Form Dsa 140 – Fill Out and Use This PDF

Identify the type of submitted document (including whether it is a resubmittal or not) and, when applicable, the number and category (e.g., for CCDs, reference IR A-6: Construction Change Document Submittal and Approval Process).

The post-approval documents are Deferred Submittals, Addenda, Revisions (NOTE: Revisions are significant changes to the DSA-approved construction documents or redesign of previously approved items) and Construction Change Documents (CCDs).

School District/Owner is the same as line two on form DSA 1: Application For Approval of Plans and Specifications. Project Name/School is the same as line one on form DSA 1. DSA file and application numbers are the same as indicated on the DSA identification stamp on the plans and the signature sheet of the specifications.

Enter the submittal date, whether additional pages are attached, and how many.

Enter the “applicant” (the architect or engineer in general responsible charge identified on line 21 of form DSA 1) contact information including the name and address of the firm where they are employed.

Check the applicable boxes based on the nature of the post-approval submittal document and related project information.

For revision or addendum prior to construction. For a project currently under construction. For a project that has a form DSA 301-N: Notification of Requirement for Certification, DSA 301-P: Posted Notification of Requirement for Certification or a 90-Day Letter issued. To obtain DSA approval of an existing uncertified building or buildings.

Enter the following information for the individual identified on line 21 of form DSA 1: name, California professional license number, discipline and signature.

Name of the Design Professional In General Responsible Charge.

For addenda, revisions, or CCDs: CHECK THIS BOX to confirm that all post-approval documents have been stamped and signed by the Responsible Design Professional listed on form DSA 1: Application for Approval of Plans and Specifications for this project.

Provide a brief description of construction scope for this post-approval document (attach additional sheets if needed). List of DSA-approved drawings affected by this post-approval document.

For addenda and revisions, a summary letter of all changes and affected DSA-approved construction documents shall be provided in addition to the brief descriptions provided in this section.

For Deferred Submittals, refer to IR A-18: Use of Construction Documents Prepared by Other Professionals, and IR A-19: Design Professional's Signature and Seal (Stamp) on Construction Documents, when applicable, for signature and seal requirements.

For projects with a form DSA 301-N: Notification of Requirement for Certification, DSA 301-P: Posted Notification of Requirement for Certification, or 90-day Letter, refer to PR 13-02: Project Certification Process for further information and requirements.