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1� WHO MAY APPLY? <br /> ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMITS. <br /> Owner-Builder must submit the following with the application: Contractor must submit the following with the application: <br /> • A property tax statement or a recorded deed • Current license numbers and a worker's compensation <br /> • A completed and signed"Owner-Builder Verification"form insurance certification (this is not necessary if this information <br /> • A completed"Authorization for Application"foram if other than is already on file with the Department) <br /> the owner applies • A waiver form if the contractor is not subject to worker's <br /> compensation laws <br /> • A completed"Authorized to Sign'form if other than the <br /> contractor applies(this is not necessary if this information is <br /> already on file with the Department) <br /> THIS PAGE TO BE FILLED OUT BY DEVELOPMENT SERVICES STAFF <br /> '' \\ <br /> PROPERTY INFORMATION <br /> Job-Site Address: - iNJ 1q APN: �P <br /> Cross-Street: nn Q :Sy k ZIP:C <br /> Precise Location: S 1 <br /> Subdivision Name: ''-" Map# VLot# <br /> ront: <br /> Zoning and Setbacks Zone: -L FLeft: 1 Riaht (6 1 Rear: 0 1 He ht <br /> School District: Stwtt)o Fire District: /� <br /> Sewer District M( _ Water District Coll <br /> Approved <br /> Site Plan Type Hazardous Materials Survey Submitted: Yes: ❑ <br /> MINO�, GENERAL: ❑ MAJOR: ❑ N/A: ❑ If answer is no-Please explain: <br /> Planning Project( UP, MS etc.)Expiration date: h <br /> US \ IM . <br /> MONTH DAY YEAR <br /> SPECIAL AREAS <br /> Subsidence Area:Yes: ❑ Nf Expansive Soil Area: YeC4 No: ❑ <br /> Fire Hazard Area:Yes: ❑ NaE Airport Zane: Yes: O NdCW <br /> Enterprise Zone: Yew No: ❑ SJAFCA: Yes: ❑ N <br /> BUSINESS LICENSE <br /> Required: Yef':2 No: ❑ BL No.: I Fee Paid: Yes: ❑ <br /> COMMENTS <br /> ray 1INh [ an <br /> BAND LE±�ElI1C_i AND INT <br /> e responsibility of the applicant to corn I wit- S- <br /> Cou .y Ordinanc <br /> s er Courses,Sections 67000 through Leveling and Interference with <br /> eg h&7014 (SeeAttached). <br /> APPROVED FOR GRADING ONLY.- <br /> - By -- <br /> i <br /> _Plan Check O YES �'.Z File# <br /> Tedriiaarr: -- -- 3 M/ Date: <br /> F BUW,q a, tSPERMJ APP-GR ING d«F"n26�1� 12.2-mi Page 2 of <br />