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Pl..ning & aoildinS rgln.t <br />Building Agcno Divisiotr <br />,0 CiYic (.nt.r Plrz, <br />P.O Aot t988 (\I-!9) <br />Srnla {trr. ( ..\ 92702 <br />(?l{) 5.17-5800 <br />CITY OF SANTAANA <br />PLAN CHECK. CHEGKLIST <br />JOB ADDRESS:tolo U). lU r.can-l-:c.rrL Bu.r o +..lL <br />TRACKING #: I ott 03b3t DATE:(r/;E <br />FOR PLAN CHECK STATUS <br />Visit http://www.santa-ana.org/pb or Call (71 4) 647-5800 <br />PLEASE READ AND INITIAL EACH ITEM BELOW <br />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. This <br />plan check may be performed at an additional cost with the intention of reducing <br />plancheck time for the Building & Safety Division. <br />I understand that the project valuation will be reviewed during the plancheck process and <br />that said valuation shall be adjusted up or down in accordance with established fee <br />computation regulations. <br />15 <br />E-, <br />/-.'/ 4. <br />/-u <br />I understand that I shall submit for <br />Mechanical, Electrical. Plumbing, Solar and Grading when plan check is required. <br />I understand that prior to the issuance of the Building Permit, I am required to obtain <br />Public Works Agency approval if any of the following apply: project valuation exceeds <br />$30,000; prolect has added plumbing fixtures; added bedrooms,or project exceeds 500 sq. ft. <br />I understand that prior to the issuance of the Buildang Permit, I am required to obtain <br />Public Works Agency approval if my project valuation exceeds $50,000 and that a <br />backflow device may be required. Please call (714) 647-3320 for further information. <br />6 <br />Applicant's Signature <br />printName: k pP ffil.,{.,qa?--lub o *rw Pl- <br />4u fe Wc Se r,/ rcz5' Ss ca l' ca'u- <br />15._ SMIP Fee <br />'l 6.=-fllfcrofi lming/ scanning Fee <br />17.- Res. Dev. Fees <br />18._ FC\ /P Surcharge Fee <br />19._ Fire Facility Fee <br />Address <br />Email <br />FOR OFFICE USE ONLY: "Checklist of items discussed" APPROVALS & FEES REQUIRED <br />'1. Y Planning Department <br />2. _ Public Works Agency <br />3. _ Fire Department <br />4. - Police Department <br />5. _ School District <br />6. _ Health Department <br />7. - OC Sanitation District <br />8._5itle 24 (Disabled Access) <br />9.- Title 24 (Energy) <br />10._ Roof Mounted Equip. <br />1 1._ Grease lnterceptor <br />'12._ List of Subcontractors <br />13._ Co49t. Debris Recyc. <br />14. '-'t:6 N:l.ttner-B u ild er Ver <br />aQ.*=- <br />(7',t4) 6/-7-580/. <br />(714) 647-fi74 <br />(714) 571610O <br />(71416/.7-5840 <br />t <br />PERMIT TECHNICIAN <br />Rev 1/23120 <br />.r//3. <br />Tetephone,urro"l. <br />-T tA' ( l3 - -J 3u,-r