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pPaU'" BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> "'• ; 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> ��FpR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS.r <br /> Scope of Work: Sin, le family 2nd dwelling attached 1 car garage <br /> Project Address: N Johnson Rd. Clements, CA 95227 <br /> Project Valuation: $1757000 Contact E-mail: millercompany@yahoo.corn <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Krn Monaco Name: Kris Miller <br /> Address: 21180 N. Johnson Rd. Address: 3/yl�, XjL116L <br /> City: Clernents State: CA City: [St <br /> te: <br /> ZIP: 95227 Ph#(209 )759-3fl76 ZIP: S� 1 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lie. No: Company Name: OWNER/BUILDER <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#(209)478-4013 <br /> Lie. No:C-20384 Company Name: San Joaquin Design Group <br /> Address: 7877 N. Pershing Ave. City: Stockton St:CA ZIP:95207 <br /> LENDING AGENCY Ph#( ) <br /> ,Company Name: N/A <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder' Yes 19 No❑ 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 Dg 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 <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 /> R\Application Forms&Handouts\HANDOUTS\Building Permit Applieation.docPage 1 of 2 <br /> (Revised(07-08-10) <br /> J <br />