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°� tyBUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ` 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> c'ZiFOR `p INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: M � ( <br /> Project Address: c�+- 5 N <br /> Project Valuation: :3c5 0 ( Contact E-mail: �� ( + ��� l <br /> OWNER NAME AND ADDRESS APPLICANT.NAME AND ADDRESS <br /> Name: �U ' r Name: �� <br /> Address: 5:7-SIV Address: g�c,�O ( �TIEV" ( <br /> City: ngIZE14 )_t r4D0,� State: C/-v City: State: (A <br /> ZIP: �iSZ)t. Ph#(ZCfI) 60Z.- +4I-f— ZIP: Ph#(-" _?A r3d6� <br /> CONTRACTOR INFORMATION Ph#( ) <br /> i <br /> Lic. No: Company Name: ����{;,,�_ CS�.J - _ �L, <br /> Address: S&G-0 City: St: ZIP: 9S3D <br /> DESIGNER INFORMATION Ph#( ) <br /> c. Company-Na ar . <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> ompany ame: <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 mysisignature below, I certify to one of the following: <br /> I alryLQa California licensed contractor or E] the property owner or[_1 authorized to act on the property owner's <br /> be if(r quires written approval and Owner/Builder Verification Form signed and submitted). <br /> I have read this construction permit application and the information I have provided is correct. <br /> 1 agree to comply with all applicable county ordinances and state laws relating to building_construction. I authorize <br /> representatives of thiYding <br /> unty to enter the abDve-identified property for inspection purposes. <br /> Applicant's Signature Date � ���c' <br /> For your conveniensts detailing any additional submittal requirements for various building permit types <br /> are available at the ivision counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:\Application Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />