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BUILDING PERMIT APPLICATION <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:(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:Nc.vJ Ho~COli'\.&.+v~-t-(ov\"" <br />Project Address:l6"13't t::.M'v.JV SB L-c\<.e.fo".IYContact E-mail:-b~io.-k\·dI (B2.1 @a ..:tt.\.;'eT <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:L0\1l\~A ..Do-vis Name:W((((~A.D6-IIi..c <br />Address:111'+0 Chevv'l St.Address:IQ<140 c.lt-evvy S+. <br />City:L-ocl<~f'ov J)State:Go-.City:L o.c:..ke .po v d)State:Cd-. <br />ZIP:9?2~7 Ph#(z61)7),7 -63/6 ZIP:"152..37 Ph#(UJ9)727 -63fG:, <br />CONTRACTOR INFORMATION Ph#() <br />lic.No:N (fl Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />lic.No:N (It Company Name: <br />Address:City:St:ZIP: <br />LENDING AGENCY Ph#() <br />Company Name:b o-vl-k 0*<:;+oc I£--+OL< <br />Address:M IVle.-V ttvc-City:S+oc.\c:.+O\.A..St:Ca..ZIP:9520 I <br />Permit will be issued to an "Owner-Builder"Yes [0"'No 0 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 />I am 0 a California licensed contractor or ~e property owner or 0 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 ordinances and state laws relating to building construction.I authorize <br />representatives of this city or county to enter the above-identified property for inspection purposes. <br />Applicant's Signature ~c§.9~Date :SU6/rO <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:\BUILDING\HANDOUTS\Building Pennit Application.doc <br />(Revised (07-22-Q9) <br />Page 1 of 2