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BUILDING PERMIT APPLICATION rf. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 181.0 E. HAZELTON AVENUE,STOCKTON CA 95205 ' BUSINESS PHONE: (209)468-3121 9 iFaN c INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165- THE 68-3165THE APPLICATION MUST BE COMPLETELY FILLED OUT BYTHEAPPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work: orrc Project Address: gb Project Valuation: 0 0 Contact E-mail: p1 �� 2 uV/SiOnJ Nt OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS -Name: o Name: ILEfo L Address. _ Address: . 2 c, City: -ST6.1 knr�, State: City. I C State: ZIP: SZ Ph#( ) ZIP: O Ph#(?Cp) 390 CONTRACTOR INFORMATION Ph#( ) Lic.No: yy G Company Name: N Address: 2� t ^ City: S7UCGC'R A) St:C ZIP: cj520 DESIGNER INFORMATION Ph#( ) Lic,No: Company Name: Address: City: St: ZIP: LENDING AGENCY Ph#{ ) Company Name: Address: City: St ZIP: Permitwill be issued to an"Owner Builder" Yes❑No❑ OFFICIAL USE ONLY If yes,a completed Owner-Builder Verification Form must Identification Number. be signed and submitted along with copy of the owners identification prior to issuance of the building permit DECLARATION BY CONSTRUCTION PERMIT'APPLICANT By my-signature below, t certify to one of the following: I I am 66a California licensed contractor or e ❑the property rty owner or El authorized to act on the properly owner's � behalf(requires written approval and Owner/Builder Verification Form signed and submitted).; I have read this construction permit application and the information 1 have provided is correct I agree to comply with all applicable county ordinances and state laws relating.to building construction. I authorize representatives of this city or county to enter the ab identified property for inspection purposes- Applicant's Signature Date S IZ Zy For your convenience ecklists d ing any I lo a[submittal requirements for various building permit types are available at the -gion counfe . Demo' ion permit and mobile home on foundation require check- list. F:Wpplimfion Forms$HandouMHANDDUTMuilding Permit ApplicefionAmPage 1 of I. (Revised(07-08-10)