Form CEM-5773P "Parking Americans With Disabilities Act (Ada) Compliance Inspection Report" - California

What Is Form CEM-5773P?

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 November 1, 2017;
  • 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 CEM-5773P by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form CEM-5773P "Parking Americans With Disabilities Act (Ada) Compliance Inspection Report" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
PARKING AMERICANS WITH DISABILITIES ACT (ADA) COMPLIANCE INSPECTION REPORT
Page 1 of 9
CEM-5773P (NEW 11/2017)
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
PROJECT INFORMATION/NAME
PARKING INFORMATION
Location Number
County
City
Route
Route Number
Cross Street
Street Address
Parking Type
On-Street Parking
Off-Street Parking
Off-Street
Conventional
Single
Latitude (y)
Postmile/Station
On-Street
Restricted ROW
Double
Width
Diagonal
Longitude (x)
N/A
N/A
Applicable Plans
Applicable Standard Specifications
Applicable Design Bulletin
2010 Standard Plan A90A
2010
DIB 82-05
2010 Standard Plan A90B
2015
2015 Standard Plan A90A
Other
2015 Standard Plan A90B
Other
ADA PARKING COMPLIANCE CERTIFICATION
Based on the field measurements shown on page 2, off-street parking complies with standard plan A90A?
Yes
No
N/A
Based on the field measurements shown on page 3, on-street parking complies with standard plan A90B?
Yes
No
N/A
Parking is ADA compliant based on ADA parking check list shown on page 4?
Yes
No
N/A
Parking is ADA compliant based on ADA parking check list shown on page 5?
Yes
No
N/A
Parking is ADA compliant based on ADA parking check list shown on page 6?
Yes
No
Parking is ADA compliant based on ADA parking check list shown on page 7?
Yes
No
This section must be completed if no is marked for any question indicating that parking is non-compliant.
District ADA Engineer compliance determination (must state ADA standard used for compliance determination):
Parking is compliant with ADA standards?
Yes
No
District ADA Engineer (print name)
Signature
Date
RESIDENT ENGINEER ADA COMPLIANCE CERTIFICATION
I have reviewed the parking inspection report and find that the constructed parking is in compliance with ADA standards.
Resident Engineer (print name)
Signature
Date
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
PARKING AMERICANS WITH DISABILITIES ACT (ADA) COMPLIANCE INSPECTION REPORT
Page 1 of 9
CEM-5773P (NEW 11/2017)
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
PROJECT INFORMATION/NAME
PARKING INFORMATION
Location Number
County
City
Route
Route Number
Cross Street
Street Address
Parking Type
On-Street Parking
Off-Street Parking
Off-Street
Conventional
Single
Latitude (y)
Postmile/Station
On-Street
Restricted ROW
Double
Width
Diagonal
Longitude (x)
N/A
N/A
Applicable Plans
Applicable Standard Specifications
Applicable Design Bulletin
2010 Standard Plan A90A
2010
DIB 82-05
2010 Standard Plan A90B
2015
2015 Standard Plan A90A
Other
2015 Standard Plan A90B
Other
ADA PARKING COMPLIANCE CERTIFICATION
Based on the field measurements shown on page 2, off-street parking complies with standard plan A90A?
Yes
No
N/A
Based on the field measurements shown on page 3, on-street parking complies with standard plan A90B?
Yes
No
N/A
Parking is ADA compliant based on ADA parking check list shown on page 4?
Yes
No
N/A
Parking is ADA compliant based on ADA parking check list shown on page 5?
Yes
No
N/A
Parking is ADA compliant based on ADA parking check list shown on page 6?
Yes
No
Parking is ADA compliant based on ADA parking check list shown on page 7?
Yes
No
This section must be completed if no is marked for any question indicating that parking is non-compliant.
District ADA Engineer compliance determination (must state ADA standard used for compliance determination):
Parking is compliant with ADA standards?
Yes
No
District ADA Engineer (print name)
Signature
Date
RESIDENT ENGINEER ADA COMPLIANCE CERTIFICATION
I have reviewed the parking inspection report and find that the constructed parking is in compliance with ADA standards.
Resident Engineer (print name)
Signature
Date
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
PARKING AMERICANS WITH DISABILITIES ACT (ADA) COMPLIANCE INSPECTION REPORT
Page 2 of 9
CEM-5773P (NEW 11/2017)
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
PROJECT INFORMATION/NAME
Location Number
Route
Nearest Cross Street
Parking Type
Single
Street Address
Double
Diagonal
ADA OFF-STREET PARKING FIELD MEASUREMENTS
Measure and verify the dimensions and slopes
Parking Stall
Parking Stall
Accessible
Regular
Van Accessible
Parking/Aisle
Parking/Aisle
Unobstructed
Length
Width
Aisle
Accessible
Aisle
Slope
Cross Slope
Area Front
(feet - inches)
(feet - inches)
Length
Aisle Width
Width
(x.x%)
(x.x%)
of Stall
(feet - inches)
(feet - inches)
(feet - inches)
(feet - inches)
A1
B1
C1
D1
D1
E1
F1
G1
A2
B2
C2
D2
D2
E2
F2
G2
17' - 11¾" or
8' - 11¾" or
17' - 11¾" or
4' - 11¾" or
7' - 11¾" or
1.7% or less?
1.7% or less?
