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BUILDING PERMIT APPLICATION <br /> N SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> I 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> ' INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: 5iADIf j WCtIi yrSidkvt +vL( HruSC. <br /> Project Address: 01275 5. !Stdie Lar1c Esculon c^ '15320 <br /> Project Valuation: Contact E-mail: Begg b anao),cot^ <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Ryan +Mfga.[vyk Name: cyan + M rn k <br /> Address: 01275 5 •SdAfe Ln . Address: `I 275 5• S&Arc Ln <br /> City: ti5Ca160 State: CA City: ESCA(0/y State: eA <br /> ZIP: %5320 Ph#(2orl) 40y-5001-7 ZIP: `15320 Ph#(ZOk) 40LI-509' <br /> CONTRACTOR INFORMATION Ph#(209) 599-25(x5 <br /> Lic. No: S75O(01 I Company Name: 5MW Txvellopmen'} Inc . <br /> Address: 11.708 E. f,UAcvrC hA City: Q.,po^ st: CA zIP: 6j53(0(0 <br /> DESIGNER INFORMATION Ph#(?zl) gy7 _g121 <br /> Lic. No: 420793 I Company Name: T. W , 5c IkWGI/�Z- <br /> Address: '2147 S. Skim° 60'r City: OakdAl2 St: CA ZIP: 425 g <br /> ot <br /> LENDING AGENCY Ph#(20q)5yg_ 7g <br /> Company Name: UM uA ' dAk- <br /> Address: 25145 Mr4cnr. Ave City: 1"toc( S5" St:cp! ZIP: c(c)3�C) <br /> Permit will be issued to an "Owner-Builder" Yes ❑ No tA 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 5-ZI-12-- <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 /> F:\Applicalion Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />