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CITY OF SANTA ANA
<br />Planning and Building Agency
<br />ORANGE COUNTY FIRE AUTHORIT)
<br />Plan Submittal Criteria Form
<br />Required for Single Family or Duplex Residences
<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
<br />Project Information
<br />❑ New Single Family Residence/Duplex ` ,Addition/Remodel
<br />i , ADU
<br />ve
<br />FOR PgInSSIJJ NCE
<br />6kKW :
<br />Date:
<br />❑ Other
<br />Address: 7D, Z i�h S� Unit #: City or Unincorporated County Area: ZIP:
<br />I 1 �'�''I S � 0-7
<br />Scope of Work: fimpo&t A now im Sf hOLA 1DiJ(�s`t7 no e 1 a-1 ri cu ( me-r6112- to tic
<br />4MC1,eG1 +0 20D M Ps (ICOMP S r Mai h me A lob r -"X
<br />Existing Area to I Cp1 Total Resulting Stories: Area Added in Past 2 Years
<br />Area: be Added: 4 b b V Area: I l (excluding this project):
<br />Yes No
<br />Questionnaire
<br />OCFA Plan Type if "Yes"
<br />1.
<br />❑
<br />[A
<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 />firesprinklers or a house that will have firesprinklers added as part of thisproject?
<br />3.
<br />Ei
<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 />El
<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 />Ei
<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
<br />sprinklered buildings, or greater than 6,200 sf for sprinklered buildings, including the area of all
<br />with Water Availability
<br />enclosed spaces, such as garages, stairs, and detached structures separated by less than 10-feet?
<br />6.
<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 walls? Note: If "Yes", then project must be evaluated by a C-16 licensed
<br />contractor to determine if a firesprinkler modification is needed.
<br />7.
<br />i571
<br />LP
<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., requiring 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 />. j�
<br />Methane - Is project located in or less than 100' from a "Division of Oil, Gas, and Geothermal
<br />'(PR160) Residential Site
<br />11''--'"'
<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-feet from 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 />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 opens ace.
<br />"OCFA approval required before issuance of a grading/building permit. All other plans types may be deterred submittals.
<br />Applicant Certification
<br />I certify, under penaltyv✓�of perjury, under the laws of the to of Cali nfa, that the information above is true:
<br />Print Name: Y I ? -�1 I 1 rt, d d Signature: Date:
<br />Phone Number: Hsi) 1407 - 1l31 Email: G
<br />Attention Building Department Staff - After you've verified all questions were answered accurately as "No", then you may accept this signed form as a
<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
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