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BUILDING PERMIT APPLICATION <br /> C <br /> y `? SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> "i, •. '` 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: ) &I - <br /> Project Address: y a J�L�1I <br /> Project Valuation: ���J 1�1)6j0 Contact E-mail: C_boh r 1 rrl G(L �'i , c4J <br /> OWNER NAME AND ADDRESS r `APPLICANT NAME AND ADDRESS <br /> Name: r Lauf j Pi 6- 1 Name: 1 171'1' JC��,"1 rv1 � )1✓ ✓. <br /> Address: 6{1 j JGJ��6� kdAddress: 3a ' Cl o 51Q L <br /> City: f ✓1 , State: Cly City: State; CA <br /> ZIP: g ' Z Ph#( ) ZIP: q 27j <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#QW- q. 0 <br /> Lic. No: Company Name: ih`, a i t)y-viof d i d <br /> Address: d / city: S 1c'Un, St: ZIP: C <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes ❑ No ❑ 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 /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> I <br /> By my signature below, I certify to one of the following: <br /> I am ❑ a California licensed contractor or❑ the property owner or 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-thisIche <br /> ounty to enter the above-identified property for inspection purposes. J <br /> Applicant's SignatureJ Date �r <br /> For your convenienlists detailing any ditio I submittal requirements for various building permit types <br /> are available at the Building Division counter. moliti n permit and mobile home on foundation require check- <br /> list. <br /> F.Mpplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />