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77 <br /> BUILDING PERMIT APPLICATION <br /> y" ?{ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCK7pN CA 95205 <br /> BUSINESS PHONE; <br /> cq - " INSPECTION REQUEST-24 HOUR RECORDE (209) 468.3121 <br /> 4tFOR R: (209) 468.3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO gpPLY FOR <br /> BUILDING PERMITS.' <br /> i r " <br /> Scope of Work: n l )'d d M - <br /> Projedt Address: 1-3qq <br /> Al <br /> -� Z PRE, <br /> f?rpject Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICA NAME AND qDr.) <br /> Name: g Name: <br /> Address: Address: <br /> City: fir, State C�f_ City:`' State: <br /> ZIP: Ph#(903 ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> ic-IYo: ompanyanti e: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> ompany ame: - <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes' No ElOFFICIAL USE ONLY <br /> If yes, a completed Owner-Builder Verification F r 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 ❑ a California.licensed contractor orthe property owner or [I authorized to act on the property owner's <br /> behalf (requires written approval and Ownuilder 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-identifi d property for inspection purposes. <br /> pltcant'"s Signature Date 2 <br /> = For your convenience checklists detailing any additional submittal requirements for various mlding Crt!!ttyp f <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation re' <br /> v i <br /> VPplioatfon Forms&HandoutslHANDOU7SVBuilding PermitApplication.docPage 1 of 2 <br /> - setl(070810) <br />