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opo •� 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 /> `q••• " INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> lFOR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS: <br /> Scope of Work: <br /> Project Address: -7A•'75wA F-0 'E <br /> Project Valuation: F, e> , -— Contact E-mail: l a U t'60.51 e Ec) /riCA i , Coal <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: AAr 1i'T" UPPAL Name: L6zVra, F, <br /> Address: 7 j r_— o o3�CUt oG� RQ Address: ` (6c( CA I v evi eL A'V e <br /> City: N� (k(t) oo State: CGI City: ;�0*,A)o State: CPA <br /> ZIP: op-Z"Zo Ph#(Zol) 3zl - 23 ZIP: ctS-ZPh#(-2cf`f) �\rs•—tC?��c <br /> -CONTRACTOR INFORMATION Ph#( -toq) <br /> Lic. No: Company Name: <br /> Address: • LL/ G� City: St: 4 ZIP: <br /> DESIGNER INFORc .— k o3 0 <br /> Lic. No: Company Name: L.ai e—ei -_S+eAA_,' ej 3>,O S r 1 <br /> Address: C k AU City: — ck+00 St:C� ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <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/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 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 /> F:\Application Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) - <br />