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BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209)468.3121 INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work: RESIDENTIAL NEW HOUSE CONSTRUCTION W/PV SYSI EM Project Address: 10512 EAST WOODBRIDGE RD ACAMPO, CA 95220 Project Valuation: $715,000 Contact E-mail: RIVERVINEPROJECT@GMAiL.COM OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: RIVER VINE VINEYARDS LLC Name: ANTHONY SARICH Address: 1169 S MAIN ST#291 Address: 1169 S MAIN ST#291 City: MANTECA State: CA City: MANTECA State: CA ZIP: 95337 Ph#(209) 993-4263 ZIP: 95337 Ph#(209 )993-4283 CONTRACTOR INFORMATION Ph#(209 )993-4283 Lic. No: 661154 Company Name: AMERICAN MODULAR SYSTEMS INC. Address: 787 SPRECKELS AVE Cj}y;MANTECA S}; CAZIp; 95336 DESIGNER INFORMATION Ph#(209)825-1921 Lic. No: 65303 Company Name: AMERICAN MODULAR SYSTEMS INC/JACOB JONES Address: 787 SPRECKELS AVE City: MANTECA St:CA ZIP:95336 I LENDING AGENCY Ph#( ) i Company Name: NONE Address: City: St: ZIP: Permit will be issued to an"Owner-Builder" Yes ❑ No ❑ OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify to one of the following: I am ®a California licensed contractor or❑the property owner or❑authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit application and certify the information I have provided is correct. I also agree to comply with all applicable county ordinances and state laws which govern this project. During the course of construction I will also takes steps to preserve all survey monuments. In addition, 1 authorize representatives of this county to enter the above- identified property for inspection/py oses. \ Applicant's Signatures/ Date « _ For your convenience checklist mg any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. I'Mpplication Fonns&HandoutslHANDOUTSkSuilding Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)