1' - 11¾" or
greater?
greater?
greater?
greater?
greater?
greater?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
N/A
N/A
Measured from
back of parking
bumper projected
to closest front
corner of stall
Remarks
Inspection by (print name)
Signature
Date
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
PARKING AMERICANS WITH DISABILITIES ACT (ADA) COMPLIANCE INSPECTION REPORT
Page 3 of 9
CEM-5773P (NEW 11/2017)
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
PROJECT INFORMATION/NAME
Location Number
Route
Nearest Cross Street
Parking Type
Conventional
Street Address
Restricted ROW
Width
ADA ON-STREET PARKING FIELD MEASUREMENTS
Measure and verify the dimensions and slopes
Parking Stall
Parking Stall
Parking Stall
Accessible
Length
Conventional
Restricted
Aisle
(feet - inches)
Width
Width
Width
(feet - inches)
(feet - inches)
(feet - inches)
A1
B1
C1
D1
A2
B2
C2
D2
19' - 11¾" or
12' - 11¾" or
7' - 11¾" or
4' - 11¾" or
greater*?
greater*?
greater*?
greater*?
Yes
No
Yes
No
Yes
No
Yes
No
*Larger local
N/A
N/A
N/A
requirement:
Remarks
Inspection by (print name)
Signature
Date
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
PARKING AMERICANS WITH DISABILITIES ACT (ADA) COMPLIANCE INSPECTION REPORT
Page 4 of 9
CEM-5773P (NEW 11/2017)
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
PROJECT INFORMATION/NAME
Location Number
Route
Nearest Cross Street
Street Address
ON-STREET PARKING FIELD INSPECTION CHECKLIST
No.
Requirement
Compliant
Photo
Remarks
Item 2-6
For on-street accessible parking complete items 2-6.
N/A
Is curb painted blue along length of on-street parking?
Yes
No
Yes
No
Yes
No
Accessible parking signs are provided for each accessible
stall (i.e., R99 (CA) and R99B (CA) or R99C (CA) typical)
Yes
No
Yes
No
Yes
No
and lowest sign edge provides a minimum of 7'-0” clearance
above the highest surrounding surface?
Accessible aisles markings are bordered by 4” blue lines,
have 4” white (blue in snow areas) line diagonals on 3'-0”
max centers and have “NO PARKING” painted in white 1' - 0”
Yes
No
Yes
No
Yes
No
high letters at traffic side ends (see Standard Plans A90B
and A24E details)? Mark item N/A if there is no accessible
aisle for on-street parking.
Parking stalls are located so that persons with disabilities are
Yes
No
Yes
No
Yes
No
not compelled to wheel/walk behind parked vehicles other
than theirs?
Parking spaces and accessibility aisles slopes are the
Yes
No
Yes
No
Yes
No
minimum feasible?
Remarks
Field inspection checklist completed by (print name) Signature
Date
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
PARKING AMERICANS WITH DISABILITIES ACT (ADA) COMPLIANCE INSPECTION REPORT
Page 5 of 9
CEM-5773P (NEW 11/2017)
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
PROJECT INFORMATION/NAME
Location Number
Route
Nearest Cross Street
Street Address
OFF-STREET PARKING FIELD INSPECTION CHECKLIST
No.
Requirement
Compliant
Photo
Remarks
For off-street accessible parking complete items 8-18.
Item 8-18
N/A
Minimum number of accessible off-street parking spaces
Yes
No
Yes
No
Yes
No
meet Table A requirements on Standard Plan A90A?
One in every six accessible off-street parking stalls, but not
less than one, is van accessible and served by an accessible
Yes
No
Yes
No
Yes
No
aisle of 8'-0” minimum width located on passenger side as
vehicle is parked forward into the stall?
Accessible stall markings are 4” white lines the full length of
Yes
No
Yes
No
Yes
No
stall?
Accessible aisles markings are bordered by 4” blue lines,
have 4” white (blue in snow areas) line diagonals on 3'-0”
max centers and have “NO PARKING” painted in white 1'-0”
Yes
No
Yes
No
Yes
No
high letters at traffic side ends (see Standard Plans A90B
and A24E details)?
Each off-street accessible parking stall includes an ISA
marking at rear limit of stall (see Detail A Standard Plan
Yes
No
Yes
No
Yes
No
A90A and A24C) with white borders, white ISA marking and
blue background?
Each off-street accessible parking stall includes a curb or
Yes
No
Yes
No
Yes
No
bumper to prevent encroachment of vehicles over the
required width of walkways?
Parking spaces and access aisles are level with surface
Yes
No
Yes
No
Yes
No
slopes and do not exceed 1.7% in all directions?
Sign R100B (CA) located in a conspicuous place at each
entrance or immediately adjacent to and visible from each
Yes
No
Yes
No
Yes
No
accessible stall and includes the required address and phone
number information?
Accessible parking signs are provided for each accessible
stall (i.e., R99 (CA) and R99B (CA) or R99C (CA) typical with
R7-8b for van accessible) and lowest sign edge provides a
Yes
No
Yes
No
Yes
No
minimum of 7'-0” clearance above the highest surrounding
surface?
Accessible parking spaces serving a particular building are
located on the shortest accessible route of travel from
adjacent parking to an accessible entrance and accessible
Yes
No
Yes
No
Yes
No
parking spaces that do not serve a particular building are
located on the shortest accessible route of travel to an
accessible pedestrian entrance of the parking facility?
Parking stalls are located so that persons with disabilities are
Yes
No
Yes
No
Yes
No
not compelled to wheel/walk behind parked vehicles other
than theirs?
Remarks
Field inspection checklist completed by (print name) Signature
Date
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.
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