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z: <br /> 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 /> d9Y;FORa`" INSPECTION REQUEST-24 HOUR RECORDER: (209) 468.3165 j <br /> i <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: Addition & Remodel to Existing Single Family Residence <br /> Project Address: 471 Yettner Road, French Camp, CA 95231 <br /> Project Valuation: Contact E-mail: GRA22875@gmaii.com <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: George Fernandez Name: Same As Owner <br /> Address: 471 Yettner Road Address: <br /> City: French Camp State: CA City: State: <br /> ZIP: 95231 Ph#(209 ) 570-6897 ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> LIC. No: C22875 Company Name: George A. Rodriguez, GRA Architects & Associates, Inc. <br /> Address: P.O. Box 9082 City: Stockton . St: CA ZIP: 95208-1082 <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❑ 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 /> 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 city or county to enter the above-identified property for inspection purposes. <br /> Applicant's;Signature Date <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 /> 1184.` <br /> R%pplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised[(07-08-10) <br />