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BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 �C3roR� THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work: BE BUILD BURNED HOME Project Address: 29899 RIVER RD.,ESCALON,CA.95320 Project Valuation: S289,000 Contact E-mail: DDEGRAFF@CELADONGC.COM OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: KATHERYN FINE Name: NATE LUDLOW Address: 29899 RIVER RD.,ESCALON,CA.95320 Address: 1570 E F STREET,A300 City: ESCALON State: CA City: OAKDALE State: CA ZIP: 95320 Ph#(209 ) 765-8396 ZIP: 95361 Ph#(209 ) 595-3468 CONTRACTOR INFORMATION Ph#(209 ) 840-3150 Lic. No: 974023 Company Name: CELADON DEVELOPMENT,INC. Address: 1570 E F STREET,A300 City: OAKDALE St: CA ZIP: 95361 DESIGNER INFORMATION Ph#( ) Lic. No: 514412 Company Name: LSODESIGN Address: 12616 MAIN 5T. City WATERFORD St. CA Zip: 95386 LENDING AGENCY Ph#( ) Company Name: NONE Address: City: St: ZIP: Permit will be issued to an"Owner-Builder" Yes❑ No OFFICIAL USE ONLY if yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify to one of the following: I am x❑a California licensed contractor or❑the property owner or❑authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit application and the information I have provided is correct. I agree to comply with all applicable county ordinances and state laws relating to building construction. I authorize representatives of this city or c ty to ter the above-identified property for inspection purposes. Applicant's Signature Z7 Date V For your convenience checklists detailing any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check- list. FAAppllcation Forms&HandoulslHANDOUITSIBuilding Permit Application.docPage t of 2 (Revised(07-08-10)