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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 BYTHE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:C;S,NGLE"FA"'"\l-Y vvJELL'~C::r (Z --=:>\C~y ') <br />Project Address:loa\(>c=A.\'?-""'~l---jq.Contact E-mail:f'I)~GrArzC.)A~-,~AOL.·'-QI'I\ <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name::JO~OLEG.~V2~Y Name:M I¥C 6-A.~C4 ~'""q~j(.,\X:'S.~~ <br />Address:loG\.o G.ARlV1<S'\l'eON(J.?d·Address:Y·O oax ~4-2-ccw-,sr, <br />City:Lr'\1)\State:CA City:Wc-cQ\:x"\~e-State:CA. <br />ZIP:~4-;l Ph#(ZQ~LA'1-~q3 ZIP:~~J?'fS Ph#(~~3\O~·AS2 <br />CONTRACTOR INFORMATION Ph#rla~%'6 -:.l.~Z 4C>\-Qc:;xx:) <br />Lic.No:iOC)Z"?O Company Name:CL~%\C 'V€S\~c..at-JSTRlk:TIVtJ . <br />Address:?D.'BG'X .;;t4z.City:'VJcxx1b-'-\<1c;e,St CA ZIP:C)?J.13~ <br />DESIGNER INFORMATION Ph#(ZC<t)':$34 ',:;t.\'3? <br />Lic.No:~Company Name:L.13e:z:r5<..."-+(.!>..g:;"oc . <br />Address:3t2 CS FA \iZ..~~O\..'-".ST roe City:La\)\stCA ZIP:~.;l4-C) <br />LENDING AGENCY Ph#(1.c~)LP'\-C7 -<iS~4'?;> <br />Company Name:''BY OvJ~E::~ <br />Address:-City:l-~t>\St(A ZIP:~42- <br />Permit will be issued to an "Owner-Builder"Yes 0 No 1&t OFFICIAL USE ONL Y <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 0 the .property owner or 0 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 ~<,z:(~6-h~Date -,\~\\0 <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:\BUILDING\HANDOUTS\Building Permit Application.doc <br />(Revised (07-22-09) <br />Page 1 of 2