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APPLICATION FOR PIEAK11T <br /> 140975 <br /> BUILDING INSPECTION DIVISION .�► FINAL DATE Give This Number WheriD,O. <br /> SAN JOAQUIN COUNTY PLANNING ANDCalling for Inspection <br /> BUILDING INSPECTION DEPARTMENT INSPECTOR __, ____ CALL 24 HOURS IN ADVANCE <br /> 1810 E. HAZELTON AVE., STOCKTON, CALIFORNIA-PHONE(209)944-3701 _ <br /> DATE ISSUED �-H'-�d S <br /> C) o APPL. DATE. <br /> APPLICANT �Ld!LQq LjA LSJ Qp,._ �_2 t 9 6C4� �n <br /> ADD ESS _ PHONE <br /> JOB LOCATION <br /> A.P.# Ill- 04.3 - 11 QQ <br /> CONTACT PHONE <br /> OWNER <br /> ADDRES PHONE <br /> SCOPE OF WORK <br /> Acc. By-libApp. By Date 4- I-s BUILDING <br /> Permit Fees$ Sch. HE $ S <br /> Remarks Plan Check $ <br /> BY: TA.S S� <br /> S.M.I.P. (State of Calif) $ <br /> Microfilm $ <br /> Cent. H/AC $ $ <br /> Size Const Val, $ MOBILEHOME INSTALLATION # $ I <br /> Plan. Dept. Ref. # Zone <br /> PLUMBING <br /> PW Dept—Drain/Flood Own. Rel. A". —Fixtures—GD—DW $ <br /> SJLHD Fire # Excay. # City Water Heater <br /> THISXECTION TO BE COMPLETED BY APPLICANT: DEPT. USE ONLY Water Line <br /> I ae owner of the property. Cl Ins Cert on Gas Piping <br /> el "w1� I will do the work myself. If I hire anyone File, Exp Date: Sewer/Drain Line <br /> v ithou• .,mp dng__v&h_W_arkFi-_C_Q_m>,-____ - i ew Water Conn. _ <br /> ensation Laws, my permit will become $ � <br /> void. ❑ Owner ❑Contr <br /> My employee(s) will do the work. <br /> I will have a Licensed Contractor do the OR (Conn. #_ 1 Maint. Dist. $ <br /> work. c � <br /> Contr. 13 Contr. No-hire MECHANICAL '4 <br /> Address Stmt. on File <br /> Comb. Unit/Heat Pump $ <br /> City Ph. 1—) Labor Code 380 Furnace/A.C. <br /> Lic. Class Number <br /> _ I am a Licensed Contractor: Gas/Water Piping <br /> Name Phone 1 ) Range/Dryer <br /> Address City —Hood/Fan/Vent — <br /> License Class.Number $ <br /> Arch/Eng Lic# ELECTRICAL <br /> Address Phone ( ) Fixtures: Incand. <br /> —Fluor—Flood <br /> Construction Lender_ Outlets: Light o/I <br /> Calif. C.C.P.#3097 _Switches Recept. <br /> I hereby acknowledge that I have read this application and state that the _ Motors HP <br /> content is correct. I agree to comply with all applicable laws and Service Amp <br /> ordinances regulating building construction/plumbing/mechanical/elec <br /> trical installations. Range/Oven/Dryer/Wtr. Htr. <br /> I UNDERSTAND THAT THIS PERMIT BECOMES VOID IF WORK IS Temp Pole--Yes—No <br /> NOT STARTED IN 180 DAYS, IF WORK IS ABANDONED FOR A panels Amp <br /> PERIOD IN EXCESS OF.180 DAYS, OR IF NO INSPECTIONS ARE <br /> CALLED FOR IN A PERIOD IN EXCESS OF 180 DAYS. IF WORK IS —Feeders-----Amp <br /> NOT TO BE DONE REFUND ST BE APPLIED FOR WITHIN 180 <br /> DAYS. <br /> Signe <br /> NER CO TRA CTO OTHER FEES Sub-Total <br /> Rec # Amt S Ian Check S_� <br /> Rec # Amt $ <br /> By AUTHORIZED AGENT Rec S' -To TOTAL FEESS Z�Z• b <br />