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BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 BUSINESS PHONE:(209)468-3121 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:N e--.J W )-(1~"-"""1 -e,.y,ld\V7~ Project Address:101,\~.NA VY")I-:?c.>7Zd Project Valuation:4 Bo,ouc>Contact E-mail:d.e..!+A.bv I ld I V)"')50 e.~YnA .•( OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name:DZi\"'I DJ v-~-t"Name:De t-\-a..B L->\I c\I VI ~5 /"7<- Address:~O \C \~A-~v"y)\00 ,~/Address:t t7 1 10.-c<6k,'12'-",1 City:~VY)pu State:,c4.City:~VY)~State:CA' ZIP:"'1 t7 -z.'20 Ph#()ZIP:q~-z,Z0 Ph#()?34051~ CONTRACTOR INFORMATION Ph#() Lic.No:~qCJ070 Company Name:D?I~5i-J II d I V?~~1...,<... Address:I~l '1tf1dk,'1Z-c{City:~VV1\QO StU-ZIP:er '7 -z,70 DESIGNER INFORMATION Ph#() Lic.No:t104--4-~1"0 Company Name:Vl)k ~VV)I -+'---I Address:City:L-odl St ZIP: LENDING AGENCY Ph#()I.~ Company Name:}'/on-e Address:City:St:ZIP: Permit will be issued to an "Owner-Builder"Yes D No D '~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 D a California licensed contractor or D the property owner or D 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 a I ation and the information I have provided is correct. I agree to comply Wit~~unty ordinances and state laws relating to building construction I authorize representatives of this city or to enter the above-identified property for inspection purposes. Applicant's Signature rv 'A Date r;/;-)/,/ For your conve nce checklists detailing any additional submittal requirements for various building permit types are available he Building Division counter.Demolition permit and mobile home on foundation require check- list. F:\Application Forms &Handouls\HANDOUTS\8uilding Permit Application.docPage 1 of 2 (Revised (07-08-10)