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CERTIFICATE OF OCCUPANCY ROUTING FORM I Fbfi SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E.HAZELTON AVENUE,STOCKTON,CA 95205 BUSINESS PHONE(209)468-3123 Permit No.: �� 1 APN:U " - ZZO_-0 Z Business License No.: I Job-Site Address: ��Qp &„ QUC o Use of Structure: Doing Business As: C �+ ,. Planning Application No.: X OWNER NAME AND ADDRESS L CONTRACTOR NAME AND ADDRESS I Name: �T-�,}� (�1TfJl"E - /`'�t�ir" "f Name: Q l.•7 J-� p�t� Address: a 0 g-(LI 14- -6uG�J �� Address: City: C�Y�iI State: City: State: ZIP: $ZZO PH: D 1 qF1_ j$g ZIP: PH: I STRUCTURE REQUIREMENTS Occupancy Group: Occupancy Load: Type of Construction: -� Square Feet: C)00 Zoning: Fire Sprinklers: Yes 1 l� Area Separation Wail in Lieu of Sprinklers: Yes I(N HeatedlCooled: Yes ! �. i Before a final inspection can be made by the Building Inspection Division,and prior to Issuance of a Certificate of Occupancy by the Building Official,APPROVAL SIGNATURES must be obtained from the agencies indicated below, It is the applicant's responsibility to r obtain all signatures and return this form to the Building Division. Please be aware that advanced notice and a field inspection time may be required by each agency prior to signature. If your project is in a flood zone,the Building Division must have the Elevation Certificate properly signed before approval can be granted. NOTE: PLEASE BRING YOUR APPROVED BUILDING PLANS WHEN OBTAINING i SIGNATURES ON THE CERTIFICAT OF OCCUPANCY ROUTING FORM. APPROVAL REQUIRED: Apt DEPAaT P BLI RK ! DATE I ENVIRONMENTAL HEALTH DATE AIR POLLUTION CONTROL DISTRICT DATE COUNTY FIRE WARDEN DATE i FIRE CHIEF DATE LOCAL FIRE DISTRICT: CITY OF STOCKTON FIRE DEPARTMENT DATE CALTRANS DATE OFFICE OF EMERGENCY SERVICES DATE V STOCKTON METRO AIRPORT(209)468-4700 DATE NOTE TO DEPARTMENTS LISTED ABOVE: Your signature indicates that your conditions have been met. Use the reverse side of this form to note comments or conditions,or to approve temporary occupancy. I Once the required signatures are obtained,return this form to the Building Division. A final building inspection will be scheduled at your request. A final inspection will not be made unless this completed form has been returned. 0112001 F:IHuildinglHandoutslHandout 72.doc(Revised 06-28-02) Page I of