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" spy BUILDING PERMIT-APPLICATION <br /> SAN JOAQUIN CODEVELOPMENT DEPARTMENT <br /> 810 E HAZELTONYAVENUE, STOCKTON CA 5205 <br /> BUSINESS PHONE: (209)468-3121 <br /> INSPECTION-REQUEST-24 HOUR RECORDER:-(209)468-3165 <br /> L1FpR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> -BUILDING PERMITS. <br /> Scope of Work: (1\SSTALi. {5,cacaaGA'- , ®( sit ASc At OSIS 5{N(aS`t°SC�+M <br /> Project Address: 17200 _SD. 1,4F= <br /> Project Valuation: ( ( c) ®p Contact E-mail: Kict, <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name:. t9l Name: �R>k-.j <br /> Address:,SI5f_S 5z' , Address: t A <br /> City: State: 1Z A City: State: CA p <br /> ZIP: �J D Ph )$a$ ZIP: ! Jp-7 Ph 1 )537 Q3LTb <br /> CONTRACTOR INFORMATION Ph#�q ) 155>-7-9 51?(t. <br /> Lia No: Y3 1 Company Name 'kZr 9 — ( M <br /> Address: { OR,fl q� City: 5St .ZIP: 9j3d�7 <br /> DESIGNER INFORMATION Ph#( ) <br /> Lia No: Company Name: <br /> Address: City: St: ZIP: <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 owner's <br /> identification prior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my s'r ature below, I certify to one of the following: <br /> I am California licensed contractor or❑ 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. <br /> Applicant's Signature Date I tz+ e( <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 /> oatioi?,Porms&Handouts\HANDOUTSNBuilding Permit Application.docPage 1 of 2 <br /> s 0�08�10) <br /> zr-„ . <br />