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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 APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work: <br />Project Address:/764(F:_rC'ef\C t;c~"'"n YGI.IlI'DnA c:A <br />V/ <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:IlArh.A~1\.Nu~/rr..Name:~OJ~o.c,L}~ve'(/rc:..(:(J t1~()IYluIJ.) <br />I 34,05 rD{50fV\eir/J #511 u , <br />Address:Address:~3 ~'5 ")~A ~ <br />City:Fo(50f'(\stateC-1 City:C?c.h.~i:State:cA <br />ZIP:05(;30 Ph#(f~)00:6 0600 ZIP:q-'73/t Ph#(C0)~17-?~6 3 <br />CONTRACTOR INFORMATION Ph#(Zbf)~q7-L)"6 '5 <br />Lie.No:7 7 Lf l5'-"S Company Name:n G ('c..0.D ~IO(J~IlJ .r;-. <br />Address:~3<5.-S--fh A~City:~U"\I;'StLA-ZIP:C(S)ih <br />DESIGNER INFORMATION Ph#(C07)3 34·t.'}")L <br />Lie.No:Company Name:;/1,'4 '5 yy!,'{1"r;~'fuV>('-"G <br />Address:c..)_AJ.,;VI 'i:.o,'S-i-.-City:i.»:-.J <br />StC,{ZIP:7';c4() <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:St ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 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 a~a California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />be alf (requires written approval and Owner/Builder Verification Form signed and submitted). <br />I have read this construction permit application and the infonnation 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 3-1{-ro <br />For your convenie checklists detai(ng any additional submittal requirements for various building permit types <br />are available at e Building Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\8UILDING\HANDOUTS\8uilding Pennit Application.doc <br />(Revised 1-23-{)9) <br />Page 1 of 2