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Dennis Bennett <br />President <br />dbennett~bennettde~com <br />BE ETT <br />BUILDING PERMIT APPLICATION <br />A.NJOAQUIN 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 />HOME,I C. <br />OFFICE:(209)334--6385 <br />DIRECT:(209)365-2420 <br />FAX:(209)334--6391 <br />1610 W.KETILEMAN LN.,STE.A <br />POST OFFICE BOX 1597 <br />LODI,CALIFORNIA 95241,USA <br />Scope of Work: <br />Name: <br />r- <br />Name: <br />City: <br />ZIP: <br />Lic.No:Company Name: <br />Address:St:ZIP: <br />Lic.No:e.. <br />Address: <br />Company Name: <br />Address: <br />Permit will be issued to an "Owner-Builder"Yes ~No 0 <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 />By my signature below,I certify to one of the following: <br />I am 0 a California licensed contractor or fA'the property owner or 0 authorized to act on the property owner's <br />behalf (requires written approval and OwneTtBuilder 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 city or county to enter the bove-i tified property for inspection purposes. <br />Applicant's Signature,..--\-_-"f.j ~~""-'t--'--r-T+-#-e~.,...::I""""'~'---_____Date 4>-(£--11 <br />For your convenience checklists detaili g 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 Pennit Application.docPage 1 of 2 <br />(Revised (07-08-10)