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BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E. HAZELTON AVENUE, STOCKTON CA 96206 <br />BUSINESS PHONE: (209) 468-3121 <br />INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3166 <br />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br />PERMITS. <br />_..--:, Scope of Work: --i. :::e Oftcey .,... <br />Project Address: ._2(-,2 ,. --e\ker - „,,, 1-c CVAI.Y.1 C <br />Project Valuation: i 1k3D(000 Contact E-mail: 0.60. Cov ricL I,,,p <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name: \D,AC, qou _The --I t. „..101 ,.-)k. i cl-rA, ---1 (m 6\ Name: V - '''t,--,c.k_ <br />Address : i ci c,f,,,,,,,,,,,, e.J.. ' 1 Address; :7--ii 7., 3 _ 1„..; C ne,r i'l v146 IA* <br />City: .1.--ock,- n State: ct, City: '---,--5 iroctor-1 State: 0 ins <br />ZIP: 9 s205 . Phite xcA) utps _s),_1'2_ ZIP: .,•1 -7.,-,;_ 1 ..--- Ph#(2fA ) 1-1 <br />CONTRACTOR INFORMATION Phig,-)cf)t) (.--( 0,5 -- ai <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 />LENDING AGENCY Ph#( ) <br />Company Name: I <br />Address: City: St: ZIP: <br />Permit will be issued to an 'Owner-Builder" Yes di\I -o 0 <br />If yes, a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />OFFICIAL USE ONLY <br />Identification Number: <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below, I certify to one <br />I am El a California licensed contractor <br />behalf (requires written approval <br />I have read this construction permit <br />with all applicable county ordinances <br />takes steps to preserve all survey monu <br />identified property for inspection pur <br />_--.--7:1 Applicant's Signature <br />of the following: <br />or 1the property <br />and Owner/Builder Verification <br />application and certify the <br />and st te laws which govern <br />elfts. In addition, I authorize <br />ios:: ' <br />--- -,- <br />owner or 0 authorized to act on the property owner's <br />Form signed and submitted). <br />information I have provided is correct. I also agree to comply <br />this project. During the course of construction I will also <br />representatives of this county to entepthe above- <br />Date 0 / '1 4 <br />For your convenience checklists d -tailing 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-list. <br />F:\Application Forms & Handouts IHANDOUTSIBuilding Permit Application 1-2015.doc Page 1 of 2 <br />(Revised (01-28-15)