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plot; A <br />r4Li.���•a'aLcs��as.�jsMii4�"tyari -1 <br />answers are "No" <br />Print Name., <br />to- <br />Plione Number:. <br />NIS <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 />I <br />act Information and Questionnaire below, then sign and date the Appli <br />roject Informati <br />ngle Family Residence/Duplex Addifion/Remode <br />Yes No Questionnaire OCFA Plan Type it "Yes" <br />*(PR160) Residential Site <br />� New — Is this a new single familyresidence or duplex? t"M WaterAVa ilabllity <br />PR400-402 Flre Spnnkler <br />Nam 26 � e ADU — Is this a new Accessory Dwelling Unit (ADU) on the same property as a house that already has (PR40"02) Fire Sprinkler <br />fire s rinklers or a house that will have firespn*nklers added aspart of this.Rroject? - -- <br />341 � �j Addition — Is this (A) an addition to a currently sprinklered building, or (B) an addition requ- - -- - - - iring a fire (pR400-4�2J Fire Spnnkler <br />spnnkler retrofit based on a threshold set bV local ordinance?am 0 - dif I R160 Residential Site <br />4. E:1 � Distance — Is the most remote portion of the addition, ADU or other detached structure greater than (P 1 <br />1404,,feet from the fire access roadway? <br />Total Area — Will the addition result in a total area of greater than 3,600 square feet (sfl for non- '(PR160) Rmdentia1 <br />l Site <br />sprinklered buildings, or greater than 6,200 sf for sprinklered buildings, including the area of all � WaterAvailability <br />enclosed s Paces, such asgara es, stairs, and detached structures se arated b less than 10-feet? <br />6. � �j Remodel — Is this a remodel of a sprinklered bullding with a scope of work that includes adding or (PR400442) Fire Sprinkler <br />91 <br />removing any interior walls? Note: If "YesN, then project must be evaluated by a C-1 6 licensed <br />contractor to determine if a fire spnnkler modification i-s needed. <br />7. Detached Structure — Is this a new detached utility or accessory structure not an ADU), such as a ;(PR160) RidenISite <br />garage, workshop, game room, pool house, ba etc., requiring fire sprinklers based on a threshold (PR4004q Fire Sprinkler <br />set by ocalordinance? - ---d - -- - <br />Gate—lsa gate being installed across a driveway or road that is designated as a fire depa ent (PRI Gate <br />access roadwa , or a drivewa or road that serves more than a single home/duptax? <br />9. Methane j Is project located in or less than 100' from a "Division of Oil, Gas, and Geothermal '(PR160) R�Idential Site <br />Resources (DOGGR) field boundary or well (active or abandoned), less than 300-feet from an oil/gas ;�PRtTF-174) Methane <br />seep, or less than I 000-feet from a landfill? (Note: For projects in Yorba Linda, this requirement only Testglffgatfon Plans <br />applies to new homes, enclosed accessory structures, addition to existing structure greater than 1000 <br />S and ADU's . <br />10. Vegetation moo S e propesruc's <br />ture (A) on the perimeter of a communty conRaining, or adjacent to ;(PRi2� Fuel Modulkaeon <br />slopes or hills, or (B) adjacent to an open space or Meldland area containing non-irrigated vegetabon, <br />R182) Accessory <br />or C) in a State Responsibility Area or Local Responsibility Area "Fire Hazard Severity Zone', as <br />Sbuch,re <br />III <br />defined b the State, or D near an area that could be effected by awl re in the o en spaceft <br />*OCFA approval requrequiredre issuance of a grading/building perm. All other plans types may be defamed submittals. <br />Applicant e <br />certify, under penalty pe►jury, under the laws of the Styofr) <br />L <br />MOMWO <br />L'004% <br />Signature: <br />Email. <br />of Ca Mi�, <br />irbs, tod000 t!5 <br />at thelnfamaon above is true: <br />0 <br />Date: <br />Attention Building Department Staff —After you've verified all questions were answered accurately as "No", then you may acceptpt ththissigned fo asis <br />written release that an OCFA review ie not required. If any questions were answered as "Yes", then the plan type n the <br />�li all <br />rmin#4 i <br />ra r I <br />and the BuildingUP01{MO" Ji o bet Bubm e <br />d a onh with tlheeappropri <br />Form (on the reverse), <br />and the Building-epa men stIl <br />ay be require <br />I requires the applicant to have their plans reviewed by 0GFA, or if any answers are "Yes" <br />a review is required, please initial this line and provide an explanation on the Plan Referral <br />Ate plans to OCFA for a determination. <br />For questions and SLIbmittal infomialion, plc:asc visit ocfa om, <br />or cell OCFA at (714) 573,,6100 <br />