140 APPLICATION FOR APPROVAL OF CONSTRUCTION CHANGE DOCUMENT – CCD CATEGORY A/B This application is for construction changes, as defined in IR A-6, to approved contract documents. This form shall be completed by the Design Professional in General Responsible Charge of the project, in accordance with California Code of Regulations, Title 24, Part 1, Section 4-338 (c) and in compliance with DSA IR A-6.

School District/Owner: DSA File #:

-

Project Name/School: DSA App. #:

-

APPLICANT CCD Cat. A / B, #: Date Submitted: Attached Pages?: No Yes (_____pages)

For CCD Cat. B, this is a voluntary submittal, DSA required submittal (attach DSA notification requiring submission).

Firm Name: Contact Name:

Email: Phone Number: Address: City: State: Zip:

A DSA 301-N, DSA 301-P, or 90-Day Letter has been issued for this project.

For project currently under construction.

To obtain DSA approval of existing uncertified building(s).

DESIGN PROFESSIONAL IN GENERAL RESPONSIBLE CHARGE Name of Design Professional in General Responsible Charge: Professional License #: Discipline:

Design Professional in General Responsible Charge Statement: The attached Construction Change Documents have been examined by me for design intent and appear to meet the appropriate requirements of Title 24, California Code of Regulations and the project specifications. They are acceptable for incorporation into the construction of the project. Signature: _______________________________________________________________________________________ DESIGN PROFESSIONAL IN GENERAL RESPONSIBLE CHARGE

CHECK THIS BOX: To confirm that all CCD drawings and, when applicable, first sheet or index of calculations and specifications have been stamped and signed by the Responsible Design Professional listed on DSA 1 for this this project. Brief description of construction change (attach additional sheets if needed):

List of DSA approved drawings affected by this CCD:

DSA USE ONLY For business office use only

Date Sent Return By Delivery Method

DSA Stamp

SSS Date Approved / Disapproved / Not Req’d

FLS Date Approved / Disapproved / Not Req’d

ACS Date Approved / Disapproved / Not Req’d

Remarks

DSA 140 (rev 12-16-16) Page 1 of 1 DIVISION OF THE STATE ARCHITECT DEPARTMENT OF GENERAL SERVICES STATE OF CALIFORNIA

FE

FE

FE

FE

FE

FE

BUILDING 1000(E) TWO-STORY CLASSROOMS AND ADMINISTRATION

BUILDING 2000(E) ONE-STORY CAFETERIA

BUILDING 3000PROPOSED TWO-STORYCLASSROOM BUILDING

LIMIT OF WORK

ARTIFICIAL TURF FIELDW/ TRACK

A1.121

Sim

BEL AIRE DRIVE

ALL

EN A

VENU

E

IRVI

NG A

VENU

E

PROPERTYLINE

A1.161

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

TYP.

BLDG 8101(E) ONE-STORY

PORTABLECLASSROOM

NON-SPRINKLED

(E) ONE-STORYUTILITY BUILDING

ALO

NG S

TREE

T

BUS

AND

PARE

NT D

ROP

OFF

ARE

A

DROP OFF ENTRY

(2) BASKETBALLCOURTS W/

RELOCATED (E)BACKSTOPS

(2) HANDBALLCOURTS

(2) FOURSQUARE

STEPPEDSEATING

(E) (

4) T

ETHE

RBALL

POS

TSS5 S32

S18S18

S5

S31

S18S18

S7S7

S18S18

S18S18

S5S5

S6S6

S36

S36

S5

S32

S7S7

S31

S36S10

S8S8

S10

S11

S10

S8S8

S35

S31

S53 S11

S32

S5S5

S34S34

S36

S52S38

S80

S72

S71

S72

S71

S73

S73

S73

S73

S73

S73S73

S73 S73

S79

S20

S29

S36

S28

S28S28

S29

S31

S36

S31

S72

S71

S37S32S32 S33S37

RUBBERIZEDMATS82

LEGEND

PLANTING AREA

NEW BUILDING

CONCRETE PAVING

EXISTING BUILDING

LIMIT OF WORK

A/C PAVING

ARTIFICIAL TURF

ATHLETIC SURFACE COATING

EXISTING A/C PAVING

RUBBERIZED TILE SURFACING

IDENTIFICATION STAMP DIVISION OF STATE ARCHITECTOFFICE OF REGULATION SERVICESFILE NO.APPL NO.

AC FLS SS .

DATE .

837 North Spring Street / Third Floor / Los Angeles, CA 90012Telephone (323) 859 3100 / Fax (323) 859 3110

KPFF CONSULTING ENGINEERS

CIVIL ENGINEER

BREEN ENGINEERING

CONSULTANTS

DESIGNER

MECHANICAL / PLUMBING / ELECTRICAL ENGINEER

BREEN ENGINEERING

DOOR HARDWARE CONSULTANT

ARCHITECTURAL HARDWARE SERVICES

REGISTRATION

AGENCY APPROVAL

ISSUE

12345

D

C

B

A

MARK DATE DESCRIPTION

KEY PLAN

SCALE :

CHECKED BY :

DRAWN BY :

DESIGNER PROJECT NO. :

Glendale Unified School District

SHEET TITLE

SHEET NUMBER

STRUCTURAL ENGINEER

12345

FIRE PROTECTION ENGINEER

BREEN ENGINEERING

19-4103-114363

As indicated

3/31

/201

7 4:

