Fillable Mandatory Disability Access Improvement Program CATEGORY CHECKLIST COMPLIANCE (City and County of San Francisco, Dept of Technology)

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Mandatory Disability Access Improvement Program CATEGORY CHECKLIST COMPLIANCE (City and County of San Francisco, Dept of Technology)

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City and County of San Francisco
Department of Building Inspection
London N. Breed, Mayor
Patrick O’Riordan, Interim Director
Technical Services Division
49 South Van Ness Avenue, Suite 500 – San Francisco CA 94103
Office (628) 652-3720 – www.sfdbi.org
Compliance Affidavit
Mandatory Disability Access Improvement Program
CATEGORY CHECKLIST COMPLIANCE FORM
PRIMARY ENTRY COMPLIANCE FORM – NO FEE
Note to the Owner or Tenant: Ordinance No. 51-16, effective May 22, 2016, requires all non-
exempt/non-waiver “Public Accommodations” either to have all primary entries and paths of travel into
the building accessible or receive a determination of Equivalent Facilitation, Technical Infeasibility or
Unreasonable Hardship from the Department of Building Inspection within a specified time period. If you
are uncertain whether you are a “Public Accommodation” or if you are exempt, please review our Pre-
Screening Form prior to hiring a licensed design professional or Certified Access Specialist (CASp). The
Pre-Screening Form may be found in Information Sheet DA-17, Attachment A1.
Submittal of this Compliance Affidavit is required for any building or portion of a building with a Place of
Public Accommodation. This Category Checklist Compliance Form is for buildings with a primary entry
or entries that are categorized in one of four categories as specified in the Ordinance. (Ordinance No.
51-16 may be found at http://sfbos.org/ordinances-2016).
The building owner shall obtain
an inspection of elements on the Compliance Form by a California
licensed design professional or Certified Access Specialist (CASp). This form is intended to assist in
compliance with the Ordinance and must be filled out by a licensed design professional or CASp. A
separate document, Technical Specifications Guidelines, provides explanation, instructions, and
minimum standards to be used in completing this form.
Multiple Businesses in One Building: Please submit one or multiple Compliance Affidavit(s) for the
building(s)
with multiple businesses. The Accessible Business Entrance (ABE) Program applies just to
the primary entry (does not apply to the elevators and the individual offices tenant entry doors) and any
primary entries serving tenant spaces which are fronting the public way. If a (public accommodation)
building provides parking for its customers, then the path from the accessible parking stall to the primary
entry is required to comply with the ordinance.
Submit the completed Category Checklist Compliance Form either:
• As a pdf attachment to dbi.businessentrance@sfgov.org, with “Category Checklist
Submittal” in subject line; or,
• As a hardcopy in person or by U.S. mail to Disability Access Compliance Unit, Department
of Building Inspection, 49 South Van Ness Avenue, Suite 500 - San Francisco, CA 94103.
SECTION 1 – ADMINISTRATIVE INFORMATION
BLOCK / LOT NUMBER
BUILDING ADDRESS(ES)
If this property has multiple addresses, please provide here or as an attachment.
ENTRY ADDRESS # of entries total
Attachment B
Rev. 4/5/2021
INFORMATION SHEET DA-17 Attachment B
Page 2 of 8
OWNER INFORMATION
Owner name(s)
Owner mailing address
Owner telephone
Owner email
TENANT/AGENT INFORMATION
Tenant/Agent name(s)
Tenant/Agent mailing address
Tenant/Agent telephone
Tenant/Agent email
Any required work will be done by (check one):
☐
Owner
☐
Tenant
☐
Both Tenant and Owner
Does this Category Checklist Compliance Form replace or supplement a previously
submitted Form for the same building and Place of Public Accommodation?
☐
No
☐
SECTION 2 – STREET VIEW OF ENTRY
Attach digital photographs of unobstructed street view of primary entry or entries.
Photo taken on:
Date
SECTION 3 – PRIMARY ENTRY COMPLIANCE CHECKLIST
CBC Section 202: ENTRANCE. Any access point to a building or portion of a building or facility used for
the purpose of entering. An entrance includes the approach walk, the vertical access leading to the
entrance platform, the entrance platform itself, vestibule if provided, the entry door or gate, and the
hardware of the entry door or gate.
C
BC Section 202: PRIMARY ENTRANCE. The principal entrance through which most people enter the
building, as determined by the Building Official.
N
ote: The architect/engineer/CASp shall make a good faith effort to identify the primary entry and when
they submit the building permit, to comply with the ABE ordinance, DBI will determine then if that is the
primary entry. DBI will not “pre-determine” for the licensed design professional.
This section is an inventory of existing conditions and is intended to assist in determining which
Compliance Category the entrance will be classified as and identify the barrier removal work required.
Complete this section for the primary entry to all public accommodations.
INFORMATION SHEET DA-17 Attachment B
Page 3 of 8
Check ONE box for each item listed below.
CODE REQUIREMENTS
DOES THE ENTRY
COMPLY?
