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oAa `" 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 /> ca ..:.••�;� INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> �jFOR <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)563-9661 <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 /> I <br /> LENDING AGENCY Fph#( ) <br /> Company Name: n/a <br /> Address: City: St: ZIP <br /> OFFICIAL USE ONLY <br /> Permit will be issued to an "Owner-Builder" Yes❑ No El <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: y <br /> I am ❑x a California licensed contractor or❑the property owner or❑ authorized to act on the propejiJwrter's <br /> 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; 1 alsply <br /> with all applicable county ordinances and state laws which govern this project. During the course of,dd rrl yyq_ also <br /> takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to "'. e 'a7o�e- <br /> identified property for inspection purposes. <br /> Applicant's Signature <br /> Date <br /> For your convenience checklists detailing any additional submittal requirements for various It types <br /> are ildlable at the Building Division counter. Demolition permit and mobile homeon fourtc , - T eck list. <br /> F IApplicatio Wms&.HandoutslHANDOUTSIBuifding Permit Application 1-2015.doa <br /> =<' (Revised(0{ )� E. <br />