WORK PLANS - Laserfiche WebLink

Home Browse Search

COMMUNITY DEVELOPMENT DEPARTMENT Building Inspection Division 221 West Pine St./PO Box 3006, Lodi, CA 95241-1910 (209) 333-6714 CONSTRUCTION PERMIT APPLICATION #1 IDENTIFY YOUR BUILDING PROJECT Application Number: Intake Person(officeuse only) APN: Job Site Address: .2&2-,4 w. G VM LM5 Suite or Space# This permit is to be issued in the name of the(_)Licensed Contractor or(_)the Property Owner as the permit holder of record who will be responsible and liable for the construction. , Property Owner Information: Name Om* �fir, WW[0 ,/ ( /� Tel No �-/� Mailing Address_.�� GJ. � iU-�%�IV�C�i rt�� wP ' ✓� - i CA q0o I Contact Name: P(G{ Q t7�-��►�f'��L Ph# -310-267, 1466 E-mail: Project Type: _Commercial Residential Permit Type(s): _Y_BLDG _.0 MECH __PLUMB >< ELEC Scope of Work: T�1� I M W MST fW— IN 1,4V v5F If stucco, how many SF? 0 Landscape Work Area SF Water Efficient Landscape Requirement(LMC 17.30.070) applies to the following projects (check one): ❑ For new construction,total landscape area greater than 500 square feet ❑ For Landscape rehabilitation total landscape work area greater than 2500 square feet Contact Public Works Department for additional application information Contract Value:$ Const.Type: Occupancy Type: Is Bldg. Sprinklered? Yes No Is Bldg. Conditioned? Yes No Existing/Proposed Well or Septic? Yes No Existing Use: Proposed Use: #of Stories: #of Units: Comm.Sq. Ftg.: Office: Retail: Warehouse: Other: Res.Sq.Ftg.: Total Sq. Ftg. Dwelling: Gar: #of cars Patio/Porch: Deck: #2 IDENTIFY WHO WILL PERFORM THE WORK (Complete either 2a or 2b) 2a-CALIFORNIA LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. Contractor Name and Address: License Number and Class: Contractor Signature 2b-OWNER-BUILDER'S DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors'State License Law for the reason(s)indicated below by the checkmark(s) I have placed next to the applicable item(s)(Section 7031.5, Business and Professions Code:Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law(Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): U I, as owner of the property, or my employees with wages as their sole compensation,will do U all of or(J portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees'or personal effort,builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner-Builder will have the burden of proving that it was not built or improved for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors'State License Law.). JACommunity Development\Building Inspection\Forms\Permits\Permit Application Current wLandscape.docl of 2