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�0.aut" 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 /> cgt,�aR'�4 INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: New single family residence, additional dwelling unit and garage <br /> Project Address: 15300 E Sargent Road, Lodi, CA 95240 <br /> Project Valuation: $1,114,265.00 Contact E-mail:greg.desmond@bluhomes.com <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name Margot& Reardon Guis Name: Greg Desmond <br /> Address: 224 Leland Ave Address: 1245 Nimitz Avenue <br /> City:Menlo Park State: CA City: Vallejo State: CA <br /> ZIP: 94025 Ph#( 650)867-7784 ZIP: 94592 Ph#(707)563-9 661 <br /> CONTRACTOR INFORMATION Ph#( 707)563-9661 <br /> Lic. No: 963352 Company Name: Blu Homes <br /> Address: 1245 Nimitz Avenue City: Vallejo St: CA ZIP: 94592 <br /> DESIGNER INFORMATION Ph#( ) <br /> Same as above Contractor Information <br /> LENDING AGENCY FP h#( } <br /> Company Name: n/a <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes❑ No Q OFFICIAL USE ONLY <br /> If yes, a completed Owner-Builder Verification Form must Identification Number: <br /> be signed and submitted along with copy of the owner's ' <br /> identification prior to issuance of the building permit. „. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my signature below, I certify to one of the following: <br /> I am ❑x a California licensed contractor or❑ the property owner or ❑authorized to act on the prot� er's <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted) rr, - <br /> I t�Gy <br /> I have read this construction permit application and certify the information I have provided is correctVAOo 90 comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of`� ?/uIlt also <br /> takes steps to preserve all survey monuments. In addition, I authorize representatives of this cour7ty'#o�` btye- <br /> identified property for inspection purposes. F <br /> Applicant's Signature <br /> Date ; <br /> For your convenience checklists detailing any additional submittal requirements forvanos . tt ty�itas <br /> are,available at the Building Division counter. Demolition permit and mobi[$r ome on foutic_y, hec Ilst. <br /> F:\Application off-PSA Handouts\HANDOUTS\Buildin Permit Application 1-2015 doc �; <br /> (Revised 7 <br /> 7,757 <br /> r �� <br />