Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N:•�VS ` 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> cq(joRN�P INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: New Residential Construction <br /> Project Address: 21718 N Cord Road, Clements, CA 95227 <br /> Project Valuation: $825, 000 . 00 Contact E-mail: rmccarty@ovcb.corn <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Richard A. McCarty Name: Same <br /> Address: 20200 N Sierra Drive Address: <br /> City: Lockeford State: CA City: State: <br /> ZIP: 95237 Ph#(201 765-7238 ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#(209) 993-4353 <br /> Lic. No: 511785 Company Name: M.L. Dawson Construction <br /> Address: P.O. Box 759 City: Galt St:CA Zip: 95632 <br /> DESIGNER INFORMATION Ph#(209) 368-6916 <br /> Lic. No: 284645 Company Name: Douglas D. Highfill Jr. Construction Services <br /> Address: 614 Marsala Ct . City: Lodi St: CA ZIP: 95240 <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes❑ No ® OFFICIAL USE ONLY <br /> If yes, a completed Owner-Builder Verification Form must Identification Number: <br /> be signed and submitted along with copy of the owner's <br /> identification prior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my signature below, I certify to one of the following: <br /> I am ❑ a California licensed contractor or 0 the property owner or❑ authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted). <br /> 1 have read this construction permit application and the information I have provided is correct. <br /> I agree to comply with all applicable county ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or • enter the above-identified property for inspection purposes. /p, <br /> Applicant's Signature L �� /I Date 6 / � / < <Y <br /> For your convenience checklists deta ing any additional submittal requirements for various building permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:Wpplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 " <br /> (Revised(07-08-10) <br />