1) Site Arrival – Accessible entrance route from public transportation, and parking
spaces/facilities
See Technical Specifications: Section 1: Site Arrival Point – Accessible Routes
Yes
☐
No
☐
N/A
☐
2) Site Arrival – Sidewalks: Free of excessive damage; changes in level > ½”; grates
and other openings > ½” ; cross slope greater than 1:48
See Technical Specifications: Section 2: Site Arrival Point – Sidewalks
Yes
☐
No
☐
N/A
☐
3) Entry Approach – Exterior Ramps
See Technical Specifications: Section 3: Entry Approach – Exterior Ramps
Yes
☐
No
☐
N/A
☐
4) Entry Approach – Exterior Lifts
See Technical Specifications: Section 4: Entry Approach – Exterior Elevator & Lifts
Yes
☐
No
☐
N/A
☐
5) Level landings both sides of door. **
See Technical Specifications: Section 5: Level Landings – Exterior / Interior
** Power door operator as per Information Sheets DA-04/05 may be considered equivalent
Yes
☐
No
☐
N/A
☐
6) Threshold max ½” (1/4” vertical max; ¼” max at a slope of 2:1 maximum)
See Technical Specifications: Section 6: Thresholds
Yes
☐
No
☐
N/A
☐
7) Floor levels within ½” both sides of door, no vertical elevation or drop-off adjacent to
threshold.
See Technical Specifications: Section 7: Floor Levels at Doors
Yes
☐
No
☐
N/A
☐
8) Doorway sized to permit a door that is 36” wide and 6’8” in height.
Net clear door opening = 32” min.
See Technical Specifications: Section 8: Doorway Size
Yes
☐
No
☐
N/A
☐
9) Door has a smooth, uninterrupted surface at bottom 10” of push side of door. **
See Technical Specifications: Section 9: Doors – Smooth Surface.
** P
ower door operator as per Information Sheets DA-04/05 may be considered
equivalent
Yes
☐
No
☐
N/A
☐
INFORMATION SHEET DA-17 Attachment B
Page 4 of 8
10) Hardware operable with one hand, single motion, no grasping, pinching, or twisting of
t
he wrist.
See Technical Specifications: Section 10: Doors – Hardware
Yes
☐
No
☐
N/A
☐
11) Door hardware located between 30” and 44” above the floor on both sides of door.
1
S
ee Technical Specifications: Section 11: Doors – Hardware Height
Yes
☐
No
☐
N/A
☐
12) Door operating force maximum 8.5lbs ( fire door-15lbs max)
1
**
See Technical Specifications: Section 12: Door Operating Force
** Power door operator as per Information Sheets DA-04/05 is considered equivalent
Yes
☐
No
☐
N/A
☐
13) Panic Hardware*
See Technical Specifications: Section 13: Panic Hardware
Yes
☐
No
☐
N/A
☐
14) Maneuvering space both sides of door. **
See Technical Specifications: Section 14: Maneuvering Space – Exterior / Interior
** Power door operator as per Information Sheets DA-04/05 is considered equivalent
Yes
☐
No
☐
N/A
☐
15) Recessed doormats, adequately anchored
See Technical Specifications: Section 15: Recess Doormats
Yes
☐
No
☐
N/A
☐
16) Vestibules and doors in series
See Technical Specifications: Section 16: Vestibules and Doors in Series
Yes
☐
No
☐
N/A
☐
17) Automatic / Power doors
1
tested and in operating condition. (required and non-
required) **
See Technical Specifications: Section 17: Automatic Doors
** P
ower door operator as per Information Sheets DA-04/05 is considered equivalent
Yes
☐
No
☐
N/A
☐
18) Turnstiles, rails, and pedestrian controls ; Security doors/ gates/ roll up doors
See Technical Specifications: Section 18: Turnstiles, Rails, Pedestrian Controls,
Security Doors, and Gates
Yes
☐
No
☐
N/A
☐
19) Historic Buildings-entry approved per CHBC*
See Technical Specifications: Section 19: Historic Buildings-CHBC
Approved under PA#
Yes
☐
No
☐
N/A
☐
INFORMATION SHEET DA-17 Attachment B
Page 5 of 8
20) CONCLUSION:
All responses to proceeding questions either Yes or N/A?
Yes
☐
No
☐
1
These requirements differ from the current or subsequent CBC or 2010 ADA’s requirements. See Technical
Specifications Guidelines for discussion of the differences.
* D
ocument how the CHBC was used and which elements would be threatened by strict compliance with the
CBC in Section 5. See Technical Specifications Guidelines, Section 19 for further information.
*
* Information Sheets may be found at http://sfdbi.org/information-sheets
SECTION 4 – CATEGORY DETERMINATION
Determine which Compliance Category the primary entry most closely falls into and check the appropriate
box below:
☐
CATEGORY ONE: If all of the checklist items in SECTION 3 were checked either Yes or N/A
and there are no steps or other barriers, check this box.
