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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 APPL Y FOR <br />BUILDING PERMITS. <br />Scope of Work:/E~.£/)~.I//\4-?AILE.f..kYvu:-h.////J.l.LJt./J&-Lcr~77oJ <br />Project Address:/592C:?.//VT O:J~ER An .£)(l.L)/'v?,.c:O~CL:J f"'\••••,,./)",'~ <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:~/'-'1.~/J./.Kf Name:~;:::- <br />Address:/~9~6'£~~M./Z1 Address: <br />City~/")~~State:C?:l City:State: <br />ZIP:95'#0 PhiJPd7 ):369--oc;.8C;ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#() <br />Lie.No:Company Name: <br />Address:City:St:ZIP: <br />D~SIGNER INFORMATION Ph#() <br />Lic.N~L J /21 Compa~ame:"f''J //\I ~-"--rs-t:ZI~Address:City: <br />LENDING AGENCY Ph#() <br />Company Name:L )In \- <br />Address: <br />,'-J //-J ~City:St:ZIP:..... <br />Permit will be issued to an "Owner-Builder"Ye~No 0 OFFICIAL USE ONL Y <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 0 a California licensed contractor or 0 the property owner or 0 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. <br />Applicanfs Signature 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:\BUILDING\HANDOUTS\Building Permit Application.doc <br />(Revised 1-23-00) <br />Page 1 of2