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ep0.ulN BUILDING PERMIT APPLICATION :tea BOG SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT f ` 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209) 468-3121 INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 �lPOR THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work: addition to existing single story residence to include conversion of existing garage to habitable space, construction of new garage. Project Address: 7491 W Howard Rd, Stockton CA 95206 Project Valuation: $102,945.00 Contact E-mail: OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: Nick Mussi Name: Haggerty Construction Inc Address: 7491 W Howard Rd Address: 2474 Wigwam Dr, Ste A City: Stockton State: CA City: Stockton State: Ca ZIP: 95206 Ph#( ) ZIP: 95205 Ph#(209)475-9898 CONTRACTOR INFORMATION Ph#( ) Lic. No: 944274 company Name: Haggerty Construction, Inc. Address: 2474 Wigwam Dr, Ste A city: Stockton St: CA ZIP: 95205 DESIGNER INFORMATION Ph#(209)475-9898 Lic. No: C 76963 1 Company Name: JC Wagner & Associates, Inc. Address: 2132 N EI Dorado St city: Stockton Fs-t: CA zip:95204 i LENDING AGENCY Ph#(209) 406-2344 Company Name: Address: City: St: ZIP: Permit will be issued to an "Owner-Builder' Yes ❑ No X❑ 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: am I] 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 certify the information I have provided is correct. I also agree to comply with all applicable county ordinances and state laws which govern this project. During the course of construction I will also takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- identified property for inspection purposes. Applicant's Signature Date For your convenienc ehecklists 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. FAApplication Forms&Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)