Form Ds-2123 - Determination Of Unreasonable Hardship Exception To Accessibility Requirements - City Of San Diego Development Services - 2016

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FORM
City of San Diego
Determination of Unreasonable
Development Services
DS-2123
Hardship Exception to
1222 First Ave., MS-401
San Diego, CA 92101
Accessibility Requirements
(619) 446-5000
J
2016
anuary
Project Address:
Project Number:
D
e
w
w
i
c
w
w
oes
lement
ill this
hAt
s the
ost
hAt is the
ill this
c
e
m
m
A
e
c
omply with
lement bE
ADe
of
Aking this
mount will
lement
omply
A
A
?
e
s
m
e
ccessibility
ccessible
lement
penD on
Aking
by
quivAlent
A
e
ccessibility
lements
R
?
A
?
e
f
?
(y
), (n
)
equiRements
ccessible
lement
AcilitAtion
es
o
A
?
(y
), (n
)
(y
), (n
)
ccessible
es
o
es
o
1. Entrance:
_______________ _______________
$ _____________
$ _____________
_______________
(Doors, doorways, gates, ramps, etc.)
2. Route to the altered area:
_______________
_______________
$ _____________
$ _____________
_______________
a. Doors, doorways, gates
_______________
_______________
$ _____________
$ _____________
_______________
b. Corridor
_______________
_______________
$ _____________
$ _____________
_______________
c. Elevator/Platform lift
_______________
_______________
$ _____________
$ _____________
_______________
d. Ramps
_______________
_______________
e. Stairways
$ _____________
$ _____________
_______________
3. Toilet facilities:
_______________
_______________
$ _____________
$ _____________
_______________
a. Men
_______________
_______________
$ _____________
$ _____________
_______________
b. Women
_______________
_______________
$ _____________
$ _____________
_______________
C. Unisex
_______________ _______________
$ _____________
$ _____________
_______________
4. Telephones
_______________ _______________
$ _____________
$ _____________
_______________
5. Drinking fountains
6. Parking:
_______________
_______________
$ _____________
$ _____________
_______________
a. Removal of ramp from aisle
_______________
_______________
$ _____________
$ _____________
_______________
b. New curb ramp
_______________
_______________
$ _____________
$ _____________
_______________
c. Re-Striping
_______________
_______________
$ _____________
$ _____________
_______________
d. Detectable warnings
_______________ _______________
$ _____________
$ _____________
_______________
7. Fire alarm system
_______________ _______________
$ _____________
$ _____________
_______________
8. Signs
_______________ _______________
$ _____________
$ _____________
_______________
9. Pedestrian walk
A
b
e
(
):
DDitionAl
uilDing
lements
specify
10. ______________________________
_______________ _______________
$ _____________
$ _____________
_______________
11. ______________________________
_______________ _______________
$ _____________
$ _____________
_______________
_______________ _______________
$ _____________
$ _____________
_______________
12. ______________________________
EQUIVALENT FACILITATION: For the following elements the cost of compliance with Section 11B-202.4 is an unreasonable
hardship. However, accessibility compliance of such elements will be provided by equivalent facilitation as specified below for
the cost noted:
________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
(A)
Total amount will spend on making the noted elements accessible,
$____________________________
PRECENDING THREE-YEAR ALTERATIONS: List project number of all improvements to the proposed area and all areas
on the same path of travel with their construction cost for the preceding three years
1
:
_____________________________________________________________________________________________________________________
(B)
Total cost of alterations (preceding 3-year period)
,
$____________________________
1
(C)
Construction cost of this project,
$____________________________
2, 3,
$150, 244.00
Dollars
> <
(B
C)
4
Adjusted construction cost of this project,
+
$____________________
Valuation Threshold
(YEAR 2016)
[(A) ÷ (B+C)]
Total Cost of Compliance in Percentage of the Adjusted Construction Cost,
x 100= ______________ percent
Printed on recycled paper. Visit our web site at
Clear Page 1
Upon request, this information is available in alternative formats for persons with disabilities.
DS-2123 (01-16)

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