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-7771 <br /> BUILDING PERMIT APPLICATION <br /> a` `a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N: :4 <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468.3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> �iFOR <br /> THE APPLICATION MUST BE COMPLETELYFILLEDOUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: addition to existing single story residence to include conversion of existing garage to habitable space, <br /> construction of new garage. <br /> Project Address: 7491 W Howard Rd, Stockton CA 95206 <br /> Project Valuation: $102,945.00 Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Nick Muss! Name: Haggerty Construction Inc <br /> Address: 7491 W Howard Rd Address: 2474 Wigwam Dr, Ste A <br /> City: Stockton State: CA City: Stockton State: Ca <br /> ZIP: 95206 Ph#( ) ZIP: 95205 Ph#(209)475-9898 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: 944274 company Name: Haggerty Construction, Inc. <br /> Address: 2474 Wigwam Dr, Ste A City:Stockton St: CA ZIP: 95205 <br /> DESIGNER INFORMATION Ph#(209)475-9898 <br /> Lie. No: C 76963 Company Name: JC Wagner & Associates, Inc. <br /> Address: 2132 N EI Dorado St City: Stockton St: CA zip: 95204 <br /> LENDING AGENCYPh#(209) 406-2344 <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes❑ No <br /> 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: %wu. <br /> I am © a California licensed contractor or❑ the property owner or❑ authorized to act on the property owner's gm <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted). r� ` <br /> I have read this construction permit application and certify the information I have provided is correct. I also agree to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above <br /> identified property for inspection purposes. <br /> rc - <br /> Applicant's Signature Date -) <br /> For your convenient ecklists detailing any additional submittal requirements for various building permit Mies s <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require checkhsf <br /> I'Mpplication Forms&Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br /> E <br />