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CERTIFICATE OF OCCUPANCY ROUTING FORM <br /> ' San Joaquin CountyCommunity Development Department <br /> Y 1 1810 E. Hazelton Ave, Stockton, Ca 95205 <br /> tFtiok4� Business Phone (209) 468-3121 <br /> Permit No: BP-1201439 APN: 212-190-12 Contractor: <br /> Job-Site Address: 11970 W LARCH RD TRAC Use of Structure: Reli eous Assembly phase 1 <br /> Planning Application No: PA 0800061 <br /> OWNER NAME AND ADDRESS <br /> Name: TRACY ISLAMIC CENTER <br /> Address: 11299 W LARCH RD TRACY CA 95304-1515 <br /> Telephone: <br /> STRUCTURE REQUIREMENTS <br /> Occupancy Group: A-3 Occupancy Load: 296 <br /> Type of Construction: VB Square Feet: 4827 <br /> Zoning: R-L Fire Sprinklers: Provided: YES Required: YES <br /> Before a final inspection can be made by the Building Inspection Division, and prior to issuance of a Certificate of <br /> Occupancy by the Building Official, APPROVAL SIGNATURES must be obtained from the agencies indicated below. It <br /> is the applicant's responsibility to obtain all signatures and return this form to the Community Development Department. <br /> Please be aware that advanced notice and a field inspection time may be required by each agency prior to signature. <br /> NOTE: PLEASE BRING YOUR APPROVED BUILDING PLANS WHEN OBTAINING SIGNATURES ON THE <br /> CERTIFICATE OF OCCUPANCY ROUTING FORM. <br /> APPROVAL REQUIRED: DATE: <br /> FRI <br /> DEPARTMENT OF PUBLIC WORKS 209-468-3000 <br /> 0 t/1 :�,Dk— 2" C <br /> ENVIRONMENTAL HEALTH 209-468-3420 <br /> COUNTY FIRE WARDEN 209-468-3165 — <br /> FIRE CHIEF-FIRE DISTRICT: TRACY RURAL 209,831-7107 <br /> CALTRANS 209-948-7543 <br /> MOUNTAIN HOUSE CSD 209-468-0327 <br /> STOCKTON METRO AIRPORT 209-468-4700 <br /> OTHER: <br /> NOTE TO DEPARTMENTS LISTED ABOVE: Your signature indicates that your conditions have been met and <br /> authorize the Community Development Department to complete a final inspection. <br /> Once the required signatures above are obtained, return this form to the Community Development Department. A final <br /> buidling inspection will be scheduled at your request. A final inspection will not be scheduled until this form has been <br /> completed and returned. <br /> FOR STAFF USE ONLY <br /> Approved <br /> ❑ Yes F� No <br /> Community Development Department Date <br />