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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 o�<'iF3'leP�c 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: 5 &,/ C -u2cjf 1 t c_ t,{ Project Address: f - Z Project Valuation: Contact E-mail: OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: � Name: � Address: Up r G Address: City: State: City: State: ZIP: "K Z G Ph#(q/h) ZIP: Ph#( ) CONTRACTOR INFORMATION Ph#( ) Lic. No: y/qt Company Name: �J.z &(z(jrtiiG- (o n/ 9/6 - Address: C) 1'3 c5- 16,C, City: ' St: ZIP:c- DESIGNER INFORMATION Ph#( ) Lic. No: 2 (o Company Name: JG 0 c c 4y, i ��F Address: �Gc� ap a ,L /yd City: St: ZIP: firu�lf LENDING AGENCY Ph#(9zo -??,f -6-7 1?7 Company Name: o)J .z-- 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 t 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 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 property for inspection purposes. Applicant's Signature 1 i� �(> Date ew—F i-Zo/ For your convenience cecklistFi s detailing any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check- list. F:Wpplication Forms&Handouts\HANDOUMBuilding Permit Application.docPage 1 of 2 (Revised(07-08-10)