Gender Inclusive Facility Waiver Form - Renovations and Additions
GENDER INCLUSIVE FACILITY WAIVER REQUEST BASED ON HARDSHIP |
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Project Number/Description |
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Date |
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PROJECT COST |
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Construction cost of overall project |
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$ |
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Construction cost of inclusive restroom work |
$ |
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Percentage of restroom cost/overall project construction cost |
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OCCUPANT LOAD & FIXTURE COUNTS |
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Occupant load of building |
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Occupants |
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MEN |
WOMEN |
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Toilets & Urinals |
Lavatories |
Toilets |
Lavatories |
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1,2,4 Required number of gender specific toilet/urinal fixtures |
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Existing number of gender specific toilet/urinal fixtures |
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Number of gender specific fixtures including new inclusive restroom(s) |
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Deficit (if any) with new inclusive restrooms and fixtures |
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PROXIMITY |
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Are there other inclusive restrooms in this building? (Circle one) |
YES or NO |
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If YES, indicate distance to nearest inclusive restroom in building. |
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Travel distance in feet |
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Travel distance - number of floors |
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3 If NO, indicate location of nearest inclusive restroom. |
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Travel distance in feet between building entries |
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Pedestrian travel time between building entries |
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HARDSHIP |
(Describe) |
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If space will be reassigned from programmatic or other dedicated use to construct the inclusive restroom(s), describe secondary effects of constructing restroom in this location. |
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INTENT |
(Describe) |
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If inclusive restroom cannot be provided in this location, describe the proposed alternate solution and how it meets the spirit and intent of the inclusive restrooms guidelines. |
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Notes |
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1 "Separate" refers to California Code of Regulations, Title 24, Part 6--California Plumbing Codes, Section 422.2, Separate Facilities: "Separate toilet facilities shall be provided for each sex." See also Table 422.1 of the plumbing code for fixture count requirements. |
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2 Include additional code-triggered required separate fixture that must be added by the work of the new project, if any. |
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3 Pedestrian travel
time is encouraged to be less than 2 minutes between building entrances to
avoid extending break times |
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4 Modify form as needed if assessing changing rooms or showers. |