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(N, <br /> BUILDING PERMIT APPLICATION <br /> g SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E.HAZELTON AVENUE, STOCKTON CA 95205 <br /> r6BUSINESS PHONE: (209)468-3121 <br /> zoa�P 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: g6Xfc„ o r lecM ecf e-( Si�1e lir k <br /> Project Address: trot // ~� STRfCY ,eoc <br /> Project Valuation: /moo c�J Contact E-mail: <br /> OWNER NAME J AND ADDRESS APPLICANT NAME AND ADDRESS f <br /> Name: C aro i4f �t Name: JMec WPo el(,►, CO."mer a,R/ A=[ ,feL f-.rylC <br /> Address: Address: !A .rrecer <br /> City: State: City: rr/00Es177 State: C q <br /> ZIP: Ph#( > ZIP: Ph#(2•1) VSf71. e/S <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: C_2S"S4 7 Company Name: rc ra/ rr�t< pec (✓re �..e. <br /> Address: 1616, V I""' e57; .. City: o c f y-, St: op ZIP: �s f <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes ❑ No ❑ <br /> OFFICIIL USEONLY , <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 ❑ 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 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 LDate <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:1Application Fortes&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br /> N_1 ( 2/0431) 1 <br />