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BUILDING PERMIT APPLICATION <br /> e 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 /> 4LIFOR•`p <br /> THE APPS tCAt 40N, tt_ "E COMt'l€ ELY` ttL i tj 1iW) a #I FPO R f �PLI��F 13x <br /> Scope of Work: 06WOEO Pool, F)DvSF_ <br /> Project Address: I `17 q I reALVA E40, JZD <br /> Project Valuation: Contact E-mail: <br /> OWt� R'{fS�fylEA[�f5`ADDR`ES APPLIpTiN " A{tptAb <br /> Name: i3ewu%) 'vL,15A meuz)e Name: o}ei)6 '44cAM P& AiecA4 CrjW <br /> Address: �U, ()X -7-1 N Address: 33_0�0 056k PAe�-, nz <br /> City: (,106r%) State: (4q City: 5-)'pC164-0 ) State: CA <br /> ZIP: Ph#( ) ZIP: glJzll) Ph#(- ) <br /> C©NTI��( T� r1JFOR(/IA [Ot Ph#( ) <br /> Lie. No: Company Name: <br /> Address: City: St: ZIP: <br /> S1�rtJJ ')( <br /> Lie. No: Company Name: <br /> Address: `Z7�� Pk-,,5,Ap�� L City: l�L ct�zvJ St: C/1 ZIP: �Zl <br /> Lr"N©1176Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes ❑ No ❑ __ `- u,+.:- =j1r <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 /> By my signature below, I certify to one of the following: <br /> I am ❑ a California licensed contractor or❑ the property owner or❑ 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:1Application Fonns&Handouts\HANDOUTS1Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10)s:_ . .-.._ <br />