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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 /> �atrF6A�`P 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: lj ew 'djol'jile/j�im&fit lbte d yli <br /> Project Address: / "atkWa 4611, G� <br /> Project Valuation: Cyd Contact E-mail: I�l <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Name: �Allr lJyl , <br /> Address C�(� �� ��� Address: <br /> City: /�r' State: � J City: �(� Staff <br /> ZIP: l'(v%l"°/� Ph# , �((� ZIP: Ph#( <br /> CONTRACTOR INFORMATION Ph#(yt) 71 l�JJ� <br /> Lic. No: f Company Name;7 / <br /> r. _. <br /> Address: ,� l � City: St:� ZIP: �✓�' �` <br /> DESIGNER INFORMATION Ph <br /> Lic. No: I Company Name: <i <br /> Address:" City: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder' Yes ❑ Noj�j_ 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 /> By my signature below, I certify to one of the following: <br /> I am Uzi 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 thi77Z <br /> o e e the above-identified property for inspection purposes. <br /> �IQApplicant's Signature Date <br /> For your convenience checklists 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 /> PMpplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />,' (Revised(07-08-10) <br />