Fillable POOL / SPA PLAN REVIEW NEW CONSTRUCTION / (Contra Costa Health Services)

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POOL / SPA PLAN REVIEW NEW CONSTRUCTION / (Contra Costa Health Services)

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ENVIRONMENTAL HEALTH DIVISION
2120 DIAMOND BOULEVARD, SUITE 100
CONCORD, CA 94520
(925) 608-5500 FAX (925) 608-5502
www.cchealth.org/eh
PlanReview@cchealth.org
POOL / SPA PLAN REVIEW NEW CONSTRUCTION / REMODEL APPLICATION
FACILITY PLAN INFORMATION
Business Name:
Change of Ownership
Former Business Name: _______________________
Address:
Suite / Unit / Space #:
City, State, Zip Code:
New Construction
Remodel
Year Round
Seasonal
Pool
(swimming, diving, wader, interactive, therapy, etc.)
Spa
Additional Pool / Spa
(same location and deck)
Spray Ground
Type of Pool Facility:
Apartment / Condos
Recreational / Community / Municipal
School
Recreational Water Park
Hotel / Motel / Resort
Health Club / Gym
Equipment or Finish Change: 1 2 3
Minor Remodel
Major Remodel
Municipal Water On-Site Water Sanitary Sewer On-Site WasteWater Treatment System
Scope of work: (Check all that apply)
Re-plaster: (tile/coping/ladder/steps)
Split Main Drains / Equalizer lines
Drain Covers
Deck
Fence / Wall / Gate
Hand / Grab Rails
Steps
Bathhouse: (restrooms, showers, dressing rooms)
Pump: Recirculating Booster
Filters: Cartridge DE Sand
Chemical Controller / Feeder
PERSON / ORGANIZATION REQUESTING PLAN REVIEW
Applicant/Contact Person: Last Name, First Name
Title:
Company:
Phone Number:
Mailing Address:
City, State, Zip Code:
E-mail(s):
Signature of Applicant/Contact Person:
Date:
BUSINESS OWNER / HOA / PROPERTY MGMT INFORMATION
Name(s):
Mailing Address:
City, State, Zip Code:
Billing Address
(if different from mailing address):
City, State, Zip Code:
Phone Number:
E-mail(s):
FOR OFFICE USE ONLY
AR#:
SR#:
FA#:
PR#:
Dist. Insp.#:
CT#:
Date Rec’d:
Rec’d By:
Amount Due:
$
Method of Payment: Check #:___________________ Cash / Credit Card: ❑ MC ❑ VISA
XR
PLAN REVIEW FEES WILL BE CHARGED AT A FLAT RATE
TIME SPENT ON A PROJECT IN EXCESS OF THE MAXIMUM HOURS ALLOTTED WILL BE BILLED AT THE CURRENT HOURLY RATE OF $199.00
CONSTRUCTION / REMODEL IS NOT TO COMMENCE UNTIL PLANS ARE APPROVED AND BUILDING PERMITS ARE OBTAINED
Revised October 2019
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POOL SPA PLAN REVIEW NEW CONSTRUCTION (Contra Costa Health Services)

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Completed 9 February 2021

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