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>0P �o BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT ` 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 c4tk6R`'�Q 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: Exa, tzp Project Address: ' S,c1\J JbW p r— C* (�AM C& 615270 Project Valuation:4&0, Contact E-mail: ' OWNER 14AME AND ADDRESS APPLICANT NAME AND ADDRESS Name: nOo Cr —Wl Name: kOoW ckrrYW04— Address:q,gy j. ej\/9/ yi go. Address: &111A S, -ewto ro. City:W0g0 C State: CR City: J - C State: Cq- ZIP: qQ31 lPh#00q) 7 - q ZIP: tTJ31 Ph#( C p CftP I CO CONTRACTOR INFORMATION Ph#( ) Lic. No: Company Name: Address: (}Jj() /'P JbtA1b City: St: ZIP: DESIGNER INFORMATIONPh#( ) nn Lic. No: N Company Name: I�1�'(1N4tl, coffi aI�G ll v J1?6J Address: IS-3q A-L-U City: PAOOM St: Ck- ZIP: l ' LENDING AGENCY Ph#(V" ) Company Name: Address: ' ) City: St: ZIP: Permit will be issued to an"Owner-Builder" Yesyp 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 am ❑ a California licensed contractor orX 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. 9 �i Applicant's Signature !(l — �f/7 Date 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. F:t,4pplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 (Revised(07-08-10)