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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 APP~ICA;"IONMUS,!;BECflM PbET,'II fl~6.~l'IY'1I:IlEA\111~:t.'lIiI<'ji!);IQEB","~JIl.om ~ <br />•....'.'.:...it.,L .'.Bj~It:;Dt .J;,mMlrrS.Js;~.-:.~'it,,,,,,,].,..~.',.".;'L i .ik.-!-:.. <br />Scope of Work:{/V"r &~b <br />Project Address:/97/c:J ~~YP5 4/b~~9.s-~o <br />Project Valuation:Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:~c;./~~~¥~,...,/./Name:"'::::~v/~~~/£/ <br />Address:/~.$-~...::r:-~SA2~Address:/9'/?'c:J ¢7L.7-4£,"~ <br />City:~~State:~City:~£.??-State:~ <br />95290 Ph#(2q ~87--;;:5Tf/ZIP:t35~Ph#(av-ijg~2-~ZIP: <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:St:ZIP:.'DESIGNER INFORMATION <br />.:l " <br />Ph#() <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />LENDING AGENCY ."'-Ph#() <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 ,OP~lpiAL LISE ONLY <br />If yes,a completed Owner-Builder Verification Form must Identification Number: <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />~-- <br />DECLARATION BY CONSTRUCTION P'EHMIT APPLICANT .'':'~~$~7'"c.!~-.:-('", <br />.,,<-,',~~,.!"•.l ..':,""".~,,.,..c.tt.\,.,-By my signature below,I certify to one of the following: <br />I am 0 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'SSignature~~Date 4/9--// <br />For your convenience checklists detai mg any additional submittal requirements for various buildinq permit types <br />are available at the Building Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />'7 <br />F:\Application Forms &Handouls\HANDOUTS\Suilding Permit Application.docPage 1 of 2 <br />(Revised (07·08·10)