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c� BUILDING PERMIT APPLICATION <br /> ,G <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> _ 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> eq<ixaRN P INSPECTION REQUEST-24 HOUR RECORDER: (209)468.3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE'APPLICANT IN ORDER TO APPLY FOR <br /> -BUILDING PERMITS. .' <br /> Scope of Work: New 4,711 Square Foot Office Building <br /> Project Address: , 19400 N Hwy. 99,Acampo CA 95220 <br /> Project Valuation: $490,000 Contact E-mail: john@deltabidgs.com <br /> OWNER NAME AND ADDRESS -APPLICANT NAME AND ADDRESS <br /> Name: JSG Trucking Name: Delta Buildings Inc <br /> Address: 19400 N Hwy. Address: 22769 N Bender Road <br /> City: Acampo State: CA City: Acampo Y p State: CA <br /> Zip. 95220 Ph#(209)368 2671 ZIP: 95220 Ph#(209) 334 0513 <br /> CONTRACTOR INFORMATION Ph#(209 ) 3340513 <br /> Lic. No: 3 9 d v7 v Company Name: Delta Buildings Inc. <br /> Address: 22769 N Bender Road City: Acampo St: CA ZIP: 95220 <br /> DESIGNER INFORMATION Ph#(209) 334 2332 <br /> Lic. No: Company Name: Mike Smith Engineering <br /> Address: 4 N Main St. City: Lodi St: CA Zip: 95220 <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder' Yes ❑ No El 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 /> Iam g <br /> a California licensed contractor or❑the property owner or ❑ 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 Vntty <br /> tion and the information I have provided is correct. <br /> I agree to comply with all applicable ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or cour 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 /> F:Wpplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07.08-10) <br />