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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 APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:IrJSTLlu......MOBI/E 1-1t11 <br />Project Address:.?blo/)(tJ BleD Qo -riZ.AC Y ~ <br />Project Valuation:Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:Dl2..k..-\-k\LS c:1\-1 D Name:LlI\II\.\Ll ~1LE\lUJ. <br />Address:ILL 1'-1OI...J..)K.Y 11 YE-Address:It LIZ.(.LlI\JI}C=Q <br />City:j:""1ZE:n,<Y0 T State:C.-h City:\"\.)12.~State:cu: <br />ZIP:Cj~53<.o Ph#(5/Q 1133?:Ao ZIP:<iS3~O Ph#(Uff)Lj~I g "1g <br />CONTRACTOR IN FORMATION Ph#()3il.132~ <br />Lie,No:Z2~49 Company Name:13eooi.(S G::,I\JSTQ LeI (0rJ <br />Address:/(0%I ~~AYWOLJ:.City:-\ue.cucJ.c St:CA.ZIP:<1538 L <br />DESIGNER INFORMATION 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 D No D 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 D a California licensed contractor or D the property owner orlsJ 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 a M M u.)f?g,J\1 .L\.AA..!Date 3 -\i -\2. <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 />F;\Application Forms &Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)