HomeMy WebLinkAbout101107928 - PermitA. PURPOSE OF THIS DOCUMENTATION: (check one)
DISABLED ACCESS COMPLIANCE
DOCUMENTATION FORM
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.Iffi"'o''-01
! findlng of unreasonable hardship for prgecb UNOER the valuation threshold'
E ;!iading of unreasonable hardship for prorecls OVER the valuation threshold*
Ef Certification of Full Compliance with the 20 l9 Califomia Building Code
st1 06
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' Valuation threshold as defined in the 2019 Califomia Building Code, Section 118-202.4 (Exception #8) and
Section 202 is lllf,g!!!Q! (as of January 2021 )
B. PROJECT INFORMATION TO BE COMPLETEO BY PETITIONER:
Proiect Address 21rl s (6R't re. *t+ C
Permit Number
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Project Descnption:
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Floor Numbere
Business Namg / Owner:
CAf-al rL€(trA l-€r9 vwv Sr CoS f ,.o o. To(to-e)
Business Phone Numberl
111 -)21 -tS lS
Legal Properly Ownor Phone Number
Tolal Constructron Cost or Ploject Valuation
$* 9r, <",c,Cost of Providing Complete Dis€bled Access$ /r! LL o \e!>
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 lssuance Date Valuation of Improvements
Total
4. Describe the impact of the proposed improvements on financial feasibility of the prolect
s
$
5. Describe the proposed improvements related to accessibility upgrades on this project
C.A<C ar: 6 \5\(czyt P(
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/ 0ll o-7? 2 I Raenc.1*Page 1 of 2
,-,SANTA
NAqtl*
Planning & Building Agency
Building Safety Oivision
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-s800
www.santa-ana.org
2. 2oo/o ol fo|,l Construction Cost or Project Valuation:
3. The actual amount to be spent to provide disabled access:
Rev: 05l20l2O21
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 thecostof eachitem: (Documentation
may be required)
Total
e
Total:
8. Petitioner must be tho legal property owner or his/her legal representative
I certify that the above noted information is true and correct.
! Legal Property Owner E ArchitecUEngineer ! Contractor E Other
Print Name: Phone No.
Signature Date: /0 -6 2/
Approved by
Accessible Features lo be Made Accessible Cost of lmprovement
a. Entrance
$E ooor E Landing ! Stairway/Steps E Ramp
b. Path of Travel
s! Path of travel from accessible parking to the building entrance
and area of remodel
$E Path of travel to sanitary facilities / 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. Drinkingfountain(s)
f. Parking
$g. Signage & Alarms
$i. Other:
$
Accessible Featuros Not to be lmproved Cost of lmprovement
a $
$
$c
$
Rev 05120t2021
Date
Page 2 of 2
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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)
av
Address:
b.
FOR AGENCY USE ONLY