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aAa "Y, BUILDING PERMIT,APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E.HAZELTON AVENUE;STOCKTON CA 95205 BUSINESS PHONE: (209)458-3121 INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THEAPPLICANT IN ORDER-TO APPLY FOR BUILDING PERMITS. Scope of Work: Project Valuation: az o Contact E-mail. illLri4, )V Ce L OWNER NAME AND ADDRESS - - - APPLICANT NAME AND ADDR d SS - Name: Jul-le N oe'V 6 Name; c 1 Address: _ i3;�� 7 (� t . L14 Address: City:. j er{: State: City: State: ZIP: _ 1137 Ph#( , Cy'7 ZIP: Ph#( ) CONTRACTOR INFORMATION Ph#( ) Lic-No:liJs Company Name: Address: S �.bVtr(�' (� City: �' . .G St: .t ZIP: Cf DESIGNER INFORMATION Ph#( } -LIC,No: - Company Name: Address: City: St: ZIP: LENDING AGENCY Company Name,. Address: City: St Permit will be issued to an'Owner-6dilder' Yes EI No❑ - OFFICIAL US ONLY Ifyes,a completed Owner-Builder Verification Form must Identification Number be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature Below,I certify to one of the following: I a a Californie licensed contractor or❑the property owner or E]authorized to act on the property owner's behalf equires written approval and Owner/Builder Verification Form signed and submitted): I have iead this construction permit application and the information I have provided is correct, 1 agree to complywith all applicable county ordinances and state-laws relating to building construction, 1 authorize representatives of this ity or county/ to�enter the above-identified property for inspection purposes,Applicant's Signatur .! I r �1J pe Date For.yottr convenien checktlsts detailing any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check- RtApplice8on Fortes&HandoutsIHANUOUMBuilding Permit Applicafion.docPage i ofp - - (Revised(07-08-10)