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BUILDING PERMIT APPLICATION <br /> j a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N <br /> I�! 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> -0(ii=nti i+�4 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> ScopeofWork: SkAkl Str+ray.. ! L'Xis�.�. ocrti\ <br /> Project Address: 15 )) <br /> Project Valuation:4.2S-,Dp p Contact E-mail: -fol d -hvtr.j„c , to <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Ern+ n�ul. ! Name: A6mw 11 <br /> �1Z f'anS�r��tor <br /> Address: )S/ (, Tri• dA Address: )3 a ilI 6N, <br /> City: Es ( 0b— State: Lc City: V r).r L State: Lv, <br /> ZIP: ys �,Zp Ph#( ) ZIP: 5P311 Ph#(doj) U-7 6y5 r <br /> CONTRACTOR INFORMATION Ph#( ) ro6�—tyy�S <br /> Lic. No: ),n Company Name: co,S <br /> Address: P. a- 13ok_ CitY'-rL f1el4L St:rt ZIP:4ts-ah-) <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: R(,)i 77 35'3 1 Company Name: <br /> Address: t-)_)J l S;th. fL.& S';e. )0.1 City: A xol.sbe st:( ,� ZIP: fSUS`L <br /> LENDING AGENCY Ph#(,fib j J-O S —21()1 <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder' Yes ❑ No ❑ 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 property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted). <br /> I have read this construction permit application and the information I have provided is correct. <br /> I agree to comply with all applicable county ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or <br /> county to <br /> enter the above-id ntified property for inspection purposes. <br /> Applicant's Signature y ` _ 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 />