☐
CATEGORY TWO: If any of the checklist items in SECTION 3 were checked No and there are
no steps, check this box. (Note: A ramp that has a slope greater than 1:10 for a distance of more
than 5 feet, or a slope greater than 1:6 for a distance of more than 13 inches shall be considered
a step. See Below.)
If there are only minor corrections such as changing the door hardware or removing a door stop
in the 10 inch smooth surface, please correct these items and submit as Category One.
☐
CATEGORY THREE: If the entry has one step, check this box. (Note: A ramp that has a slope
greater than 1:10 for a distance of more than 5 feet, or a slope greater than 1:6 for a distance of
more than 13 inches shall be considered a step.)
☐ Check here if entry has a ramp that qualifies as a step.
☐
CATEGORY FOUR: If the entry has more than one step or any other major barriers, check this
box.
CATEGORY ONE: If you checked Category One, complete SECTIONS 1, 2, 3, 4, and 6 and submit
this form to dbi.businessentrance@sfgov.org
. Be sure to include a photograph of the entry.
CATEGORIES TWO THROUGH FOUR: Complete the information asked in ALL SECTIONS and submit
this form by the date of Compliance Schedule. Full plans are not required at this time. If required, plans
will be submitted with a permit application when applying for a permit.
INFORMATION SHEET DA-17 Attachment B
Page 6 of 8
SECTION 5 – PROPOSED BARRIER REMEDIATION
This section must be completed by the California licensed design professional or CASp in
consultation with the Owner or Tenant.
Any box checked “No” in SECTION 3 will require a remedy and must be addressed. Please give a concise
description of all non-compliant elements and propose the work needed to make the entry useable. Attach
any additional information or sketches needed to this form. This is a rough proposal for the removal of
barriers and a full set of plans is not required at the time of checklist submittal.
You may use any equivalency offered in the San Francisco Administrative Bulletins or Information Sheets
and the Division of the State Architect’s 2016 California Access Compliance Reference Manual as
applicable. Some “equivalencies” based upon the 1998 California Building Code are discussed in the
Technical Specifications Guidelines, but these only apply if allowed and approved at the time of
construction or alteration.
IMPORTANT NOTE: Before submitting this proposal to the Disability Access Compliance Unit for review,
it is recommended that you consult with the San Francisco Planning Department to determine if
the proposed remedies will be in compliance with the Planning Code. Your building may be classified
as having historic significance, which could restrict how the entry may be altered. You may be eligible
for use of the California Historic Building Code. Please see the manual section “Use of the California
Historic Building Code.”
Complete the following clearly and legibly, and/or attach a separate document with the address clearly
listed at the top of all pages. This form and all attachments will be kept by the Department and will not be
returned to the owner/applicant, make any copies necessary prior to submittal.
5.1 PROPOSED BARRIER REMEDIATION
On the lines provided, please enter all of the items checked “No” on the checklist and enter a
proposed remediation next to the number.
Please itemize the numbers and remedies in the order they appear on the checklist.
Example: Item 2: Sidewalk smooth firm and level. Repair 4 damaged cracked and warped flags of
sidewalk.
Item 6: Threshold to be replaced with a maximum ½” high threshold
Item 12: Per Information Sheet DA-04 power door operator
Item 14: See Item 12
The barriers listed herein will be remedied as noted below:
INFORMATION SHEET DA-17 Attachment B
Page 7 of 8
5.2 REQUEST FOR TECHNICAL INFEASIBILITY OR UNREASONABLE HARDSHIP
☐ I will submit to DBI a building permit within the Compliance Schedule (see Table 1107D) (with
or without additional work) to document the Request for Approval of (please mark one):
☐ Technical Infeasibility
☐ Unreasonable Hardship
☐ Alternate Methods
☐ Equivalent Facilitation
Permit fees will be per SFBC Section 110A. In addition, AAC and/or other applicable fees from
other departments will apply.
INFORMATION SHEET DA-17 Attachment B
Page 8 of 8
SECTION 6 –VERIFICATION AND SIGNATURES
6.1 LICENSED DESIGN PROFESSIONAL/CASp
Under penalty of perjury, I certify that the information provided in Sections 3, 4, and 5 of this form is based
on my personal review of the building and its records, or review by others acting under my direct
supervision, and is correct to the best of my knowledge.
Professional name
Professional telephone Professional email
Signature Date
Certification Number Expiration date
(NOTE: For CASp inspectors, provide certification number and expiration date)
6.2 OWNER / AGENT
Under penalty of perjury, I certify that the information provided in Sections 1 and 2 of this form is correct
to the best of my knowledge.
☐ Owner / Property Manager
☐ Agent
☐ Agent Authorization Form (see
Attachment C) is attached
Signature Date
FOR DBI USE ONLY
DBI has received the materials submitted and filed under “Mandatory Disability Access
Improvement Program” per Ordinance No. 50-16, No. 102-18 and No. 60-20.
Date received by DBI:
[Architect/Engineer Stamp Here]
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Mandatory Disability Access Improvement Program CATEGORY CHECKLIST COMPLIANCE (City and County of San Francisco, Dept of Technology)

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Completed 3 December 2021

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