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°¢4U`" BUILDINGPERMIT APPLICATION <br /> xr /.i f .? SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �. �. 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: 209 468-3121 <br /> q CI FOR�� 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: �ginea�r�n< �" �� ( � a��a ivt Y6 7 I <br /> .. W . t9tdLc �! <br /> Project Address: C �;4 �r ��%� umZ � QAAA � C®M <br /> Project Valuation: 6.E;00 Gr Contact E-mail: n,r ays 0 <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: b a Name: <br /> Address: Address: <br /> City:C� ' p� State: City: State: <br /> ZIP: Ph#(,.,tp ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: S-79S Zf Company Name: <br /> ryry cc ^^ v®c <br /> Address: (06 PZl f/wnCtn d City:,, /ice Ce St:c ZIP: <br /> DESIGNER INFORMATION Ph#(?gq) 4,70 -SgC3 ( <br /> Lic. No: Company Name: <br /> Address: Q ® City: 5"et< h St: <,A ZIP:4Qy' <br /> LENDING AGENCY Ph#(meq b _ ® U pol(z <br /> Company Name: ® C •�1� �G Qeb�` <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes M 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 ❑ a California licensed contractor or X 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 certify the information I have provided is correct. I also agree to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey mon ents. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection pur <br /> Applicant's Signature Date <br /> For your convenience ch ck 1 r rng any additional submittal requirements for various uildin permit types <br /> are available at the Building D isrVi on ounter. Demolition permit and mobile home on foundation require check-list. <br /> FAApplication Forms&Handouts\HANDOUMBuilding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />