Fillable BUILDING PERMIT SUBMITTAL FORM (City of Yorba Linda)

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BUILDING PERMIT SUBMITTAL FORM (City of Yorba Linda)

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Last revised March 24, 2016
City of Yorba Linda
4845 Casa Loma Avenue, Yorba Linda CA 92886
Building Division
Permit Counter 714-961-7120
Plan Check No: ______________
BUILDING PERMIT SUBMITTAL FORM
Applicant’s Name: _________________________________________________ Phone: __________________
Please fill in applicable information below, and return this form to Building Division staff. Please provide any additional information you believe will assist the
Building Division in processing your application, or ask for assistance.
Applicant to complete below (check appropriate box for applicant) Only Building Division to complete below
Job Site Address _______________________________________ Suite No. __________
Tract____________________ Lot________________ APN#_________________________
Owner’s Name
___________________________________________________________
Mailing Address _________________________________________________________
City, State, Zip
___________________________________________________________
Tel No ______________________________________
Type of permit(s) requested
□ Structural □ Plumbing □ Mechanical □ Electrical
(Be sure to fill in the work sheet for each permit discipline)
Occupancy ____________Type of Construction
_______________
Proposed Work ________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Architect/Designer’s Name__________________________ License No. ___________
Address ________________________________________________________________
City, State, Zip
___________________________________________________________
Tel No _____________________________________
Special Conditions: N/A
□ Geological Condition □Post Tension Foundation
□Fuel Modification Area □ Methane Barrier
□Special Fire Protection Area □ Methane Mitigation
□Other_________________
Engineer’s Name _______________________________ License No. _____________
Address ________________________________________________________________
City, State, Zip
___________________________________________________________
Tel No ____________________________________
Tenant Improvement: N/A
Type of Business_______________________________________
Company Name
________________________________________
Contact Person of Company ______________________________
Tel No _______________________________________________
Contractor’s Company Name _____________________________________________
Contractor License No. ____________________ Lic. Expiration date _______________
Contractor License Class __________________________________________________
Address ________________________________________________________________
City, State Zip ___________________________________________________________
Tel No _____________________________________
Workers’ Comp Insurance Carrier
____________________________________________
Workers’ Comp Policy No. _________________________________________________
Expiration Date of Policy ___________________________________________________
City Business License No. ___________ City Business License Expire Date __________
Square footage:
Dwelling: _______________ Attached Garage: ______________
Addition: _______________ Alteration: ____________________
Deck: __________________ Attached Patio Cover: ___________
Reroof : ____________ (sq) Gazebo : _____________________
Detached Accessory structure: ____________________________
Pool / Spa: ____________________ / _____________________
Fence/Retaining wall : _________________________ (linear feet)
Tenant Improvement (existing/altered) ___________ / __________
Office: ____________________ Warehouse: _________________
Last revised March 24, 2016
Other:
________________________________________________
City Hall Staff use below only Submittal Checklist
Building Division Contact (714) 961-7120
Two sets of complete plans including site plan, architectural, structural, plumbing, mechanical, and electrical plans
One copy of site plan for Engineering Dept N/A
Two sets of Structural Calculations N/A
Two sets of Energy Documentation N/A
One copy of a Soil report N/A
One copy of an Asbestos report N/A
Two copies of Hazardous Material Report N/A
Three copies Letter of Intent
Site Plan with curb, gutter, sidewalk & sewer line shown
One copy Covenant and Agreement for Maintenance of side Yards for Oversized Buildings with a site plan (Notarized) N/A
Accessibility compliance form reproduced on the plans with signatures N/A
___________________________________________________________________________________________________
Traffic Impact Mitigation
Commercial Dev & Improvement
□ Industrial
□ Commercial
□ Office Use
□ N/A
Parks & Recreation
□ Pay Fee
□ Exempt
□ N/A
Planning Division Contact (714) 961-7130
□Yes □No
□Yes □No
□Yes □No
□Yes □No
□Yes □No
□Yes □No
Comments:
Planner's name and date
□ Eastern Corridor □ N/A
□ Sewer Connection/OCSD □ N/A
Traffic Impact Mitigation □ N/A
□ SFD □ exempt
□ TTM vested prior to 7/93 □ exempt
□ TTM less than 21 parcels □ exempt
□ TTM 21 or more parcels
□ Comm'l Dev/Improv (REF: Planning)
Public Works Department Contact (714) 961-7170
□Yes □No
Contact Engineering Division for requirements
Comments:
Engineering staff's name and date
AGENCY:
APPLICANT MUST CONTACT:
Department of Oil and Gas and Geo-thermal Resources
http://www.conservation.ca.gov/DOG/general_info/construction_site_review.htm
Review and approval required for oil well location
DOGGR (714) 816-6847
□Yes □No
Orange County Fire Department
Approval is required for Residential Site Review Methane Mitigation
OCFA (714) 573-6100
□Yes □No
South Coast Air Quality Management District / Asbestos Report
SCAQMD (909) 396-2001
□Yes □No
Orange County Health Department
OCHD (714) 433-6000
□Yes □No
Placentia-Yorba Linda School District
School Fees are required for 500 SF or more of additional square footage (not alterations)
PYLSD (714) 985-8440
□Yes □No
Yorba Linda Disposal
Approval required for new trash enclosure location/access
YLD (714) 630-8610
□Yes □No
Yorba Linda Water District
Approval required for New sewer line Other
YLWD (714) 701-3000
□Yes □No
Orange County Sanitation District
Approval required for Grease trap Sand or Oil Interceptor/Clarifier and/or Separator
OCSD (714) 962-2411
□Yes □No
Other:
OTHER
□Yes □No
Last revised March 24, 2016
Applicants MUST DIRECTLY CONTACT all above departments, divisions, agencies and districts
having jurisdiction in order to facilitate review, approval and fee assessment prior to the issuance of
a Building permit.
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BUILDING PERMIT SUBMITTAL FORM (City of Yorba Linda)

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Completed 5 August 2020

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