Disabled Access Compliance Documentation Form - City Of Santa Ana Page 2
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24. Identify the accessibility features and equivalent facilities that WILL 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 Improvement
a.
Entrance:
Door
Landing
Stairway/Steps
Ramp
$
b.
Path of Travel:
Path of travel from accessible parking to the building entrance
$
and area of remodel
Path of travel to sanitary facilities / public phone / drinking fountain
$
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:
$
5. Identify 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)
Accessible Features Not to be Improved
Cost of Improvement
a.
$
b.
$
c.
$
Total:
$
6. Petitioner must be the legal property owner or his/her legal representative:
I certify that the above noted information is true and correct.
Legal Property Owner
Architect/Engineer
Contractor
Other:
Print Name:
Phone No.
Address:
Signature:
Date:
FOR AGENCY USE ONLY
Approved by:
Date:
Rev: 7/28/2014
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