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`0�4 �0 BUIL®INC PERMIT APPLICATION <br /> r <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 / <br /> c'2lxa¢ : t92,.q9)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: <br /> Project Address: ( L30-3 h/6 <br /> Project Valuation: 2 cX) Coo ,pp Contact E-mail: Me LOA e-oo SfrU Cf ldn � she ( cc (,h E <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: o ' Pedip Name: /-( 'e e0-11 <br /> Address: 36 3 W, '[,A 1) 6 ( Address Z- 1711\76A pt <br /> City: -Tf-Atv <br /> State: LI City: //w State: <br /> ZIP: Ph#") q11_1-61q33 ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( -731 C <br /> Lic. No: 54 3 2,5® Company-Name: IleA <br /> Address: &07 P q• I!' e, n en e City: St: ZIP: <br /> DESIGNER 1 FORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) .9 <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 /> 1 am 9a 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 sigDed and submitted). <br /> ,a <br /> I have read this construction.permit application and certify the information I have provided-is correct. I also agree,to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection purp ses. <br /> Applicant's Signature -• - 6 Date 7—2 <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-list. <br /> F:10.pplicafion Forms&Handouts\HANDOUTS'Building Permit Application 1-2015.doc Page 1 of 2 <br /> (Rgmaed Mi_?R_451 <br />