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BUILDING PERMIT APPLICATION r. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT n 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE:APPLIQANT IN ORDER TO APPLY FQR RUjLDING.PERMITS Scope of Work: p Project Address: t Project Valuation: 000 Contact E-mail: m5lYIAr� S�/ GL OWNEs�R NAME AND ADDRESS. APPLICANT NAME AND ADDRESS' Name: •%�» 8c� C� Name: ...1' Address; 1 y/qC1 1_0 reo Address: City: e'L-1 A, State: C� - Cid: State ZIP: Cf��aZ� Ph#(2aq j gSty. c�/93 ZIP: Ph#( ) CONTRACTOR INFORMATION ':';: Pit#(2cq) __. c, f Lic. No: 017 Company Name: Wr Address: -,r2 r W11 V City: 121 St:Ct,_ ZIP: S 3Co(a DESIGNER INFORMATION`;._ .: Ph#(Zpq) rjTy.- Ve13 Lia No: Z2 ij Sg Company Name: $a y, Ja rn f h sl (� Address: 19m, City: 5,64 St:gf� ZIP: j S- LENDING AGENCY Phil( ) Company Name: Address: City: St: ZIP: Permit will be Issued to an"Owner-Builder" Yes❑No Q 'OF.FICNAL:USE ONLY :o:: If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY'CO NS TRU CTION Ll NT By my signature below, I certify to one of the following: I am ❑a California licensed contractor or[. the property owner or❑authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit application and the information-I have provided is correct. I agree to comply with all applicable county ordinances and state laws relating to building construction. I authorize representatives of this city or county to enter the above-identified.propeny for inspection purposes. Applicant's Signature_ 6a Date Z y 1 For your convenience checklists detailing any additional submittal requirements for varfou building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check- list. FAApplicallon Forms&HandoutAHANDOUTS1Building Permit Applicatlon.dooPage 1 of 2 (Revised(07.06-10)