12:2

2 PM

A1.11

SITE PLAN

CheckerAuthor

A11047.05

Balboa Elementary School1844 Bel Aire Drive, Glendale, CA 91201

SCALE: 1" = 20'-0"SITE PLAN1

PROJ

ECT

NORT

H

TRUE

NORT

H

KEYNOTE

KEY TEXT KEY TEXT

S36 (E) GATE

S37 (E) ASPHALT BERM

S38 (E) TRASH ENCLOSURE

S52 (E) SORTING AND RECYCLING WASTE AREA.ALLOCATE A SPECIFIC CONTAINER FOR PAPER,CARDBOARD, GLASS, PLASTICS, METALS ANDLANDSCAPE WASTE

S53 (E) GUARDRAIL

S71 (E) PV CANOPY

S72 (E) STEEL COLUMN/CONCRETE BASE

S73 POLE-MOUNTED SITE LIGHT. SEE 5/A1.21 AND E-1.0

S79 CHAINLINK FENCE

S80 CONCRETE RETAINING WALL SEE WALL TYPE R44/S503

S82 PLAYGROUND OVERHEADS TO BE INSTALLED ATHEIGHTS SPECIFIED BY DISTRICT

S5 (E) CONCRETE PAVING

S6 CONCRETE PAVING

S7 (E) ASPHALT PAVING

S8 ASPHALT PAVING

S10 CONCRETE RAMP

S11 CONCRETE STAIRS SEE 1/S503

S18 (E) PLANTING AREA

S20 20'-0" WIDE SWINGING GATE. DETAIL 2/A1.21

S28 (E) STORAGE CONTAINER

S29 (E) PLANTER

S31 (E) CHAIN LINK FENCE

S32 (E) CONCRETE STAIRS

S33 (E) CONCRETE RAMP

S34 (E) LUNCH SHELTER

S35 (E) COLUMN

1 5-4-15 DSA ADDENDUM #1

03-31-17 CCDA-035

ARTIFICIAL TURF FIELDW/ TRACK

1C

C2.1

CCCC

BASKETBALL COURT W/RELOCATED (E) BACKSTOPS

HANDBALLCOURT

FOURSQUARE FOURSQUARE

HANDBALLCOURT

9'-0"108'-0"9'-0"

R 18' - 0"

126'-0"

8'-1

1 1/

2"11

1'-0"

9'-0

1/2

"

129'-0

"

3'-0

"

1'-7"

1'-5"

S72

S71

.DN

11'-6"

8'-1 1/2"

68'-4"

43'-3

"

TYP

62'-5"

1A

C2.1

3'-1

"3'-0

"2'-1

1 1/

2"

TYP

EQ

TYP

EQ12'-0"

TYP

16'-0"

(E) TETHERBALLPOST

(E) TETHERBALLPOST

(E) TETHERBALLPOST

(E) TETHERBALLPOST

9

A1.22

Sim9

A1.22

Sim

9

A1.21TYP.

TYP.

50' - 6"

5' -

2"

4'-0"

2'-0"

TYP.

16'-0

"

TYP.

62'-5"

7'-0

"

10'-6"

TYP.

50'-6"

BASKETBALL COURT W/RELOCATED (E) BACKSTOPS

S75 S75

S74 S74

S76S76S76 S76

RUBBERIZED MAT

TYP.

40'-0

"2'-0

"

TYP.

16'-0

"

30'-11" 6'-0"

32'-0

"

LEGEND

PLANTING AREA

NEW BUILDING

CONCRETE PAVING

EXISTING BUILDING

LIMIT OF WORK

A/C PAVING

ARTIFICIAL TURF

ATHLETIC SURFACE COATING

EXISTING A/C PAVING

RUBBERIZED TILE SURFACING

IDENTIFICATION STAMP DIVISION OF STATE ARCHITECTOFFICE OF REGULATION SERVICESFILE NO.APPL NO.

AC FLS SS .

DATE .

837 North Spring Street / Third Floor / Los Angeles, CA 90012Telephone (323) 859 3100 / Fax (323) 859 3110

KPFF CONSULTING ENGINEERS

CIVIL ENGINEER

BREEN ENGINEERING

CONSULTANTS

DESIGNER

MECHANICAL / PLUMBING / ELECTRICAL ENGINEER

BREEN ENGINEERING

DOOR HARDWARE CONSULTANT

ARCHITECTURAL HARDWARE SERVICES

REGISTRATION

AGENCY APPROVAL

ISSUE

12345

D

C

B

A

MARK DATE DESCRIPTION

KEY PLAN

SCALE :

CHECKED BY :

DRAWN BY :

DESIGNER PROJECT NO. :

Glendale Unified School District

SHEET TITLE

SHEET NUMBER

STRUCTURAL ENGINEER

12345

FIRE PROTECTION ENGINEER

BREEN ENGINEERING

19-4103-114363

As indicated

3/31

/201

7 4:

23:14

PM

A1.16

PARTIAL SITE PLAN @ FIELD

CheckerAuthor

A11047.05

Balboa Elementary School1844 Bel Aire Drive, Glendale, CA 91201

SCALE: 1" = 10'-0"ENLARGED SITE PLAN @ FIELD1

KEYNOTES

PROJ

ECT

NORT

H

TRUE

NORT

H

KEY TEXT

S71 (E) PV CANOPY

S72 (E) STEEL COLUMN/CONCRETE BASE

S74 RELOCATED (E) BASKETBALL BACKSTOP & GOAL.SEE 6/A1.21 FOR FOUNDATION DETAIL.

S75 HANDBALL COURT WALL. SEE 7/A1.21.

S76 PAVEMENT STRIPING

1 5-4-15 DSA ADDENDUM #1

03-31-17 CCDA-035

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