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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:iJ,A 11 •(A4oIO .o*!h"oo~•fl.J...~B-',Project Address:I)JSf~Vl.A4L<\~~ <br />Project Valuation:5 C>cP.rD Contact E-mail: <br />OWNER NAME AND ADDRESS r-,APPLICANT NAME AND ADDRESS <br />Name:Sv\~l.L /j,O j \A....C-Name:\..\).~rl M -s ~u..<.Lo~~* <br />\~~1~'v).v.l-J..k\~/J..1.\c.~"\~~~~~Address:Address:\~'Kl , <br />City:L,6t.}-State:c...-<.-City:~State:4- <br />ZIP:~~)..~o Ph#()ZIP:~~-3 :l...Ph#(~)14S'~4~l <br />CONTRACTOR INFORMATION r-,Ph#() <br />~'!>11i.Company Name:\.\J.A s ':1 flM>Wt-~t.1-r-Lic.No:J.k-L <br />l S ~1' <br />\., <br />City:~St:~ZIP:q.st.,--Address:~'-"v \.~\-.fW\..<:.~e.. <br />DESIGNER INFORMATION Ph#() <br />Lic.No:Company Name:Yl1lk~'5 m I I-i.,.s:AA ". <br />Address:4-VL vY\~1'''1 "51--City:Ltrfh ..St:~ZIP:~).4D <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 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 />J, <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />-; <br />By my signature below,I certify to one of the following: <br />I am ~Iifornia 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 />- <br />I have read this construction permit application and the information I have provided is correct. <br />I agree to comply with al:~~able county ordinances and state laws relating to building construction I authorize <br />representatives of this cit r county to enter the above-identified property for inspection purposes. <br />Applicant's Signature \.\M~rs ~Date iZ./q //J <br />For your convenience Ch~Cklist~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:lApplication Forms &Handouts\HANDOUTS\Suilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)