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yo,.Pa ,po` 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 CfFO'M1 THE APPLICATION`MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of work:Travel Stop and Restaurant (Arby's) Project Address:15250 North Thornton Road, Lodi, CA 95242 Project Valuation: u q Spa 000 Contact E-mail:bwright@gsb-inc.com or hmankin@gsb-inc.com OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name:Mr. Terry Ross, Loves Travel Stops& Country Stores Name:Mr. Terry Ross, Loves Travel Stops & Country Stores Address:PO Box 26210 Address:PO Box 26210 city:Oklahoma City State:OK city:Oklahoma City State:OK ZIP:73126 Ph#( )405-302-6744 ZIP:73126 Ph#( )405-302-6744 CONTRACTOR INFORMATION Ph#( ) n/a Lic. No:n/a Company Name:n/a Address:n/a I City:n/a St: ZIP:n/a DESIGNER INFORMATION I Ph#( )405-848-9549 Lic. No:C-18762 Company Name:GSB, Inc. Architects Planners Address:3555 NW 58th St., Suite 70OW City:Oklahoma City St: OK ZIP:73112 LENDING AGENCY Ph#( )n/a Company Name:n/a Address:n/a City:n/a St: ZIP: n/a Permit will be issued to an"Owner-Builder" Yes ❑ No Q 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 ❑ a California licensed contractor or H 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 county to enter th ove-identified property for inspection purposes. . Applicant's Signature Date; For your convenienceding Div siodetailing an additional submittal requirements for various building permit types are available at the Builn counter. Demolition permit and mobile home on foundation require check- list. FMpplication Forms&HandoulsU-IANDOUTS\Building Permit Appllcation.docPage 1 of 2 (Revised(07-08-10)