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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 FILLE'D.QUT BY IT"HEAPPLICANT IN'OR[!)ER TQ'~P-P.L Y FOR <br />BUILDING P.ERMITS.t;,'" <br />Scope of Work:Co tJ s TRlle -r.~~f)~NEw'R.E"SI DF-tV C E <br />Project Address:II~OO [)cV~\~E ('R-ol\t>LObI CA·152Lf2- <br />Project Valuation:Contact E-mail:.t~~~~f'~.~.LtJ3 f~T~!~·"'~~M <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADQRESS <br />Name:AVTA-f<..S"J\.1 A Name:r r <br />Address:~f>Lf '3 .•..TU~-rLe:-VALLEy DRlvE-Address: <br />City:STDC.K.TotJ State:(A,City:State: <br />ZIP:~52o{Ph#(Zu:pCft;(•301/ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#(Z.o1)S I ~-13Lt 0 <br />Lie.No:q Lf {(q I Company Name:!VAl f)U PRO SUI L-DER S IlJ(, <br />Address:1135 .Dc=L IV E'R 1"ST.City::;7C>L KTD rV st:cA-ZIP:'152.oLf <br />DESIGNER INFORMATION Ph#(2oe,)Co~2.·Y~IL-f J <br />Lie.No:(.32.553 Company Name:APE)(A-RCttITEL -rUR e <br />Address:132...5 EL r (N I\-L DR..SV\T~D'-f City:SToCKToN si:CI\.ZIP:152-05 <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 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 />,'""..<..-~:;.~\t'lr~!4fl:..C-', <br />DECLARATIO~N BY CONSTRUCTION P'ERMIT APPLICANT ,c"'':.".Ji,':",.•t~_.".••O;l.'''" <br />By my signature below,I certify to one of the following: <br />I am 0 a California licensed contractor or ~the property owner or 0 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 prov.ided 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 />F:\Application Fonns &Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)