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" BUILDING PERMIT APPLICATION <br /> r. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> C9�fFORa�P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR: <br /> BUILDING PERMITS.' <br /> Project Address: 20 c3r'a1C1ALAn <br /> Project Valuation: tp f 0 v0 Contact E-mail <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS tCpidn <br /> Name: P-1d' ok0( t Lu Name: (Vj <br /> Address: Zo'� S Ca_VIn C6 Address: <br /> City: State: C�� City: Sa c(ra (w State: <br /> ZIP: S 2 2 Ph#( ) ZIP: C(CN�( I Ph#(I((o) 44(a -- 2-SS8 <br /> CONTRACTOR INFORMATIONPh#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: C Z 30< Company Name: V IWC Mtn cl <br /> Address: ( City: `ac Int UK till St: ZIq <br /> LENDING AGENCY Ph#"- ((o) 44 <br /> Company Name: S <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes [] No ❑ .`OFFICIAL USE ONLY <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 am ❑ a California licensed contractor or ❑ the property owner or❑ authorized to act on the property owner's <br /> behalf (requires written approval and Owner/Buflder 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 above-identified property for inspection purposes. <br /> Applicant's Signature Date <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 /> FAApplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />