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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 />INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 <br />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER-TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:~/J.J//~£.~~,s./~h ~Ll/o£<e~d;·f"t'!ho#d <br />Project Address:t7 C6ntact E-mail:fie /')<€.we"1.f.e -'t q-,C.-0 '"'-7 <br />OWNER NAME AND ADDRESS APPLICANT NAME AND AODRES§' <br />Name:~,thu i%~~,~Name:I!'J5.{tie-/~<"""d.J.J.p;c <br />Address:I q ,Yqq e-!It '!J,.v 4:...-'1 /10 Address:321 /s 1:'-..rl <br />City:f!!/l'.1or!State:CA.City:Mtp c/ed;b State:Co. <br />ZIP cff'j'c,.y Ph#(~fist -?/J'J ZIP:qS-3J~4 Ph#(261lJ ~b ../S I J <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name:8/J <br />Address:City:St:ZIP: <br />Ph#(~5"Zc,.-1::/-.I .DESIGNER INFORMATION <br />Lic.No:Se 1:-:,"'10 Company Name:.e 4·tU'e/~s :/tUoe <br />Address:5z/-/r (i Sf:City:Mod'cs/••.st:.ZIP?j'S'.fJ4 <br />LENDING AGENCY Ph#() <br />Company Name:NIA. <br />Address: <br />, <br />City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Ye~~o 0 OFFICIAL USE ONLY <br />Identification Number:If yes,a completed Owner-Builder Verification Form must <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 0 a California licensed contractor o~he property owner or 0 authorized to act on the property owner's <br />behalf (requires written approval and Ow rl uilder 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 ~X~Yc7$the a ::red property for inspection purposes. <br />Applicant's signaturf r.%./~.;;.13 ,u.!-~/Date ~/:2//q <br />For your convenie~heck~detailing any additional s~bm~tt1t7!ifuiremtnts for various building permit types <br />are available at the Building lvislon counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\BUILDING\HANDOUTS\Building Permit Application.doc <br />(Revised (07·22·09) <br />Page 1 of 2