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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 APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:e-:A-clr-ft/C/;/ <br />Project Address:Id-~~7 AI·.4/j/IIi/E Rd Contact E-mail:co»!k c.je C-ontf,l..St -h -e.f <br />"OWNER NAME ~ND ADDRESS APPLICANT NAME AND ADDRESS <br />Name(Coh//;;;:/1'L)l)c L fo oI-e !1/Name:/?4-d tUl/k~m <br />Address:1~{Pd-'7 N·4L?/AJE M Address:33h~£~h/Z£s-f lA-ie Rei <br />City:todft State:CA-City:-/JC/f-mPO State:(t7-- <br />ZIP:7C;-;;-if-{)Ph#~)tdJl -83()7 ZIP:'f5~o Ph#Qd()603-S-IOJ <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes C8INo D 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 D a California licensed contractor or D the property owner or (2J.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 enilbove-identified property for inspection purposes. <br />AppiicanrsSignature an~Date .,);'~t{) <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:\8UILDING\HANDOUTS\8uilding Permit Application.doc <br />(Revised (07-22-09) <br />Page 1 of2