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BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 BUSINESS PHONE:(209)468-3121 INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 Tt.\.~0.~L rrl~"I\.5"~~""",. THE APPLICATION MUST BE COMPLETEL Y FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work:"')~t\.u~~l~1JCLvIJ":;'GIl_W.\:•(JA..J'tI\h fe....;..;c .~•.•S,-:',;ft<..->/1,~.k"",=, Project Address:42-C;'6 J .-l (z.),~\--/'rv'" I I )<;H-Ivv"1 C;c;n». OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name:CH-\di..M~ht.\t.'VJ~r\.....("'e~~.LL-C-Name:i<o LAtJIJ C~A1~Ill.vC1i ~ Address:IA./Jdli CS.H-A-r'Z-\...tW C2..0 Address:p.().60x fib?-0 City:L-tA."kl..f1 ~()State:elf City:S\tx.,l~~1 State:C'/~ ZIP:tfs ~~O Ph#(1-4,)-5 ~'}--)'0 ••.0 ZIP:<=t S~B Ph#(U})4-f:>2---l4.ca1 CONTRACTOR INFORMATION Ph#(ZU'1)4--b L -'Z-Ccld-=f Lic.No:4S 1-b ~4-Company Name:(2v(.....~..lV?("ON 5'1l-'L'c.17~""J:',.It:-- Address:p.O.66X.Q.Cr=to City:5·(t)c...\L.~,v-StO)-ZIP:9's?.. DESIGNER INFORMATION Ph#(lJ."j )8:34-7-33 2- Lic.No:C.04+510 Company Name:V\Al~e <)\1""\"t'H c..Ivc.,.\N P c-,z..,.vl.,.; Address:4-N..i/lI\~:\~J Lh .0:r:--se CPj-5~City:ZIP:Ci':) LENDING AGENCY Ph#(~,) Company Name:I\.cT \L .~('oJ ""r \-1.,;.)*-,~tt.- Address:City:St ZIP: Permit will be issued to an "Owner-Builder"Yes 0 No J<!.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~nature below,I certify to one of the following: I am a California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's be If equires 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 C.rvr ~~~~tified property for inspection purposes.. Applicant's Signature .»:~-:r..~Date tL '-if/\I For your convenience,=~lin any additional submittal requirements for various building permit types are available at the Bui dino ..Ion co nter.Demolition permit and mobile home on foundation require check- list. F:\8UILDING\HANDOUTS\8uilding Permit Application.doc (Revised 1-23-09) Page 1 of2