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BUILDING IT APPLICATION <br /> e iia 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 /> 4 fFd•R <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS:: .: <br /> Scope of Work: i�� s z i '--e)l ConiC(7 �i (unlbae �1ee�ne� ZtG /& uci�, <br /> Project Address: g O - CD o te( <br /> Project Valuation: *,2 5C C) p. Contact E-mail <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name:'-IRdJ, t7a t 3_ Ke. Name: , loss Ike,s, l✓'a ,In+ 1 Nv— . <br /> Address:Ztj'(gU F. ty O(ts ��ot Address: f� C Rte, L.,t . <br /> City: Li+,acle State: A . City: Loom 5 State: <br /> ZIP: L'i5302 Ph#( ) La39 55Dt ZIP: 9t5C,5D Ph#(IliG) <br /> CONTRACTOR INFORMATION t, <br /> 1 Ph#(91 ) ��}- Ogg 6 <br /> Lic. No: g52l5�i$ Company Name: j-tyti-A ,', fit) Oke( Ox,vo,a <br /> Address: 9-5LRD __i�LACLbh A -,D . Lfd City: LODAkL5 St:C ZIP: R5C05C) <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: tJot, +- <br /> Address:-- City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes ❑ No <br /> 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 /> identificationprior 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❑the property owner oro authorized to act on the property owner's <br /> behallf''(requires written approval and Owner/Builder Verification Fo m 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 <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 /> FAApplication Forms&Handouts\HANDOUT&Building Permit Applioation.docPage 1 of 2 I, <br /> (Revised(07-08-10) <br />