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BUILDING PEWIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 <, o 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 ground ,ount grid-tied solar PV system Project Address 31411 Kasson Rd. Tracey, CA 95304 Project Valuation: $60,000 Contact E-mail: alex@skylinksolarinc.com OWNER NAME AND.ADDRESS APPLICANT NAME AND ADDRESS Name: John Petlansky Name: .e b nY a b- nL Address: 31411 Kasson Rd Address: 3137 Swetzer Rd. Suite E City: Tracey State: CA City: Loomis State: CA ZIP 95304 Ph#( 925) 963-4272 ZIP: 95650 Ph#( 916 990-2187 CONTRACTOR INFORMATION Ph#( 916) 990-2187 Lic. No: 944323 Company Name: SkyLink Solar Inc Address. 3137 Swetzer Rd. Suite E City: Loomis St: CA ZIP: 95650 DESIGNER INFORMATION - Ph#( 510) 496-5500 Lic. No: Company Name: Sungevity Address: 66 Franklin St. Suite 310 City: Oakland St: CA ZIP: 94607 LENDING AGENCY Ph#( } Company Name: N/A 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, I authorize representatives of this county to enter the above- identified property for inspe tion pur S. i Applicant's Signature Date For your convenience c ecklists detailing 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. F:1Application Forms 8 Hand outslHANDOUTS1Building Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)