Form RW11-6 "Non-residential Rental Application" - California

What Is Form RW11-6?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2007;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form RW11-6 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form RW11-6 "Non-residential Rental Application" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 1 of 3
NON-RESIDENTIAL RENTAL APPLICATION
PERSONAL INFORMATION NOTICE
RW 11-6 (REV 07/2007)
Pursuant to the Federal Privacy Act (P.L. 93-579) and the Information Practices
Act of 1977 (Civil Code Sections 1798, et seq.), notice is hereby given for the
request of personal information by this form.
The requested personal
information is voluntary. The principal purpose of the voluntary information is
to facilitate the processing of this form. The failure to provide all or any part of
COMPLETE ALL ITEMS-PLEASE PRINT
the requested information may delay processing of this form. No disclosure of
(Co-Applicants complete separate forms.)
personal information will be made unless permissible under Article 6, Section
1798.17 of the IPA of 1977. Each individual has the right upon request and
proper identification, to inspect all personal information in any record
maintained on the individual by an identifying particular. Direct any inquiries
on information maintenance to your IPA Officer.
BUSINESS
YEARS IN
FEDERAL ID NUMBER
MORTGAGE PAYMENT
RENT PAYMENT
BUSINESS NAME
Sole Proprietorship
BUSINESS
(per month)
(per month)
Partnership
APPLICATION DATE
Corporation
CURRENT BUSINESS ADDRESS (Street, City, State, ZIP Code)
YEARS
MONTHS
CURRENT LANDLORD NAME
BUSINESS TELEPHONE
FORMER LANDLORD NAME
BUSINESS TELEPHONE
FORMER BUSINESS ADDRESS (Street, City, State, ZIP Code)
YEARS
MONTHS
STANDARD INDUSTRIAL CLASSIFICATION (SIC)
SIC CODE DESCRIPTION (describe each SIC code if more than one are applicable)
CODE(s) (for activities conducted on the lease
premises)
GIVE BRIEF NARRATIVE DESCRIPTION OF OPERATIONS AND ACTIVITIES THAT WILL TAKE PLACE ON THE LEASE PREMISES
WILL LEASE ACTIVITIES REQUIRE COVERAGE UNDER GENERAL
IF GENERAL INDUSTRIAL PERMIT IS REQUIRED, HAS WASTE
PERMIT ORDER 97-03-DWQ (GENERAL INDUSTRIAL PERMIT) ISSUED
DISCHARGE IDENTIFICATION (WDID) NUMBER BEEN OBTAINED
BY STATE WATER RESOURCES CONTROL BOARD (SWRCB)?
FROM SWRCB?
YES
NO
IF YES, PROVIDE WDID#:
YES
NO
If lease activities will require coverage under the General Industrial Permit, Applicant will be required to provide a copy of the following information as a
condition of the lease:
Notice of Intent (NOI) or No Exposure Certification (NEC) filed with the SWRCB.
Receipt Letter from SWRCB showing Waste Discharge Identification Number.
Storm Water Pollution Prevention Plan (SWPPP) covering lease activities.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 1 of 3
NON-RESIDENTIAL RENTAL APPLICATION
PERSONAL INFORMATION NOTICE
RW 11-6 (REV 07/2007)
Pursuant to the Federal Privacy Act (P.L. 93-579) and the Information Practices
Act of 1977 (Civil Code Sections 1798, et seq.), notice is hereby given for the
request of personal information by this form.
The requested personal
information is voluntary. The principal purpose of the voluntary information is
to facilitate the processing of this form. The failure to provide all or any part of
COMPLETE ALL ITEMS-PLEASE PRINT
the requested information may delay processing of this form. No disclosure of
(Co-Applicants complete separate forms.)
personal information will be made unless permissible under Article 6, Section
1798.17 of the IPA of 1977. Each individual has the right upon request and
proper identification, to inspect all personal information in any record
maintained on the individual by an identifying particular. Direct any inquiries
on information maintenance to your IPA Officer.
BUSINESS
YEARS IN
FEDERAL ID NUMBER
MORTGAGE PAYMENT
RENT PAYMENT
BUSINESS NAME
Sole Proprietorship
BUSINESS
(per month)
(per month)
Partnership
APPLICATION DATE
Corporation
CURRENT BUSINESS ADDRESS (Street, City, State, ZIP Code)
YEARS
MONTHS
CURRENT LANDLORD NAME
BUSINESS TELEPHONE
FORMER LANDLORD NAME
BUSINESS TELEPHONE
FORMER BUSINESS ADDRESS (Street, City, State, ZIP Code)
YEARS
MONTHS
STANDARD INDUSTRIAL CLASSIFICATION (SIC)
SIC CODE DESCRIPTION (describe each SIC code if more than one are applicable)
CODE(s) (for activities conducted on the lease
premises)
GIVE BRIEF NARRATIVE DESCRIPTION OF OPERATIONS AND ACTIVITIES THAT WILL TAKE PLACE ON THE LEASE PREMISES
WILL LEASE ACTIVITIES REQUIRE COVERAGE UNDER GENERAL
IF GENERAL INDUSTRIAL PERMIT IS REQUIRED, HAS WASTE
PERMIT ORDER 97-03-DWQ (GENERAL INDUSTRIAL PERMIT) ISSUED
DISCHARGE IDENTIFICATION (WDID) NUMBER BEEN OBTAINED
BY STATE WATER RESOURCES CONTROL BOARD (SWRCB)?
