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Plrnlling & Building A8.Dc! <br />BuildiDE Agcncr., DilisioD <br />20 ( ivic C.ntcr Pl.r. <br />P.O Bor l9Et {\l.l9) <br />s.trr.tD..(A9270! <br />(7tl) 617-580{) <br />CITY OF SANTAANA <br />PLAN CHECK. CHECKLIST <br />L.+ qe70 <br />c656 DATE:t /6/ar <br />FOR PLAN CHECK STATUS <br />Visit http://www.santa-ana.org/pb or Call (714) 647-5800 <br />PLEASE REAO 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 />mmputation regulations, <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; project has added plumbing fixtures; added bedrooms,or project exceeds 500 sq. fl. <br />I understand that prior to the issuance ofthe Building Permit, lam 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 />JOB ADDRESS: <br />TRACKING #: <br />h*, I <br />3 <br />[uq <br />4tt <br />A^ <br />2 <br />lro 5. 9u<,rn 7l lonla A^o <br />A,!t 5 <br />64b <br />Applic€nt's Signature <br />Print Name <br />Telephone Number <br />1 )(flanning Department <br />2.Sublic Works Agency <br />3. / Fire Deoartment <br />4. 7 Potice department <br />5. _ School District <br />6. _ Health Department <br />7. - OC Sanitation District <br />PERMIT TECHNICIAN <br />Rev 1/23/20 <br />Llt -q tr --7 4t< <br />8._ Tfle 24 (Disabled Access) <br />9._ Title 24 (Energy) <br />10._ Roof Mounted Equip. <br />1 1._ Grease lnterceptor <br />12._ List of Subcontractors <br />1 3._ Const. Debris Recyc. <br />EZL1 Nowner-Builder Ver. <br />Address: 71 I 1 7.. l"' f o^lcn l)r <br />Email:trn< utQe. c u fo r c q' l u l u-l; e i, 5 " c r 14 <br />1D<6M|P Fee <br />1 6,-64616616;nn/ scannrng Fee <br />17.- Res. Dev. Fees <br />18._ FCWP Surcharge Fee <br />19._ Fire Facality Fee <br />FOR OFFICE USE ONLY: "Checklist of items discussed" APPROVALS & FEES REQUIRED <br />(714t 6/7-5804 <br />(714't U7-fi74 <br />(714) 57&6100 <br />(714) 647-5840 <br />q