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if.. DI <br />N COUNTY COMM <br />'1810E. HAZEL* <br />CT1ON REQUEST-24 H <br />St: CA ZIP: 95205 DESIGNER INFORMATION <br />I ATION <br />St: CA ZIP: 95354 <br />THE APPLICATION MUST BE COMPLE TELY <br />idcastle Precast <br />Project Address: 3800 East Mariposa Rd. Stockton, CA 9521 <br />Project Valuation: $2,000,000 <br />OWNER NAME AND ADDRESS <br />Name: Oldcastle Precast <br />Address: 3800 East Mariposa Rd. Stockton, CA 95215 <br />City: Stockton, CA 95215 State: CA <br />ZIP: 95215 Phtt( 209) 466-4212 <br />CONTRACTOR INFORMATION <br />Lic. No: 979224 Company Name: Mid-Cal Contractors <br />Scope of Work: New Office and Light Frame Metal Build' <br />Lic. No: 4813 <br />Address: 1003 12th street <br />Company Name: N/A <br />Company Name: Justin W. Capp Engineering & Design <br />City: Modesto <br />LENDING AGENCY Ph#( ) N/A <br />Address: N/A <br />Permit will be issued to an "Owner-Builder" Yes El No M <br />If yes, a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />City: N/A ISt: ZIP: N/A <br />OFFICIAL USE ONLY <br />Identification Number: <br /> <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below, I certify to one of the following: <br />I am m a California licensed contractor or El the property owner or El authorized to act on the property owner's behalf (requires written approval and Owner/Builder Verification Form signed and submitted). <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-identified property for inspection purposes. <br />Applicant's Signature <br />Date 1/2 0/16 <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-list. <br />F:kAppfication Forms & Handouts11 -1ANDOUTS1Building Permit Application 1-2015.doc (Revised (01-28-15) Page 1 of 2