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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 COMPLETELY FILLED OUT BY THE APRtlCANT IN ORDERTO APPLY FOR <br />I;3UILDING PERMIT~.,,,'- <br />Scope of Work:'R~;'ofc:'"-/','a t ri c::IIVl o It'+v rll1 o{itoc.Jje.c..~sh e.1'~ <br />Project Address:25"Fv-e.j/I c.J....rf:.lMJIJ <br />Project Valuation:0/300 r Contact E-mail:V'OVl.c.~j (,../1'0..ke f3?I,cA-tQ).L <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRES~ <br />Name:.f~c./~0",IU C2.,/ei-Name: <br />Address:1/2 (}>rU r ~.Address: <br />City:De •.ttl~If State:CA-City:State: <br />ZIP:'t'i7o-f Ph#Et.(j~)C['f~.C(7f(ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#() <br />Lie.No:CfO//t;q Company Name:Ce"t l-v"(UoflR 1/De~~/,·1'...•JA <br />Address:J9()o fa..'",'/-.,~c:City:;1-1,I2e jt/O StC/J ZIP:q>3>0 <br />DESIGNER INFORMf\TION Ph#() <br />Lie,No:Company Name: <br />Address:City:St:ZIP: <br />l'EN'DI,NG AGENCY Ph#() <br />Company Name: <br />Address:City:I Sf:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 dFPICIAL"tJSEONliyv·1::;--"~,:'~'"',-•._•~.L·'..'.'.,. <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 />-QECLARAl'lON 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 Fonn 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 apPlicaT~and state laws relatingto buildingconstruction.I authorize <br />representativesof this 7:.to enter ove-identifiedproperty for inspectionpurposes.• <br />(<-Applicant's Signature _Date <-t -L <:::)'-'"For your convenience checklists detailing any additional submittal requirements for various building pennit types <br />are available at the Building Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\Application Forms &HandoutslHANDOUTS\8uilding Permit Application,docPage 1 of 2 <br />(Revised (07-<J8·10)