Ver 2022.01
City of Commerce
Public Works Department
Screening Application for On-Street Physically Challenged Accessible Parking Space Applicant Name: _____________________________________________ Date: _____________________ Phone Number: _____________________________ Email: _____________________________________ Address of Request:______________________________________________________________________ Are you a tenant or owner of your residence? ____Tenant or ____Owner If tenant, is the property owner aware of this request? ____Yes or ____No Who is the parking space for? ___Self ___Child ___Spouse ___Parent ___Other If other please specify: ________________________________________________________ Please clearly mark Yes or No to the questions listed below to determine if your property is eligible for blue curb evaluation:
1. Is this request for a business or commercial property? ____Yes or ____No
2. Is there an existing blue curb within 1 block that can be used? ____Yes or ____No
3. Does the request property have on-site parking? ____Yes or ____No
4. Does the request property have a driveway? ____Yes or ____No
5. Can at least one vehicle park in the driveway? ____Yes or ____No
6. Does the request property have a garage or carport? ____Yes or ____No
7. Does the request property have access to a back alley where a car can park inside the property? ____Yes or ____No
8. Is this request for an apartment with 5 or more units? ____Yes or ____No
9. Is this request for bus or van pick up use? ____Yes or ____No If you answered YES to any of the questions (1-9) the request for a blue curb will be denied and not brought before the Traffic Commission, except for Question 1 where it meets the exceptions outlined in the section “Exceptions” of the Policy. You may dispute the decision by appearing in person at the next Traffic Commission Meeting.
If you answered NO to all questions (1-9) please submit this request to the building and safety counter, you will be contacted by Traffic Commission staff for subsequent information needed for Traffic Commission evaluation.
I certify that the answers to the questions contained in this Application Form are true and correct to the best of my knowledge. I understand that on-street disabled persons parking spaces (blue curb) is available for use by anyone possessing a valid disabled Person’s placard and/or Disable Person’s license plate issued by the DMV, and is not a reserved parking space for the applicant.
Applicant’s Signature: _________________________________________ Date:_____________________________ Print Name
Ver 2021.01
City of Commerce
Public Works Department
Application for On-Street Physically Challenged Accessible Parking Space (Blue Curb) Applicant Information (Holder of a California Disabled Person Parking Placard):
Name: ______________________________ Phone No.: ________________________ Address: ______________________________ City: Commerce Zip Code: 90040 .
E-mail Address: _____________________________
Representative for the applicant (usually a family member):
Name: ______________________________ Phone No.: ________________________ Address: ______________________________ City: Zip Code: ________ E-mail Address: _____________________________
Accessible Parking Space (Blue Curb) Address:_____________________________, Commerce, CA 90040 NOTE: If the Blue Curb location is not in front of the applicant’s residence, but at a neighboring residence, then the attached Application Addendum must be completed.
Are you the property owner or tenant of the residence in which the proposed blue curb will be placed? Property Owner Tenant
NOTE: If the applicant is a tenant, then the property owner must be notified by completing the attached Application Addendum.
Who is the parking space for?: Applicant (Self) Child (name): _________________________ Check all that apply: Parent (name): ________________________ Vehicle License Number: ______________________ (Note: Only if Vehicle has a Disabled Person’s License Plate) Valid Disabled Person’s Placard Number: ______________________ Expiration Date: ____________ Identification Provided: Resident Activity Card
(Current & Valid) California Driver’s License or California I.D. Card Why do you need an on-street physically challenged accessible parking? (Check all that apply):
Medical Condition Wheelchair Bound Cannot walk far (or limited mobility) Must use cane or walker Other (please explain):______________________________________ Do you currently drive? Yes No
Number of vehicles in household or at this address: _____ Operating ______ Non-operating (or stored) Number of available parking spaces on property: _____ Garage _______ In driveway/Carport
Ver 2021.01
Please answer the following questions to help us determine feasibility of your request:
1. Can your driveway be used for access by the physically challenged person’s vehicle? Yes No If not, why?_____________________________________________ _____________________________________________
2. Is there an existing on-street physically challenged accessible parking space in close proximity that you can use? If so, where is it located?
Yes No If so, please give location:__________________________________ Address
3. Is there any other information you would like to provide? _______________________________________________________________________________ NOTE: The neighbors around the applicant must be notified that a new blue curb may be placed at the applicant’s residence. Please have five (5) of the applicant’s neighbors fill out the attached petition. If the applicant lives in an area where there are less than 5 neighbors, please note that on the petition.
IMPORTANT: All the neighbors filling out the petition must live in the same block as the applicant. * * * * * * * * * * * * * * *
I certify that the answers to the questions contained in this Application Form are true and correct to the best of my knowledge and that I have read and understand the Policies and Procedures for On-Street Physically Challenged Accessible Parking Spaces.
An on-street physically challenged accessible parking space is available for use by anyone possessing a valid Disabled Person’s placard and/or Disabled Person’s license plate issued by the California Department of Motor Vehicles (DMV), and is not a reserved parking space for the applicant.
Applicant’s or Representative’s Signature:_______________________________ Date: ________________
City of Commerce
Public Works Department
Application ADDENDUM for On-Street Physically Challenged Accessible Parking Space (Blue Curb) Ver 2021.01
Please fill out this Application Addendum if you are a TENANT at your residence and NOT the property owner:
Applicant Information (Holder of a California Disabled Person Parking Placard):
Name: ______________________________ Phone No.: ________________________ Address: ______________________________ City: Commerce Zip Code: 90040 .
