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i <br /> 0 <br /> p4ui"" BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ¢ t a <br /> 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> c9�icoR�'�P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY"T'HE APP.LICANTIN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: " <br /> Project Address: C <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME Ar ADDRESS <br /> Name: !Ctrl l Name: E - n <br /> Address: ��� 77 Address: ., <br /> City: State: City: State: , <br /> ZIP: "7� Zip: I Ph#( <br /> CONTRACTOR INFORMATION Ph# <br /> Lic. No: y Company Name: <br /> Address: City: ( st: ZIP: <br /> DESIGNER INFORMATION PhO19,1ov <br /> Lic. No: Company Name: / t <br /> Address: S i�xdvv City: st: Z�yZIP: �% <br /> LENDING AGENCY = Ph#( <br /> Company Name: �'� <br /> Address: zb-I&?, iIy: Fk wyo St:f ZIP: f� <br /> Permit will be issued to an "Owner-Builder" Yes❑ No OFFI"CIAL 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 /> DECLARATIO-WBY CONSTRUCTION PERMIT APPLICANT <br /> By my signature below, I certify to one of the following: <br /> I am 40'a 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 signed and submitted). <br /> I have read this construction permit application and the information I have provided is correct. <br /> I agree to comply with all applicable county ordin ce and state laws relating to building construction. I authorize <br /> representatives of this city or co t ter the/ bov -identified property for inspection purposes. <br /> 1 <br /> Applicant's Signature Date /" J <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:1Applicafion Forms&HandoutsWANOOUTS18uilding Permit Appliudion.docPage i of 2 <br /> (Revised(07-08-10) <br />