HomeMy WebLinkAbout200 W Santa Ana Blvd Unit# 125 - Misc. PermitPlanning & Building Agency
Building Safety Division
20 Civic Center Plaza
P.o. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-5800
www.santa-ana,org
DISABLED ACCESS COMPLIANCE
DOCUMENTATION FORM
SANIA
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ACC.O1 CBC 2015
A. PURPOSE OF THIS DOCUMENTATION: (check one)
! Finding of unreasonable hardship for prqects UNDER the valuation threshold*
! Finding of unreasonable hardship for prqecb OVER the valuation threshold'
Eacertification of Full Compliance with the 2016 Califomia Building code
. Valuation threshold as defined in the 20'16 Califomia Building Code, Section 1'l8-202.4 (Exception #8) and
Section 202 is $lsga!g? (as ofJanuary 2017)
B. PROJECT INFORMATION TO BE COMPLETED BY PETITIONER:
Project Address:h Ut SA*tr+ AJr -Oerrr. Srr l?f Permil Number:
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Project Description:
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Floor Numberl L
Business Name / owner:
c,CldJW Catn'1 tltm* C42(
Business Phone Number:2t./ PSn r'/((,
Legal Property Owner:M* u*rre Phone Number:1n 267 1,(^
Total --onstruaion eoit or Project valuation:'
$
Cosl of Providing Complete Disabled Access:
$
The cost of all construction contemplated in the determination of the valuation of improvement
threshold based on the valuation of site and building improvements for the last three-year period.
Permit No Valuation of lmprovements
Total
2. 20yo otf01€] Conslruction Cost or Pro.lect Valuation:
3. The actual amount to be spent to provide disabled access
4. Describe the impact of the proposed improvements on financial feasibility of the project
5. Describe the nature of the use of the facility under construction and its availability to persons with
disabilities and the nature of accessibility that would be gained or lost:
s
$
Rev: 1/9/2017 Page 1 ot 2
lssuance Date
6 ldentify the accessibility features and equivalent facilities that Wltt be brought into compliance with
the latest edition of Title 24 as a part of this project and an estimate of the cost of each item:
(Documentation may be required)
Accessible Features to be Made Accessible Cost of lmprovemsnt
a. Entrance
E ooor n Landing E Stairway/Steps ! Ramp $
b. Path of Travel
! Path of travel from accessible parking lo the building entrance
and area of remodel $
E Path of travel to sanitary facililies / public phone / drinking fountain $
E Path of travel from the public way to the building entrance $
c. Sanitary facilities ( Floor no )$
d. Public phone(s)$
e Drinking fountain(s)$
f. Parking $
g. Signage & Alarms $
i. Other:$
$Total:
7. ldentify the accessibility features that WILL NOT comply if a request for unreasonable hardship is
granted. Provide an estimated cost of compliance for each item: (Documentation may be required)
Cost of lmprovement
a $
b $
c.$
$Total:
Print Name LAE PhoneNo. lst-ti{-2q1
Address 7?-or 6 . \r\rEjtriJ ?Mr rj^Jrf U A{tulern
I aDate: a ISignature
Approved by
Rev: 1/9/2017
FOR AGENCY USE ONLY
Date 1-lr-z-
Page 2 ol2
Accessible Features Not to be lmproved
8. Petitioner must be the legal property owner or his/her legal representative:
I certify that the above noted information is true and correct.
E Legal Property owner ! ArchitecuEngineer EliContractor E other: