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BUILDING PERMIT APPLICATION <br /> Q; SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N; <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> �9i'tF&R 4 INSPECTION REQUEST-24 HOUR RECORDER: (209) 4683165 <br /> THE APPLICATION IMU! <br /> T<BE COMPLETELY FILLED OUT BY'THE;APPLICANT IN ORDER TO"APPLY <br /> ,FOR <br /> BUILDING.P_ERMITS: - <br /> Scope of Work:Conversion of an existing car garage into a wine production and wine barrel stor ge <br /> Project Address: &539 E. Peltier Road, Acampo, CA 95220 <br /> Project Valuation: $80, 000 Contact E-mail: tm@wmbarchitects . com <br /> OWNER NAME AND.ADDRESS" APPLICANT NAME AND ADDRESS <br /> Name: Debra Green Name: WMB Architects, Inc. <br /> Address: 6535 E. Peltier Road Address: 5757 Pacific Ave. <br /> City: Acampo State:CA. city: Stockton <br /> State: CA. <br /> Zip: 95220 Ph#(209) 333-0637 71P: 95207 Ph#(209) 944-9110 <br /> < CONTRACTOR INFORMATION` Ph#( ) <br /> Lic. No: Company Name: TBD <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION; Ph#( ) <br /> LIc. No:C16986 companyName:WMB Architects, Inc . <br /> Address: 5757 Pacific Ave. Ste.226 City: Stockton st, CA. Zlp: 95207 <br /> LENDINGAGENCY. _r Ph#(209) 944-9110 <br /> Company Name: n/a <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 toenterthe above-identified property for Inspection purposes. <br /> Applicant's Signature' 'I���I� Date dI � 1 � l t <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 /> FMpplicatlon Forms&HandoutsWANDOUTS1Building Permit Applicatlon,docPage 1 of 2 <br /> (Revised(07-08-10) <br />