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Application - C inmerciai Coat,, , Building P rynMt1. (Non-Residential Mobile Unit) SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E.HAZELTON AVENUE,STOCKTON,CA.95205 BUSINESS PHONE(209)468-3123 REQUEST FOR INSPECTION v v ECTION P41ONE(209)4683165(24 HOUR RECORDED PERMIT NO. THIS SECTION IS TO BE FILLED OUT BY DEVELOPMENT SERVICES STAFF. SITE LOCATION INFORMATION '1- 20—'13 / Date: Technician: Job-SNe Address: �`�y Z S C L c 1,1 7_1?Et ��'� APN: Z01 Cross-Street: T-,4 C_ "><&V%a A J city: :IkI a,(,7Lc/� ZIP: 19-5 Precise Location: 7 �O/L Tj}"5 1 ��cJ�'N�'� Q /-'C r�7 Flle No.: MLA- 9-3- '- /V I-) L A/1` 7-2f✓E P_0A CLLjS � =t �. Subd. History: Subdivision Name: (v/Zjt/(/2S s� �tA{ iYl{/Lt7 Map# BI/Lot FACILITY INFORMATION Water Supply Existing On-She Well: New On-Site Well: Public: Sewage Disposal Existing Septic System: New Septic System: Public: Storm Drainage No Change: New On-Site System: Public: Driveway/Access Existing Driveway: New With Curb-Gutter: New Without Curb-Gutter: THIS PORTION OF THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR PERMITS REQUIRED TO INSTALL A COMMERCIAL COACH. Scope of Work: Business Name (DBA): Fl 1) eoalvf42 E u! /lit,:// Bus. LIc. No: 6uli t li/�,tc ^OWNER NA jME AND ADDRESS (� APPLICANT NAME AND ADDRESS Name: IAF t/IY i ;C,( I��il/��, �i�r�( F_ Name: (/�!� �u� C,Gcilill, /U-N Address: 1 I txJ i ? \ i k C L,E Address: City: )<�,I,jo o 0R pj)04� State: t� city: E 1-�� T t ' state: .� C ZIP: `,J 74 2 6 P)07 Ph:(a;.,) 6, ` t. ( ZIP: C,S 3 :3 C Ph:(lC�`?) YSt- L 3 S 1 CONTRACTOR INFORMATION Ph:( ) LIc. No: Company Name: Address: City: St: ZIP: 11ESICNER INFORMATION V`" l ) C Llc. No: JO _ I !�� Company Name: Address: Ctty: ��( ,: / -' St: /? ZIP: MOVING CONTRACTOR Name: Address: City: St: ZIP: MOVING INFORMATION Move Date: Hours: to Height: Width: Length: Weight: HCD No: Travel Route From: To: Via: Note: Routes that Include travel on State Routes or City streets must be approved by those agencies prior to Issuance of a Transportation PermH by the County. Evidence of such approvals must be attached to the application. WHO MAY APPLY? ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMITS. Owner-Bui{ders must submit the following with their application: • A property tax statement or a recorded deed • A completed and signed'Owner-Builder Verification'form • A completed'Authorization for Application'form If other than the owner applies. Contractors must submit the following with their application: Current license numbers and a worker's compensation Insurance certification (this Is not necessary if this Information Is already on file with the Department) A waiver form If the contractor is not subject to worker's compensation laws A completed'Authorized to Sign'form If other than the contractor applies (this Is not necessary if this Information Is already on file with the Department).