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eA ul" BUILDING PERMIT APPLICATIO' <br /> Q' ?a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> °gttk-o R'`P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE.APPLICATION.MUST';BE;COMP,LETELY'FILLED`OUT;"BY THE APPLICANT!IN ORDER TO'APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: t/ O/ diCL411116& <br /> Project Address: -!PL-2 7 '14,) <br /> Project Valuation: Contact E-mail:A6611JPf7�-7r-5_5L�7-146�;'I, <br /> OWNER'tNAME AND°ADDRESS` APP.LICAN7<NAME AND;ADDRESS <br /> Name: <br /> rJ"Yl - Name: cJ .. _ �' a • . /� <br /> Address: 7 5, LL / Address: elcllfi J5' I%cf/fL <br /> City: State: 61.4,_ City: 6W&4 State: <br /> ZIP: Ph#p?9) 3_- _a ZIP: ?5_36 Ph#W, <br /> CONTRACTOR INFORMATION" _ Ph#( ) <br /> Lic. No: Company Name: J .e r <br /> Address: City: St: ZIP: <br /> DESIGNER:INFORMATION ' ' Ph#( ) <br /> Lic. No: Company Name: j <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 signature below, I certify to one of the following: <br /> I am ❑ a 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 'unty to enter the above-identified property for inspection purposes. J , <br /> Applicant's Signature �— Date / <br /> For your convenience ecklists detailing any additional submittal requirements for various building permit types <br /> are available at the B [ding Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:Wpplication Forms&HandouWHANDOUTS%Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) - <br />