Fillable RETAIL FOOD PLAN REVIEW NEW CONSTRUCTION / REMODEL (Contra Costa Health Services)

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RETAIL FOOD PLAN REVIEW NEW CONSTRUCTION / REMODEL (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
RETAIL FOOD PLAN REVIEW
NEW CONSTRUCTION / REMODEL APPLICATION
FACILITY PLAN INFORMATION
Business Name:
❑ Change of Ownership
❑
Former Business Name: _______________________
Street Address:
Suite / Unit / Space #:
City, State, Zip Code:
New construction:
❑
YES
❑
NO Sq. ft.:___________
Remodel for closed facility:
❑
YES
❑
NO Adding sq. ft.: ____________
Remodel for active operating facility:
❑
YES
❑
NO Adding sq. ft.: _____________
Status during construction:
❑
Operating
❑
Closed
(If operating, provide written procedures to prevent contamination of the food preparation areas.)
Scope of Work:
Municipal Water On-Site Water Sanitary Sewer On-Site WasteWater Treatment System
Type of Food Facility:
Bakery (sq. ft. )
Commissary (Cart / Vehicle)
Commissary (Catering)
Restaurant (# of seats )
Production Kitchen / Event Center
Retail Food Market (sq. ft. )
School
Snack Bar
Cocktail Lounge/Bar
Host Facility
Single Food Equipment or Finish Change
Two Food Equipment or Finish Change
Three Food Equipment or Finish Change
Minor Remodel (i.e., Type II hood, walk-in cooler)
Type I Hood
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:
PERMITTEE / TENANT
BUSINESS OWNER INFORMATION
Business Owner Name(s): (If corporation, provide primary contact)
Primary Contact Name(s):
Owner Mailing Address/Home Address:
City, State, Zip Code:
Billing Address
(if different from mailing/home address):
City, State, Zip Code:
Phone Number:
E-mail(s):
FOR OFFICE USE ONLY
AR#:
SR#:
PE#:
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
Plan Review Construction/Remodel Application
Revised October 2019
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RETAIL FOOD PLAN REVIEW NEW CONSTRUCTION REMODEL (Contra Costa Health Services)

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Completed 9 February 2021

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