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BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 181.0 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> R ' <br /> BUSINESS PHONE: (209)468-3121 <br /> Y;FORP INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BYTHEAPPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS, <br /> Scope of Work: ? <br /> ( d. <br /> Project Address: I Vo <br /> . d <br /> Project Valuation: Contact E-mail: t( CPQ <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Mame: � Name: Voko <br /> Address: _ ( r ,N Address: , J <br /> City: State: City: _ State: <br /> ZIP: `7� � Ph#Q ) -7 IP: Ph# <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: <br /> Address: City. St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic,No: Company Name: <br /> Address: City: St: ZIP: <br /> L <br /> LENDING AGENCY Ph#{ ) <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❑ a California licensed contractor or El the property owner or E]authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted). <br /> I have-re-ad 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 erco nK to enter the above-identified property for inspection purposes_ <br /> Applicant's Signature �� Date <br /> For your convenience checklists detailing any additional submittal requirements for vario s building permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:1App11cation Forms&Handouts\HANDDUTS\Building Permit Applioatim.docPage 1 of 2 <br /> (Revised(07-0610) <br />