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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 COMPLETEL Y FILLED OUT BY THE APPLICANT IN ORDER TO APPL Y FOR <br />BUILDING PERMITS. <br />Seope of Work: <br />Project Address:95'rs ~.""~~~CI'f\0 \..-.\~~~~~.9s~31=> <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name~~~,~,,s,'"~~~~~~~~~S.~,-~\\c.Name~~\L"i~\\~~"'\::....~'S.x..-'-~1'.'0---J <br />Address:C\(OC)N.',~~.'Q.-S,).\-.'~'Vx..~C--f\·Address:ql,o ~."~"-~Q.\.....,~""=.~C~· <br />City:\..-'~_~N State:C-~City~,~~~State:<:.~ <br />ZIP:0<;::;1 ~t.Ph#Q:,g}~'7_~cFJ «:ZIP:q ~~'3 C-Ph~C9}~7-;;.cPt:S:- <br />CONTRACTOR INFORMATION Ph#(} <br />Lie.No:Company Name: <br />Address:City:St ZIP: <br />DESIGNER INFORMATION Ph#(} <br />Lie.No:Company Name: <br />Address:City:St:ZIP: <br />LENDING AGENCY Ph#(} <br />Company Name:~~~¥-..0'"~'\'r\.~.:<Z..\c....~ <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Ye~o 0 OFFICIAL USE ONL Y <br />If yes,a completed Owner-Builder Verification orm 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 0 a 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 />Applicants Signature~,~'>.~"Date~Q <br />Foryourconveni';'c.Ch.Ckti~=anyaddili~bmittal requirementsfor varl us bui ding permit types <br />are available at the Building Division unter.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