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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:~-L./vr ~~I-J~.--~--~/~-n-.~-~•.J .- <br />,.--~, <br />Project Address:-J ~I 1/-7#.~~~7--7-~~...--~q~c:>~1 <br />0"--r •••I ••_.J'~' <br />Project Valuation:/~0 -•.elO Contact E-mail:_T __~,~''::'Fr'_.•..AC.JC.7 ~I <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />J.u72.A Name:~~~~10'-;1-~Name:CHA~./..•../.rrr .J'_;_ <br />Address:~40 #..--r-_I 12J ••/,,-Address:~Lo 14711~., <br />City:~y State:C::::::A City:~a .--State:c:::::;.A,D <br />ZIP:C!6~-"'7LP Ph~)~.--ZIP:~G~/""'"./1 Ph#I2B'J)€i?7/.Q.l~Q- <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name:.N/.A. <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lic.No:.:::::72G4~Company Name:-'7rAL::r;?.-:-~.L./L_~--'/N~ <br />~/C-P/~~ <br />,--_J'Address:City:/4p~-"'-~D St<::::;A ZIP:- <br />LENDING AGENCY Ph .•••••,67/.tIlL I"-D <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes D No D 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 D a California licensed contractor or D the property owner or D 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 retatinarn building construction.I authorize <br />representatives of this city or county to enter the above-identified prope~ction purposes. <br />Applicant's Signature ~\Date d·-Z:'f!f2.rZ~ <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:lApplication Forms &Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)