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, r <br /> era�'N BUILDING PERMIT APPLICATION <br /> e co`j SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> oaYiFSR`'�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 BUILDING <br /> PERMITS. <br /> Scope of Work: ( I N/ oo <br /> Project Address: g. ItiLQ V, C s?_ <br /> Project Valuation: t� b/17()Q , Con act E-mail <br /> OWNER NAME AND ADDRESS APPLICANT NvaME AND ADDRESS <br /> Name: p YLU_kV At I/tt G° Name: t C . <br /> Address: , 3eS to/ Address: j �, A <br /> City:" state: } city: State: CA- <br /> ZIP: f �j+>! Ph#('A) �i�j'�7 7/ ZIP: Ph#( ) ajjp b I � <br /> CONTRACTORINFORMATION Ph#(M) q I 5-1 q <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> I_ 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 /> Permitwill 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/Buiider Verification Form signed and submitted). <br /> I have read this construction permit application and certify the information I have provided is correct. I also ag?be to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- <br /> 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-list. <br /> VApplid' t-28-15)cation Forms <br /> I ise <br /> &HandoutsXHANDOUMBuilding Permit Application 1-2015.doc Page 1 of 2 <br /> �?w (O <br /> t <br />