E-mail Address: _____________________________
Property Owner’s Information:
Name: ______________________________ Phone No.: ________________________ Address: ______________________________ City: Zip Code: ________ E-mail Address: _____________________________
Accessible Parking Space (Blue Curb) Address:_____________________________, Commerce, CA 90040 * * * * * * * * * * * * * * *
To be filled out by the property owner only:
NOTE TO THE PROPERTY OWNER:
The applicant above has applied to the City of Commerce to install an on-street physically challenged parking space (Blue Curb) in front of the residence located above.
Please acknowledge this blue curb parking space by signing and dating below. If you object to this, please contact the Public Works Department of the City of Commerce by calling (323) 722–4805, ext. 4451. A City representative can explain to you the details and provide you a copy of the Blue Curb Parking Policy. * * * * * * * * * * * * * * *
An on-street physically challenged accessible parking space is available for use by anyone possessing a valid Disabled Person’s placard and/or Disabled Person’s license plate issued by the California Department of Motor Vehicles (DMV), and is not a reserved parking space for the applicant.
Property Owner’s Signature:_______________________________Date: ____________________________ City of Commerce
Public Works Department
Application ADDENDUM for On-Street Physically Challenged Accessible Parking Space (Blue Curb) Ver 2021.01
Please fill out this Application Addendum if you are intending to install the Blue Curb parking space at your neighbor’s residence.
Applicant Information (Holder of a California Disabled Person Parking Placard):
Name: ______________________________ Phone No.: ________________________ Address: ______________________________ City: Commerce Zip Code: 90040 .
E-mail Address: _____________________________
Neighboring Property Owner’s Information:
Name: ______________________________ Phone No.: ________________________ Address: ______________________________ City: Zip Code: ________ E-mail Address: _____________________________
Accessible Parking Space (Blue Curb) Address:_____________________________, Commerce, CA 90040 * * * * * * * * * * * * * * *
To be filled out by the neighboring property owner only:
NOTE TO THE NEIGHBORING PROPERTY OWNER:
The applicant above has applied to the City of Commerce to install an on-street physically challenged parking space (Blue Curb) in front of your residence located above, due to space restrictions on the applicant’s property.
If you APPROVE, Please acknowledge this blue curb parking space by signing and dating below.
If you DISAPPROVE, please contact the Public Works Department of the City of Commerce by calling (323) 722–4805, ext. 4451. A City representative can explain to you the details and provide you a copy of the Blue Curb Parking Policy. Should you still object, please note it below and then sign and date this form.
In that event, a Blue Curb parking space will NOT be installed in front of your property.
As the neighboring property owner to the applicant, I ____________________________ Print Name
APPROVE DISAAPROVE
the installation of the Blue Curb in front of my property.
Neighboring Property Owner’s Signature:_______________________________ Date: _______________ Ver 2021.01
City of Commerce
Public Works Department
Biennial Re-Application for On-Street Physically Challenged Accessible Parking Space Applicant Information (Holder of a California Disabled Person Parking Placard):
Name: ______________________________ Phone No.: ________________________ Address: ______________________________ City: Commerce Zip Code: 90040 .
E-mail Address: _____________________________
Representative for the applicant (usually a family member):
Name: ______________________________ Phone No.: ________________________ Address: ______________________________ City: Zip Code: ________ E-mail Address: _____________________________
Who is the parking space for?: Applicant (Self) Child (name): _________________________ Check all that apply: Parent (name): ________________________ Existing Accessible Parking Space (Blue Curb) Location:_________________________________________ Vehicle License Number: ______________________ (Note: Only if Vehicle has a Disabled Person’s License Plate) Valid Disabled Person’s Placard Number: ______________________ Expiration Date: _____________ Identification Provided: Resident Activity Card
(Current & Valid) California Driver’s License or California I.D. Card Reason for continuing to keep On-Street Physically Challenged Accessible Parking Space (Blue Curb):
Check all that apply:
Medical Condition Wheelchair Bound Must use cane or walker Cannot walk far (or limited mobility) Other (please explain):_____________________________ ______________________________
Number of vehicles in household or at this address: _________ Operating _________ Non-operating (or stored)
Number of available parking spaces on property: _________ In driveway/Carport _________ Garage
* * * * * * * * * * * * * * *
I certify that the answers to the questions contained in this Re-application Form are true and correct to the best of my knowledge and that I have read and understand the Policies and Procedures for On-Street Physically Challenged Accessible Parking Space.
An on-street physically challenged accessible parking space is available for use by anyone possessing a valid Disabled Person’s placard and/or Disabled Person’s license plate issued by the DMV, and in not a reserved parking space for the applicant.
Applicant’s Signature: ______________________________ Date: ____________________________ Ver 2021.01
City of Commerce
Public Works Department
Removal of On-Street Physically Challenged Accessible Parking Space Name of Person (requesting removal of parking space): _______________________________________ Relationship to Current Applicant: Spouse Other family member No relationship Applicant’s Name (person that originally requested the parking space):__________________________ Address: ______________________________
(Existing Location of Blue Curb Accessible Parking Space) City: Commerce Zip Code: 90040
Telephone: ______________________________
E-mail Address: _____________________________
Identification Provided: Resident Activity Card
(Current & Valid)
California Driver’s License or California I.D. Card Reason for requesting the removal of the existing On-Street Physically Challenged Accessible Parking Space? Check all that apply:
Person deceased Person moved No longer needed
Other (please explain):_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ * * * * * * * * * * * * * * *
I certify that the answers to the questions contained in this Application Form are true and correct to the best of my knowledge and that I have read and understand the Policies and Procedures for On-Street Physically Challenged Accessible Parking Space.
Requestor’s Signature: __________________________ Date: ____________________________