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o �UIIY BUILDING UIL I G PERI AyPLICATION -� N: ,q� �, `•.K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 g BUSINESS PHONE: (209) 468-3121 o'�tlk&RN�P - INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING .PERMITS. Scope of Work: :F0 41" C m h ev 'on't.Sj M Project Address: 46.Z ' Do kYV � , Project Valuation: Contact E-mail: OWNER NAME AND ADDRESS APPLICANT NAME AND.ADDRESS Name: (( ` Name: `fit !/C P Address: Address: City: U' State: City: State: ZIP: �0 Ph#(dX/) � 2 _ � 7�j�j. ZIP: Ph#( )- CONTRACTOR INFORMATION Ph#( ) c. No: Company Name: Address: City: St: ZIP: DESIGNER INFORMATION Ph#( ) tic- No: Company_Name: Address: City: ' St: ZIP: LENDING AGENCY Ph#( ) Company Name: Address: City: St: ZIP:- Permit will be issued to an "Owner-Builder" Yes ❑ No ❑ OFFICIAL USE ONLY 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 CONSTRUCTION PERMIT APPLICANT By my signature-below, I certify to one of the following: I am ❑ a California 6-censed contractor or❑ the property owneror❑ 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 certify the information I have provided is correct. r also agrige to comply with all applicable county ordinances and state laws which govern this project. During the course of construction I will also takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- identified property for inspection purposes. Applicant's Signature �1Date Forour convenience checklists de 'in a '-an y g yiongl submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. FAApplication Forms&HandoutsNHANDOUTS1Building Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)