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°t ..coc BUILDING PERMIT APPLICATION <br /> y 1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E.HAZELTON AVENUE, STOCKTON CA 95205 <br /> =" ,r BUSINESS PHONE: (209) 468-3421 <br /> ...............` INSPECTION REQUEST-24 HOUR RECORDER:-(-209)468-3165 <br /> <lFOR�' <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: ®6C, <br /> Project Address: 8 �j rsp' p /�D /C/-117 Cl eV7 04A <br /> Project Valuation: Contact E-mail: asj�V A LO✓o' l I �1 f�, C©' <br /> OWNER NAME A D ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: ' tJc-- Ci V t ,t Name: L U V o+4-t -7✓1 G <br /> Address: (a(Q S Address: ZZ 76W -1- S <br /> City: L\ State: City: �G { )yl State: L <br /> ZIP: Ph#(?jf) H6Z 0(0-6gZIP: Ph#(4�)q <br /> CONTRACTOR INFORMAT ION Ph#(Z60j) 61 2 C)C) <br /> Lic. No: Company Name: dD 4 Vt C <br /> Address: Z2j lw qq-'1 '( City: �j �i— St:( ri- ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lia No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDINC-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 signature below, I certify to one of the following: <br /> 1 am �a California licensed contractor-or❑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 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 monuments. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection purposes. <br /> Applicants Signature i Date 2 <br /> Far your convenience checklists detailing any additional submittal requirements for various buiidi g permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. <br /> o ds,"&Hand outsAHANDOUTSOuilding Permit Application 1-2015.doc Page 1 of 2 <br />