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BUILDING PERMIT APPLICATION <br /> U f u < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> f+. <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> •C9 -A <br /> L�FOR`' INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THEAPPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: > \CVN,\+~ l c, v� <br /> Project Address:` t (' 'r,. CV_>7,Cj`+ <br /> Project Valuation: Contact E-mail 0_11,\ t�k'�t?5',LC <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> -Jame: t'.-,-',LolV\ c' .c ` 2s-oC+C a Name: v ..c CC C2Cti t <br /> Address: i{ Address: '1C)0\� <br /> City: State: City:��A <br /> ZIP: ti1� 2U'l Ph#( ) ZIP: 66 <br /> CONTRACTOR INFORMATION Ph#{ ) <br /> Lic. No: Company Name: <br /> Address: City: St ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic, No: Company Name: <br /> Address: City: St: ZIP: <br /> L <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 owners <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 /> 1 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 this city or county to enter the above-identified property for inspection purposes_ <br /> Applicant'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 /> ' <br /> F:Application Fonns&Handouts\HANDOUTMuilding Pemft Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />