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CITY OF SANTA ANA <br />Planning and Building Agency <br />»• Storage - Merchandizing: Area > 500sf with items located high r than I' <br />/ high -hazard commodities, such as plastic, rubber, foam, etc.) pp <br />A roved <br />� <br />12• Storage -Use/Research with Flammable/Combustible Liqui r-RMIT' ISSUANCE <br />O Motor vehicles/aircraft maintenance/repair; Ll Cabinetry /wo clvmrking / <br />finishing facility; (Note: provide Chem Class + floor planlArchite,,.., tural for 14 <br />occupancy; Special Equipment plan may be needed) Master ID: <br />13• Use -Size &Gathering Type (Check all that apply): In room > 1000 sf for PFZ %� <br />� training/ adult education), or > 49 people for: ODrinking/Dining"r-%Uc;tctiLlUll, <br />O Meeting; 0 Training; O Religious function; 0 Other gatherings <br />14• Use -Healthcare/Outpatient Services: For > 5 people, who may not be able to PR 2xx <br />� immediately evacuate without assistance <br />15• Use - Education/Minors: For children (academic tutoring for age 5+ exempt PR 2xx <br />� unless classified as "E"Occupancy by Building Official) <br />16• � Use -Special Occupants (check all that apply): ❑Adult /Chi[d Daycare; O 24-hr t PR 2xx <br />Care! Supervision; ❑Incarceration or Restraint <br />»• � Use -Congregate Housing/Dormitories: For 17 +people PR 2xx <br />18• / Use -High Rise: Hi -Rise structures (55+ ft to highest occupied floor) PR 2xx <br />19• / Water -Hydrants: Add, relocate, or modify fire hydrants PR 470 <br />209b Water -Underground: Install, modify or repair Underground, Backftow PR 470 <br />Preventers, Fire Dept. Connection for private fire hydrant/ sprinkler/standpipe <br />systems <br />21• , / ,Water -Sprinklers: New installation or Modification of Existing Sprinkler system PR 4xx <br />•Note: Listed Fee Codes are probable startingpoints <br />Applicant Certification <br />Icertify, under the penalty of perjury, under the laws of the State of California, that the information above is true: <br />Print Name: , \0aw 1 <br />Phone #: <br />Signat"Ure: <br />Email: 'kl)Artaed%asa r <br />ci�+s+•c� Date: �JLtk I1o}5 <br />Attention: Building Department <br />If you want 0CFA to review this project for any reason, regardless of Screening Form information, please <br />initial and complete the following (customers must upload when submitting plans online): <br />City (or County) Staff Contact Name: Title: <br />Email: <br />Reason: <br />Phone Number: Date: <br />Initals: <br />* Alternatively, City and County staff may contact OCFA staff directly, send an email to <br />FrontCounter@ocfa.org or leave a message at (714) 573-6100. <br />2 <br />