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BUILDING PERMIT APPLICATION <br />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 />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY ;rHE APPLICANT IWORDER TO APPLY F,OR <br />--B!..IILDIN,G.PE~MITS.. <br />Project Valuation:=>(O~~Contact E-mail:12-O.71.\1~.)(t-\~qb@y~Hoo.COM <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Address:\\4D\DA\Jl~iLl).Address:\(.C!\-O \»A-\J \~(2.t>, <br />City:Lo D 1 State:e A City:Lov 1 State:LA <br />ZIP:~52..1-"'L Ph#(caf),<p 'i-i--3 '8 ~ZIP:q 6 21-2.Ph#(l.o1 ?Cc t;-t ~g ~ <br />CONTRACTOR INFORMATION Ph#() <br />" <br />Lie.No:Company Name: <br />St ZIP:City:Address: <br />DESIGNER INFORMATION Ph#(Z.q),,!>,-s--4-\0 <br />Address:(o~c:;l~'tj(~\,City:lV\r'O!ffi''?'lO StCA Zlp:q5"3~<1 <br />LENDING AGENCY'!'"~"Ph#r.tt:?1)G:;t:S"4-1 o <br />Company Name: <br />Address:/City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes [if No 0 <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />OFFyICIAL USE ONLY <br />Identification Number: <br />By my signature below,I certify to one of the following: <br />I am 0 a California licensed contractor or 0 the property owner or ~uthorized 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 provlded is correct. <br />I agree to comply ~all app~,ble county ordinances and state laws relating to building construction,I authorize <br />representatives of ~he above-:entified property for inspection purposes, <br />Applicant's Signat~~~-:x £-\.V d-Date C:?...f1.~-I I <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 />F:\AppJication Forms &Handouls\HANDOUTS\Suilding Permit AppJication.docPage 1 of 2 <br />(Revised (07-08-10)