Form TR-0405 "Certification of Compliance With Americans With Disabilities Act (Ada)" - California

What Is Form TR-0405?

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 March 1, 2015;
  • 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 TR-0405 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form TR-0405 "Certification of Compliance With Americans With Disabilities Act (Ada)" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CERTIFICATION OF COMPLIANCE WITH AMERICANS WITH DISABILITIES ACT (ADA)
TR-0405 (REV 03/2015)
Permit No.
Dist/Co/Rte/PM
Encroachment permit projects that create, alter, or affect pedestrian facilities are required to be designed and constructed in
accordance with the policies and standards in the current Design Information Bulletin 82 (DIB 82). Certification of compliance must be
submitted by the permittee or permittee's authorized representative prior to the issuance of an encroachment permit or rider AND after
construction is completed. DIB 82 can be found at:
http://www.dot.ca.gov/hq/oppd/dib/dibprg.htm
A separate TR-0405 form must be used for the Design and Post Construction Certifications. A California Licensed Professional
Engineer, Licensed Architect or Licensed Landscape Architect's Stamp* is required except when (1) an authorized utility company
representative or (2) an authorized Caltrans representative signs the form (at the discretion of the District Permit Engineer).
Design Certification (prior to issuance of encroachment permit)
I
a California Licensed Professional Engineer, Licensed Architect or Licensed Landscape Architect,
do hereby certify that:
I
an authorized Caltrans representative, do hereby certify that:
I
an authorized representative of
(utility company only)
do certify that:
This project has been designed in accordance with DIB 82.
An approved Exception to Accessibility Design Standards is attached.
SIGNATURE
TITLE
DATE
Post Construction Certification
a California Licensed Professional Engineer, Licensed Architect or Licensed Landscape Architect,
I
do hereby certify that:
an authorized Caltrans representative, do hereby certify that:
I
I
an authorized representative of
(utility company only)
do certify that:
This project has been constructed in accordance with DIB 82.
An approved Exception to Accessibility Design Standards is attached.
SIGNATURE
TITLE
DATE
CA. LICENSED PROFESSIONAL ENGINEER, LICENSED
ARCHITECT OR LICENSED LANDSCAPE ARCHITECT'S
STAMP
I attest to the technical information contained herein and have
*A Licensed Architect or Licensed Landscape Architect may prepare this document and sign and
judged the qualifications of all technical specialists providing
seal it in lieu of a Registered Civil Engineer, provided the same Licensed Architect or Licensed
engineering data upon which recommendations, conclusions,
Landscape Architect designed the on-site improvements. Use the seal of the appropriate licensed
and decisions were based.
person in responsible charge.
ADA Notice
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CERTIFICATION OF COMPLIANCE WITH AMERICANS WITH DISABILITIES ACT (ADA)
TR-0405 (REV 03/2015)
Permit No.
Dist/Co/Rte/PM
Encroachment permit projects that create, alter, or affect pedestrian facilities are required to be designed and constructed in
accordance with the policies and standards in the current Design Information Bulletin 82 (DIB 82). Certification of compliance must be
submitted by the permittee or permittee's authorized representative prior to the issuance of an encroachment permit or rider AND after
construction is completed. DIB 82 can be found at:
http://www.dot.ca.gov/hq/oppd/dib/dibprg.htm
A separate TR-0405 form must be used for the Design and Post Construction Certifications. A California Licensed Professional
Engineer, Licensed Architect or Licensed Landscape Architect's Stamp* is required except when (1) an authorized utility company
representative or (2) an authorized Caltrans representative signs the form (at the discretion of the District Permit Engineer).
Design Certification (prior to issuance of encroachment permit)
I
a California Licensed Professional Engineer, Licensed Architect or Licensed Landscape Architect,
do hereby certify that:
I
an authorized Caltrans representative, do hereby certify that:
I
an authorized representative of
(utility company only)
do certify that:
This project has been designed in accordance with DIB 82.
An approved Exception to Accessibility Design Standards is attached.
SIGNATURE
TITLE
DATE
Post Construction Certification
a California Licensed Professional Engineer, Licensed Architect or Licensed Landscape Architect,
I
do hereby certify that:
an authorized Caltrans representative, do hereby certify that:
I
I
an authorized representative of
(utility company only)
do certify that:
This project has been constructed in accordance with DIB 82.
An approved Exception to Accessibility Design Standards is attached.
SIGNATURE
TITLE
DATE
CA. LICENSED PROFESSIONAL ENGINEER, LICENSED
ARCHITECT OR LICENSED LANDSCAPE ARCHITECT'S
STAMP
I attest to the technical information contained herein and have
*A Licensed Architect or Licensed Landscape Architect may prepare this document and sign and
judged the qualifications of all technical specialists providing
seal it in lieu of a Registered Civil Engineer, provided the same Licensed Architect or Licensed
engineering data upon which recommendations, conclusions,
Landscape Architect designed the on-site improvements. Use the seal of the appropriate licensed
and decisions were based.
person in responsible charge.
ADA Notice