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BUILDING PERMIT APPLICATION } 2a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT f 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209) 468-3121 �4c=aoR�`p 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: Project Address: 02 ©'. Al Z-LA Q Project Valuation: Contact E-mail: OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: )—o Ain- Cry n57-oilt Name: Address: v20 2 E Cam A0, Address: �_L uj City: State: CA, City: STc)ckc)A State: C2A, ZIP: c2.3 t7 Ph#( ) ZIP: 5o)_017 Ph#(oLjp�) $ /CONTRACTOR INFORMATION Ph#(� S`l$ Lic. No: (4 Company Name: (j O 6 ` 5, — Address: 19K, City: St:C4, ZIP: g_ao 2 DESIGNER INFORMATION Ph#( - Lic. No: Company Name: Address: City: St: ZIP: LENDING AGENCY Ph#( ) Company Name: 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 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 ama California licensed contractor or Elthe property owner or❑ authorized to act on the property owner's beha�v(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 nter thea d�ntified property for inspection purposes. Applicant's Signature Date # lJ For your convenience checklists 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. FAApplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 ,r (Revised(07-08-10)