FROM SWRCB?
YES
NO
IF YES, PROVIDE WDID#:
YES
NO
If lease activities will require coverage under the General Industrial Permit, Applicant will be required to provide a copy of the following information as a
condition of the lease:
Notice of Intent (NOI) or No Exposure Certification (NEC) filed with the SWRCB.
Receipt Letter from SWRCB showing Waste Discharge Identification Number.
Storm Water Pollution Prevention Plan (SWPPP) covering lease activities.
NON-RESIDENTIAL RENTAL APPLICATION
Page 2 of 3
RW 11-6 (REV 07/2007)
PERSONAL INFORMATION NOTICE
Pursuant to the Federal Privacy Act (P.L. 93-579) and the Information Practices
Act of 1977 (Civil Code Sections 1798, et seq.), notice is hereby given for the
request of personal information by this form.
The requested personal
information is voluntary. The principal purpose of the voluntary information is
to facilitate the processing of this form. The failure to provide all or any part of
COMPLETE ALL ITEMS-PLEASE PRINT
the requested information may delay processing of this form. No disclosure of
(Co-Applicants complete separate forms.)
personal information will be made unless permissible under Article 6, Section
1798.17 of the IPA of 1977. Each individual has the right upon request and
proper identification, to inspect all personal information in any record
maintained on the individual by an identifying particular. Direct any inquiries
on information maintenance to your IPA Officer.
APPLICANT
NAME (First, Middle Initial, Last)
DEPENDENTS
Unmarried
Self
Children
Married
DATE OF BIRTH
SOCIAL SECURITY NUMBER
HOME PHONE
Spouse
Others
Separated
-
-
DRIVER'S LICENSE NUMBER
VEHICLE (Year, Make, Model)
NAME/HOME ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
CURRENT EMPLOYER
BUSINESS TELEPHONE
O
C
BUSINESS ADDRESS (Street, City, State, ZIP Code)
C
U
P
A
CURRENT POSITION
MONTHLY GROSS PAY
YEARS
MONTHS
T
I
O
FORMER EMPLOYER
FORMER POSITION
YEARS
MONTHS
N
Include checking, savings, credit unions, and savings and loan associations.
You need not list income from
D
alimony, child support, or
E
Company Name/Location
Account Number
Average Balance
O
P
separate maintenance unless
$
T
O
Checking:
you wish it considered for
H
S
purposes of approving this
E
I
$
application.
Savings:
R
T
Types of
Monthly
$
Other:
I
A
Other Income
Amount
N
C
C
C
$
Checking:
O
O
M
U
$
Savings:
E
N
T
$
S
Other:
Please check box A if account is joint credit (Applicant and Co-Applicant). Check box B if the credit is in Applicant's name only, or box C if the credit is in your
Co-Applicant's name only. Be sure to list all open accounts with or without a balance. Attach separate sheet if necessary.
A B C
Loan Type
Creditor's Name
City
Account Number
Monthly Payments
Balance
C
R
E
D
I
T
R
E
F
E
R
E
N
C
E
S
NON-RESIDENTIAL RENTAL APPLICATION
Page 3 of 3
RW 11-6 (REV 07/2007)
Business Assets
Please attach financial statements for the past two (2) years. (If self-employed or retired, attach financial statements and/or income tax returns.)
I certify that I have never filed for bankruptcy and have no accounts past due.
APPLICANT'S SIGNATURE
DATE
In Case of Emergency Notify:
Home Address
Home Phone
City
Relationship
1.
2.
Local Personal References
Home Address
Home Phone
Occupation
Length of Acquaintance
1.
2.
Sections 7(a)(1) and (b) of the Federal Privacy Act of 1974 (Public Law 93.5.79) provide:
"It shall be unlawful for any Federal, State or Local Government Agency to deny to any individual any right, benefit, or privilege
provided by law because of such individual's refusal to disclose his/her social security account number."
"Any Federal, State or Local Government Agency which requests an individual to disclose his/her social security account number
shall inform that individual whether that disclosure is mandatory or voluntary, by what statutory or other authority such number is
solicited, and what uses will be made of it."
The Department of Transportation's authority for requesting disclosure is Streets and Highways Code Section 104.6, which reads:
"The Department is authorized to lease any lands which are held for State Highway purposes and are not presently needed
therefore on such terms and conditions as the Director may fix and to maintain and care for such property in order to secure rent
therefrom."
The Social Security Number will be used to (1) trace delinquent tenants who have vacated without leaving a forwarding address; and (2) enable the
State Controller to collect delinquent rent by the offset procedure required by State Administrative Manual Sections 8072.3, 8790.7 and 10510, as
authorized by Government Code Section 12419.5.
Applicant represents that statements made above are true and correct and hereby authorizes verification of references including, but not limited to, the
obtaining of a credit report and agrees to furnish additional credit references on request. Applicant acknowledges receipt of notification of the provisions
of the Federal Privacy Act of 1974 and consent thereof.
I CERTIFY THAT I HAVE READ THE NOTICE TO APPLICANTS DESIRING TO RENT DEPARTMENT OF TRANSPORTATION PROPERTIES AND
AGREE TO THE CONDITIONS SET FORTH.
The undersigned makes application to rent nonresidential property designated at address below for the rental fee and upon approval of this application
agrees to sign a rental or lease agreement and to pay all sums due before occupancy.
RENTAL PROPERTY ADDRESS
RENTAL FEE
APPLICANT'S SIGNATURE
DATE
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
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