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BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENUE,STOCKTON CA95205 <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:~(J j,,\~d rl-4 'tlCJn fr\([;.)51iYJ.L,~10 vY1A'h,,v6lcJ..PnI--P.·vx~ <br />fi2fXp b-6le.Dr IJ , <br />Project Address: <br />Project Valuation:Contact E-mail:c,6c.h(\JI){)la~f)./Cld ,W)Vl <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:W JU-JAM z:,LJf3'f3'1 6eJ6rl-liD1'-i Name:CA-llJ6 5c+-+OCJfL1PL ARt'A-l (/)eP <br />Address:'lZ (Jl~e:~If-l-rC Vt<..Address:'33w Q);:FJe (JAe lc of<.. <br />City:S Joe tlcm.J State:CA City:S-rOCC-rOY\J State:CA <br />ZIP:tj6zoq Ph#(ZCIj)15&6lPLP CJ ZIP:Q621'4 Ph#(zt,Aq)4(;t,L-/~0 <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#([01)q~0Y!b <br />Lic.No:Company Name:Ut-t€.)5 .X1-11!)MP,-f-ll?tA-t Cd ~p <br />Address:33S?Dct~PAt::.k 012 City:5-rOvtiOr-V St:CA ZIP:qCj?ICj <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes D No D OFFICIAL USE ONL Y <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 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 Date <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:\Application Forms &Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)