Form DOA-0201 "Helicopter Site Approval Permit - Application" - California

What Is Form DOA-0201?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2021;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DOA-0201 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form DOA-0201 "Helicopter Site Approval Permit - Application" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
HELICOPTER SITE APPROVAL PERMIT - APPLICATION
DOA-0201 (REV 04/2021)
PLEASE PRINT OR TYPE AND COMPLETE ALL APPLICABLE ITEMS
HELIPORT INFORMATION
HELIPORT NAME
COUNTY
BUSINESS PHONE
HELIPORT ADDRESS
EMAIL
°
'
" N.
LATITUDE:
GEOGRAPHIC COORDINATES OF HELIPORT
°
'
" W.
LONGITUDE:
OWNER INFORMATION
OWNER'S NAME
OWNER'S ADDRESS
BUSINESS PHONE
FAX NUMBER
EMAIL
AGENT'S NAME (If Applicable)
AGENT'S ADDRESS
BUSINESS PHONE
FAX NUMBER
EMAIL
PROPERTY IS CONTROLLED BY:
Length of Lease
OTHER, SPECIFY
FEE
LEASE
PHYSICAL INFORMATION
PROPOSED HELIPORT USE:
Public Use
Specific Use
DESIGN HELICOPTER
TOUCHDOWN AND LIFTOFF AREA
PREVAILING WIND DIRECTION
(TLOF)
FEET
FEET
Overall Length
Length
PROPOSED TAKEOFF PATHS
FEET
FEET
Main Rotor Diameter
Width
(Magnetic Bearing From Center of FATO)
FEET
FEET Diameter
Height
Or Circular
FINAL APPROACH AND TAKEOFF AREA
ELEVATION OF FATO
FEET
Undercarriage Length
(FATO)
FEET
FEET
Undercarriage Width
Length
FEET MSL
ELEVATION ABOVE GROUND LEVEL
Pounds
FEET
Maximum Takeoff Weight
Width
WILL HELIPORT BE LIGHTED FOR
FEET Diameter
Or Circular
FEET
NIGHT OPERATIONS?
ANTICIPATED CONSTRUCTION DATES
START
COMPLETION
PROPOSED USES
(Check all that apply)
Public Service
Commuter
Corporate
Hospital
Other
CERTIFICATION
I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT I AM AUTHORIZED TO SUBMIT THIS APPLICATION.
OWNER OR AGENT'S SIGNATURE
TITLE
DATE
PRINT NAME
BUSINESS PHONE
EMAIL
SUBMIT COMPLETED HELICOPTER SITE APPROVAL PERMIT APPLICATION FORM, ALONG WITH ANY SUPPORTING
SUBMIT
DOCUMENTS. CLICK SUBMIT TO SEND THE FORM AND YOUR ATTACHMENTS TO THE DIVISION OF AERONAUTICS.
OR, SCAN THE COMPLETED FORM WITH YOUR ATTACHMENTS AND EMAIL TO :
AIRPORTS@DOT.CA.GOV
Page 1 of 2
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
HELICOPTER SITE APPROVAL PERMIT - APPLICATION
DOA-0201 (REV 04/2021)
PLEASE PRINT OR TYPE AND COMPLETE ALL APPLICABLE ITEMS
HELIPORT INFORMATION
HELIPORT NAME
COUNTY
BUSINESS PHONE
HELIPORT ADDRESS
EMAIL
°
'
" N.
LATITUDE:
GEOGRAPHIC COORDINATES OF HELIPORT
°
'
" W.
LONGITUDE:
OWNER INFORMATION
OWNER'S NAME
OWNER'S ADDRESS
BUSINESS PHONE
FAX NUMBER
EMAIL
AGENT'S NAME (If Applicable)
AGENT'S ADDRESS
BUSINESS PHONE
FAX NUMBER
EMAIL
PROPERTY IS CONTROLLED BY:
Length of Lease
OTHER, SPECIFY
FEE
LEASE
PHYSICAL INFORMATION
PROPOSED HELIPORT USE:
Public Use
Specific Use
DESIGN HELICOPTER
TOUCHDOWN AND LIFTOFF AREA
PREVAILING WIND DIRECTION
(TLOF)
FEET
FEET
Overall Length
Length
PROPOSED TAKEOFF PATHS
FEET
FEET
Main Rotor Diameter
Width
(Magnetic Bearing From Center of FATO)
FEET
FEET Diameter
Height
Or Circular
FINAL APPROACH AND TAKEOFF AREA
ELEVATION OF FATO
FEET
Undercarriage Length
(FATO)
FEET
FEET
Undercarriage Width
Length
FEET MSL
ELEVATION ABOVE GROUND LEVEL
Pounds
FEET
Maximum Takeoff Weight
Width
WILL HELIPORT BE LIGHTED FOR
FEET Diameter
Or Circular
FEET
NIGHT OPERATIONS?
ANTICIPATED CONSTRUCTION DATES
START
COMPLETION
PROPOSED USES
(Check all that apply)
Public Service
Commuter
Corporate
Hospital
Other
CERTIFICATION
I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT I AM AUTHORIZED TO SUBMIT THIS APPLICATION.
OWNER OR AGENT'S SIGNATURE
TITLE
DATE
PRINT NAME
BUSINESS PHONE
EMAIL
SUBMIT COMPLETED HELICOPTER SITE APPROVAL PERMIT APPLICATION FORM, ALONG WITH ANY SUPPORTING
SUBMIT
DOCUMENTS. CLICK SUBMIT TO SEND THE FORM AND YOUR ATTACHMENTS TO THE DIVISION OF AERONAUTICS.
OR, SCAN THE COMPLETED FORM WITH YOUR ATTACHMENTS AND EMAIL TO :
AIRPORTS@DOT.CA.GOV
Page 1 of 2
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
HELICOPTER SITE APPROVAL PERMIT - APPLICATION
DOA-0201 (REV 04/2021)
PLEASE PRINT OR TYPE AND COMPLETE ALL APPLICABLE ITEMS
REQUIRED DOCUMENTS LIST
Please submit the following as described in the California Code of Regulations, Section 3534 of Title 21,
For Caltrans/Aeronautics Use Only
Airports and Heliports with this Application:
Initials/Date
Two copies of scaled drawings of the airport and adjoining areas. See Title 21, Section 3534(b)(1)
/
for required details.
Topographic map that shows the location of the approach surfaces relative to the heliport.
/
Local area map of drawing depicting the heliport and the location of schools, places of public
/
gatherings and residential areas within 1,000 feet of the center of a proposed FATO.
Documentation of approval of the plan for construction by either the Board of Supervisors of the
/
county or the City Council of the city (as appropriate) in which the heliport is to be located.
Documentation of action by the Airport Land Use Commission of the county in which the heliport is
/
to be located (as appropriate).
Documentation of compliance with the California Environmental Quality Act.
/
Documentation showing ownership of the heliport. The owner, for purpose of this permit, is the
person with the authority to possess the facility, which may be in fee simple or a leasehold for a
/
period of at least one year.
FAA Airspace Determination regarding the airport. Enclosed is FAA Form 7480-1 (Notice of Landing
Area Proposal), which must be completed and mailed to the FAA at the address indicated on the
/
form.
Page 2 of 2
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
Page of 2