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BUILDING PERMIT APPLICATION <br /> ri, ? SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> r BUSINESS PHONE: (209)468-3121 <br /> 4Foai' 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: N �j��4„�/� �y r/N c j(✓r M wCr- ��p� <br /> Project Address: `373.7 C/-1051Zx_yL14r_1) <br /> Project Valuation: Z5- 02L`2 Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: c< czly& Z_ Name: <br /> Address: _ 373Z /�{ . Address: . 4 rt/, p t04,1494- <br /> City: �cg� � State:C�, City:�j,' 1�.,p � State: >�a <br /> ZIP: �Z/rL_ Ph# a?) qct' �(�Z ZIP: U Ph#(&R) ��9•/ k2 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: P1 Company Name: <br /> Address: tr9 W, riz�- e•� 1�- City: St: Ir-.ZIP: 9Srzo3 <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Zg Company Name: <br /> Address: ' �� Sr , City: St: c ZIP: 9�s� <br /> LENDING AGENCY Ph#( ) �i— <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 owners <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 <br /> �California licensed contractor or[I 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 county to enter the above-identified property for inspection purposes. 7 <br /> Applicant's Signature Date �( <br /> For your convenience checklists de ailing 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 /> FMpplicstion Forms$Handouts\HANDOUMBuilding Permit Appllcation.docPage 1 of 2 <br /> (Revised(07-08-10) <br />