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" BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> �,/• BUSINESS PHONE: (209)468-3121 <br /> q::.:::.:• INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> CI FOR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of work: Furnish As Built Drawings per Request of Darwin Davis <br /> Project Address: <br /> 2420 E.Eight Mile Road, SIQ <br /> Project Valuation: Contact E-mail: 1CU fero bra erane.com <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Bragg Investment Company,`Inc. Name: Owen Ku fer <br /> Address:6242 N. Paramount Blvd. Address:6242 N. Paramo int Blvd. <br /> city: Lon Beach state: CA. city:Long Beach State: CA. <br /> zIP: Ph#(563-984-2480 ZIP:90805 Pn#(56ti 4-2480 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lir. No:A 504420-C Company Name: Bragg In estmennt CoMpany, 111C <br /> _51 1Address: 6242 Paramount Blvd. city: Long Beach st:CA. zip:90805 <br /> DESIGNER INFORMATION Ph#(916 729-0593 <br /> I <br /> Lic. No: Company Name: Foothill En inecrinfy <br /> Address:8442 Story Ride Way CIty:Antelo e St: CA. ZIP: 95843 <br /> LENDING AGENCY Ph#( ) <br /> Company Name: N/A <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes EXNo ❑ 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❑the property owner or[X authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted). <br /> I 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 cit�,unty to enter the above-identified property for inspection purposes. <br /> J <br /> Applicant's Signature �� I— <br /> Date July 30 3014 <br /> For your convenience checklists detailing 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 /> FMpplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />