Appendix A
13 CA ADC Div. 3 Ch. 13 Art. 1 App. ABarclays Official California Code of Regulations
13 CCR Div. 3 Ch. 13 Art. 1 App. A
Appendix A
VEHICLE FUNCTIONAL AND EQUIPMENT ELIGIBILITY INSPECTION FORM
Legal Owner: | Address: |
City: | Zip: |
VIN: | License Number: |
Make: | Model: |
Model Year: | Odometer Reading: |
VEHICLE QUALIFICATION | |||
Vehicle within 61-90 days of next scheduled Smog Check: | yes | no | 2602(c) |
If yes, vehicle failed next scheduled Smog Check: | yes* | no | |
Vehicle registered in District for at least 24 months: | yes | no* | 2603(a)(2) |
Vehicle on BAR repair cost waiver | yes* | no | 2603(a)(4) |
Vehicle on BAR economic hardship extension | yes* | no | 2603(a)(4) |
Vehicle within 60 days of next scheduled Smog Check: | yes | no | 2603(a)(5) |
If yes, vehicle passed next scheduled Smog Check: | yes | no* | |
The vehicle has been tampered with: | yes* | no | 2603(a)(7) |
The vehicle has been driven to the inspection site | yes | no* | 2603(b)(1) |
* Vehicle is not qualified for the VAVR program. |
EQUIPMENT ELIGIBILITY | The following shall be present and in place: | 2603(b)(3) |
All doors | yes | no* | Hood | yes | no* |
Dashboard | yes | no* | Driver's seat | yes | no* |
One bumper | yes | no* | All side and/or quarter panels | yes | no* |
Exhaust system | yes | no* | One headlight | yes | no* |
One taillight | yes | no* | One brake light | yes | no* |
One side window | yes | no* | Interior pedals operational | yes | no* |
FUNCTIONAL ELIGIBILITY | The following shall be completed: | 2603(b)(4) |
Vehicle starts using keyed ignition | yes | no* |
Vehicle starts without the use of starting fluids or external battery | yes | no* |
Vehicle driven forward for a minimum of 25 feet | yes | no* |
Vehicle driven in reverse for a minimum of 25 feet | yes | no* |
* Vehicle is not eligible for the VAVR program. |
INSPECTOR CERTIFICATION: (Check correct boxes.) I certify that this vehicle has ( passed not passed) both the functional and equipment eligibility inspections and ( is is not) eligible for acceptance into the VAVR program pursuant to California Code of Regulations, Title 13, Sections 2602 and 2603.
Printed Name: | Date: | |
Signed: |
The following should be completed if the vehicle is eligible for acceptance into a VAVR program.
OWNER ACCEPTANCE: I accept receipt of this CERTIFICATION of eligibility into a VAVR program. I agree not to alter the vehicle's equipment or functionality from that presented to the inspector. I agree to maintain the vehicle's condition and registration until the vehicle is retired.
Printed Name: | Date: | |
Signed: |
Credits
History
1. New appendix A filed 12-8-99; operative 1-7-2000 (Register 99, No. 50).
2. Repealer and new appendix A filed 7-13-2007; operative 8-12-2007 (Register 2007, No. 28).
This database is current through 4/26/24 Register 2024, No. 17.
Cal. Admin. Code tit. 13, Div. 3 Ch. 13 Art. 1 App. A, 13 CA ADC Div. 3 Ch. 13 Art. 1 App. A
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