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i °�G° " BUILDING PERMIT APPLICATION ):'�C- .COG i N r� 1 j SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT i 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 cgLl i:oRa�P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work: Project Address: G p �(dd,- Sra _� v C q �/ �"0h^cw( 't.focV., Project Valuation: Contact E-mail: OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: Name: �� 16 06 4 Z- G Address: Address: 50? Is C 6C v, City: State: O y City: p®e XTe State: e- 4 ZIP: Ph#(2ny) _ ZIP: 95 y f — Ph#( - ) yXv _1//g CONTRACTOR INFORMATION Ph#( ) Lie. No: Company Name: Address: City: St: ZIP: DESIGNER INFORMATION Ph#( ) Lie, No: Company Name: Address: City: St: ZIP: LENDING AGENCY Ph#( ) Company Name: Address: City: St: ZIP: Permit will be issued to an "Owner-Builder" Yes ❑ No ❑ OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify to one of the following: I am ❑ a California Incensed contractor or❑ the property owner or Ix authorized to act on the property owner's- behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit application and certify the information I have provided is correct. I also agree to comply with all applicable county ordinances and state laws which govern this project. During the course of construction I will also takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- identified property for inspection purposes. Applicant's Signature Date V&e 20/S For your convenience c ecklists etailing any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. FMpplication Forms&Handouts\HANDOUMBuilding Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)