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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 COMPLETEL Y FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:Oe:."lAc.H60 Pr-:lf',o E:..rvc.£...O ~~ <br />Project Address:uutttJ (.l ~/-4 ce«LA 1\)£ <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:11f'1 ~M A 'fl-/e ~$~6 5AM6,qoO Name:CHtA~5cffe-/1"-i Pi;,qeL-H C()1!P <br />Address:(;(;'16 t4~H'Le't LAf\£Address:'3 "3 SO OL~(2..PRre~O~ <br />City:5rOC,k:.rON State:CA City:.tJ r~O.rV State:c,q <br />ZIP:qb21~Ph#()ZIP:q5211 Ph#(Ztfi)1S(;QS('(' <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lic.No:Company Name:CtI£A6 6CA~~M(JL (.)~C<J~ <br />Address:33!50 ()e.e;te fiR e«:O~City:~IOc.-t::..ro vU St:CA ZIP:q~2/~ <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:st:ZIP: <br />Permit will be issued to an 'Owner-Builder"Yes 0 No 0 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 0 a California licensed contractor or e property owner or 0 authorized to act on the property owner's <br />behalf (requires written approval and Own~r/Builder Verification Form signed and submitted). <br />I have read this construction permit application and the information I have provided is correct <br />Iagree 10 comply with all applicable county or~ws relating to building conslruction.Iauthorize <br />representatives of this city ~rcounty tOrhe above-i enti roperty for inspection purposes.., <br />/0Applicant's Signature I V ('11j J /l Date L{6 <br />I l~.'-....--.For your convenience checklists deta i any additional 5UDmlUai 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\Building Permit Application.doc <br />(Revised 1-23-00) <br />Page 1 of 2