (indicate the source and date of the elevation data in the Comments area below.) G2.1-1 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3. 1-1 The following information(Items G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED G7.This permit has been issued for. L1 New Construction 1_1 Substantial Improvement G8.Elevation of as-built lowest floor(including basement)of the building is: _R(m) Datum: G9.BFE or(in Zone AO)depth of flooding at the building site is: —ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS __ I I Check heral(attachments FEMA Form 81-31,January 2003 Replaces hprevrow•en+itions