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CITY OF SANTA ANA <br />PLAN CHECK -CHECKLIST <br />JOB ADDRFSR·1044 W Do r h nook <br />TRACKING#: 0 '794 °101 63-9/7 DATE:13- - 3-0-(3 <br />FOR PLANCHECK STATUS CAI-L (714) 647-5800 <br />PLEASE INITIAL EACH ITEM RFI OW <br />-E--1.I agree to pay a plancheck fee established for this project with the understanding that this <br />payment is not a guarantee that a permit will be issued and that this fee is not refundable <br />once a plancheck has commenced. <br />I understand that I may request an "Accelerated Plancheck" at an additional cost to me. <br />This plancheck will be performed by an in-house plan checker with the intention of reducing <br />plancheck time for the Building & Safety Division. <br />-131_ 3.I understand that the project valuation (from which plancheck and permit fees are <br />calculated) will be reviewed during the plancheck process and that said valuation shall be <br />adjusted up or down in accordance with established fee computation regulations. <br />i>f--4-I understand that I shall su6mit separate plans, applicatibns and plancheck fees for the <br />following when plan check is required: <br />a. Electrical Plans - 2 complete sets c. Mechanical Plans - 2 complete sets <br />b. Plumbing Plans - 3 complete sets d. Grading Plans - 3 complete sets <br />I understand that I shall Visit the Public Works Department to verify whether a field <br />inspection of the property is required. 1 understand that prior to the issuance of the Building <br />permit I am required to obtain Public Works Agency approval if my project valuation exceeds <br />$30,000 or has added plumbing fixtures, or added bedrooms, or exceeds 500 sq.ft. <br />AGRFED TO BY APPLICANT OR AGFNT - n <br />Applicant's Signature <br />Print Name €--1-er .L-ul i,,o Addrese / 51 ' E oval,1, ..IL.v r.c #Jz- D <br />Telephone Number (YIll) - 4!-1- 5.39?Fax <br />FOR OFFICE USE ONLY: "Checklist of items discussed" APPROVALS & FEES REQUIRED: Y/N <br />Full-t- 64 <br />1.-215Ianning Department <br />22-Public Works Agency <br />3.1 Fire Departmemt <br />4.- Police Department <br />5._ School District <br />6._ Health Department <br />7.05Title 24 (Energy ) <br />8.Jitle 24 (Disabled Access) <br />9.-klkoof Mounted Equip. <br />10.2flist of Subcontr. <br />11.-k-Bldg. Pmt. Info. <br />12.rSummary of Appr. Req <br />, 13'35FY Information <br />14.-96onstr. Act. Reg. <br />15AM-Res. Dev. Fees <br />16_Mklip <br />17*Microfilming <br />18.-PConst. Debris Recyc. <br />19.0FCWP Surcharge <br />20_ LOA/Owner-Builder Ver. <br />PERMITTECHNICIAN <br />f L- <br />Form 58: 3-26-04 <br />1 <br />11 --