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BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENUE,STOCKTON CA95205 <br />BUSINESS PHONE:(209)468-3121 <br />INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 <br />THE APPLICATION MUST BE C0MPLE-r:5!-Y.FtLLE-(i)·.OUTBY lfHE AB.P-l\.ICANT IN O~DER J0.e;«pp-bY ~.0R <br />•,•••••••.>,,;B\:.lILDltiG;I1ERM!ffS.\.,..'n Q .~J>__.~o,'C'>I.'. <br />Project Address:/0 10 E.;:3./".JC /,f C4/Y/,..J ;)/)./ll 11//)k {';J (I;7S336 <br />Project Valuation:C~ntact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name: <br />City:;1J/-)/IJ lecr/State:C~~ <br />Address: <br />State:City: <br />ZIP: <br />Ph#() <br />City: <br />Ph#() <br />City: <br />Ph#() <br />ZIP:0;G]h Ph#(c../?7 ~J-~JS-v Ph#() <br />CONTRACTOR INFORMATION <br />Lic.No:Company Name: <br />Address:St:ZIP: <br />DESIGNER INFORMATION .. <br />Lic.No:Company Name: <br />Address:St:ZIP: <br />LENDING AGENCY <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes ~No D <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />.OF~19IAL USE ONLY <br />Identification Number: <br />By my signature below,I certify to one of the following: <br />I am D a California licensed contractor or rx(the property owner or D authorized to act on the property owner's <br />behalf (requires written approval and Own;.:)'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 cityor.ceunty to-enter the above-identified property for inspection purposes..>} <br />Applicant's Signatur:k:/~~Date s--/CJ-II <br />v <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:\Application Forms &Handouls\HANDOUTS\8uilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)