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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:S'FR <br />Project Address:I 771:J.E.E l,.(0\€""10\Av~ <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:Ti~OcA.(e Name:G~SC'~~~o llOt~ <br />Address:Po Box 1'1 DR Address:30s-S".ci-.AvE <br />City:~~State:~\AJy City:R.'·.lJn"",State:~ <br /><ih,/21 Ph#f(3»66f_7/3"-1 <br />, <br />ZIP:ZIP:C1S3'b Ph#QdI)5"73-:t53" <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:<66llwg Company Name:S'~.l-,~((a-"'J Co,st.7",c , <br />Address::2 140 J...~R;[)o-.(2,).._City:R,'l>tJ '"St~ZIP:C?S-3'b <br />DESIGNER INFORMATION Ph#() <br />Lic.No:Company Name:5AMF- <br />Address:City:St ZIP: <br />LENDING AGENCY Ph#() <br />Company Name:IJ 00/\'i <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No ~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 ~California licensed contractor or 0 the property owner or 0 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 I-{l ~10. <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:\BUILDING\HANDOUTS\Building Permit Application.doc <br />(Revised 1-23-09) <br />Page 1 of 2