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BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �,. <br /> ( 1810 E. HAON AVENUE,STOCKTON CA 95205 lx <br /> H 4 <br /> .1 ZELTBUSINESS PHONE: (209)468-3121 h <br /> ' INSPECTION REQUEST-24 HOUR RECORDER: (2D9)'468-3165 <br /> �tRtlR �`tr <br /> r <br /> TI FPPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER-TO APPLY FOR <br /> BUILDING PERMITS. <br /> Sco^etork �o �titj GAo2tN it �..Ulvt�l►C� <br /> Profd ess .; 2Q vi. <br /> ' 1�/1vl•t✓ Tort <br /> Projec l shot), Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Nalfe <br /> Name: � n$' <br /> Address Address: <br /> I{y State: C ty State: <br /> " ZIP Ph#( ) ZIP: Ph#( )G� A <br /> f <br /> CONTRACTOR INFORMATION Ph#{ � <br /> c� <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph##( ) <br /> Lic.No: CtCo0'16 Company Name: J. A Q ( 51/gj A -,c I41V;e� <br /> Address: &3Z6 V-J�2i <br /> LENDINGAGENCY Ph#p( ) <br /> Company Name: <br /> Address: City: StZIP: <br /> Permit will be issued to an "Owner-Builder' Yes ❑ No ❑ 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 owners <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 /> 1 am❑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 haveread 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 Date <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:�Application Fortes g Handouts\HANDOUTS\Building Penna Applioetion.docPage 1 of 2 <br /> (Revised(07-08-10) <br />