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¢litf <br />CITY OF SANTA ANA <br />Planning and Building Agency <br />UTHORI Y A�II��d <br />Plan Submittal Criteria Form <br />Required for Single Family or Duplex Residences FOR IT I S ANC E <br />(Use Commercial form for lots with 3+ dwelling units or new residential tracts) <br />Complete the Project Information and Questionnaire below, then sign and date the Appli nt Certification. <br />Master ID: <br />Project Information Date: <br />ORANGE COUNTY FI: <br />❑ New Single Family Residence/Duplex ❑ Addition/Remodel P5kADU <br />Address: -5-11 a2 Unit #: City or Uni corporated County Area: ZIP: <br />�2 <br />Scope of Work: <br />.2 Jvets ADO <br />Existing Area to � �Z Total Resulting Stories: Area Added in Past 2 Years <br />Area: be Added: Area: ((excluding this project): <br />Yes No Questionnaire nCFA Pl.. Tvnn if "V-11 <br />1. <br />rl <br />New — Is this a new single family residence or duplex? <br />"(PR160) Residential Site <br />with Water Availability <br />PR400-402 Fire Sprinkler <br />2. <br />ADU — Is this a new Accessory Dwelling Unit (ADU) on the same property as a house that already has <br />(PR400.402) Fire Sprinkler <br />fire sprinklers or a house that will have fire spriink(ers added as part of thisproject? <br />3. <br />El <br />rffl ® <br />Addition — Is this (A) an addition to a currently sprinklered building, or (B) an addition requiring a fire <br />(PR400-402) Fire Sprinkler <br />sprinkler retrofit based on a threshold set by local ordinance? <br />4. <br />❑ <br />K <br />Distance — Is the most remote portion of the addition, ADU or other detached structure greater than <br />"(PR160) Residential Site <br />140-feet from the fire access roadway? <br />5. <br />g5 <br />Total Area — Will the addition result in a total area of greater than 3,600 square feet (sf) for non- <br />*(PR160) Residential Site -1 <br />sprinklered buildings, or greater than 6,200 st for sprinklered buildings, including the area of all <br />with Water Availability <br />enclosed s aces, such as garages, stairs, and detached structures separated by less than 10-feet? <br />6. <br />❑ <br />Remodel — Is this a remodel of a sprinklered building with a scope of work that includes adding or <br />(PR400.402) Fire Sprinkler <br />removing any interior wails? Nete: If "Yes", then project must be evaluated by a C-16 licensed <br />contractor to determine if a fire s rinkler modification is needed. <br />7. <br />F1 <br />Detached Structure — Is this a new detached utility or accessory structure (not an ADU), such as a <br />"(PR160) Residential Site <br />garage, workshop, game room, pool house, barn, etc., req�iiring fire sprinklers based on a threshold <br />(PR400.402) Fire Sprinkler <br />set by local ordinance? <br />8. <br />Gate — Is a gate being installed across a driveway or road that is designated as a fire department <br />(PR180) Gate <br />access roadway, or a driveway or road that serves more than a single home/duplex? <br />9. <br />Methane — Is project located in or less than 100' from a "Division of Oil, Gas, and Geothermal <br />•(PR160) Residential Site ✓ <br />Resources' (DOGGR) field boundary or well (active or abandoned), less than 300-feet from an oil/gas <br />*(PR172-174) Methane <br />seep, or less than 1000-feetfrom a landfill? (Note: For projects in Yorba Linda, this requirement only <br />Test/Mitigation Plans <br />applies to new homes, enclosed accessory structures, addition to existing structure greater than 1000 <br />sf, and ADU's). <br />10. <br />a <br />Vegetation — Is the property/structure (A) on the perimeter of a community containing, or adjacent to <br />'(PR125) Fuel Modification <br />slopes or hills, or (B) adjacent to an open space or wildland area containing non -irrigated vegetation, <br />(PR182) Accessory <br />or (C) in a State Responsibility Area or Local Responsibility Area "Fire Hazard Severity Zone', as <br />structure <br />defined by the State, or D near an area that could be affected by a wildfire in the open space. <br />araF, . —4. 1 u ucvlc Iaaual IUC vI a yi. AUII Ig[JUIIUII IY IJcrIrIIL mw uuler pans types may ae aererrea suDmRtals. <br />_ Applicant Certification <br />I certify, under penalty of perjury, under the laws of the State o oMl aRhe information above is true: / <br />Print Name: I ��FP, Pt _ Signature: __. ' Date: � 7 ��< <br />Phone Number:_ f-t—o2t� —F{ (5 Email:_- kk�n� A C) C_(�^^� w TC <br />Attention Building Department Staff — After you've verified all questions were answered accurately as "No", then you may accept this signed form as G <br />written release that an OCFA review is not required. If any questions were answered as "Yes", then the plan type on the right side may be required. <br />__If all answers are "No" and the Building Department still requires the applicant to have their plans reviewed by OCFA, or if any answers are "Yes" <br />and the Building Department prefers for OCFA to determine if a review is required, please initial this line and provide an explanation on the Plan Referral <br />Form (on the reverse), to be submitted along with the appropriate plans to OCFA for a determination. <br />For questions and submittal information, please visit ocfa.org, or call OCFA at (714) 573-6100 <br />