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APPROVED - DESIGN L SUBJECT OUN EAL. SAN I A! o Date: Date: Name: Name: Board Approved 9/ /2 BY DATE SAN JOAQUIN RIVER CLUB, INC. 30000 Kasson Road Tracy, CA 95304 Phone (209) 835-1969 • Email sjrcinc@gmail.com BUILDING PERMIT APPLICATION 41 APPLICANT: Mar ()rr MEMBER #: eB4(e (I SITE ADDRESS: 7 MAILING ADDRESS: 30("00 161 S ci4 35 z)r) ed ro.6.3 cliCOUNTY SITE APN# 06. _— CONTRACTOR NAME AND LICENSE #: IA 1 pe) heiyi -Tr _ CONTRACTOR ADDRESS: e /fel Application fee is non-retyndable. Description (include materials, size and use): C_ nie rje rv COUNTY PERMIT IS REQUIRED?(YES NO (Member's Initials) 7/9 • 0 - CLUB AND COUNTY PERMITS EXPIRES 6 MONTHS FROM APPROVAL DATE SAN JOAQUIN RIVER CLUB, INC. WILL NOT BE RESPONSIBLE FOR SITE IMPROVEMENTS Notice is hereby given that the San Joaquin River Club, Inc. a non-profit corporation of the State of California, is the owner of certain properties as recorded in the official book of records of the San Joaquin County. The San Joaquin River Club, Inc. will not be responsible for construction of, and/or addition to, and/or alteration of said building, or for material or labor or professional services to be used thereon. The member/applicant assumes all responsibility. Building permits may be required from San Joaquin County, 1810 E. Hazelton St. Stockton, CA. Contact the County for a complete list of improvements that require permits. Copy of initial County site permit must be returned to the SJRC prior to construction. Permit must be posted on site and a copy of the final County site permit must be returned to the SJRC for retention in the site file. Refer to the SJRC Building Regulations for additional information. i• APPLICATION SIGNATURE: ()Li ' PHONE #: 1-96 9- n,)-33 (91 CONTRACTOR SIGNATURE: r PHONE #: )20 C1 q/3 --(0613t/ Application Fee: $30.00 for original or renewal permit. Penalty Fee: $125.00 if project was begun prior to permit approval or continued after permit expired. Amount Paid: 0 _.\) Date: q - I - a Receipt #:•50 1 6 rj I agree to comply with the Building Regulations of the San Joaquin River Club, Inc. and the County of San Joaquin, if applicable. I agree I will in no way hold the SJRC responsible for any property damage or physical injury related to this work. I further agree to maintain all impro ments andhome in GOOD CONDITION, and within the site boundaries. BUILDING COMMITTEE APPROVAL Name: 7111 (C: ..4404/- iv) Date: C.) 7-02Fo2°02.2 BOARD APPROVAL