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°pRN••.co 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 /> o" INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> '4Lt F oR��P <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: �ye�j ,� c:: lka -e <br /> Project Address: C)yb C L � , � <br /> Project Valuation: Contact E-mail:Glp L tGv� pC tc7 <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: v ✓ c to t Name: __t-AQ_ & <br /> Address: �a ��� g isR� p,1 ({ Address: (PCS` 1e.c) <br /> City: 44_- , State: Ctk City: State: CA- <br /> ZIP: ZIP: Ph#(ei )� <br /> CONTRACTOR INFORMATION Ph#(0'C)J <br /> Lie. No: L !�-( 1 t 5 1 Company Name: le- <br /> Address: j7, U borc I ZZU City: StCC-, zip: '7f 1 <br /> DESIGNER INFORMATION Ph#(ZOO ^ I <br /> Lie. No: Company Name: JT F� D S , <br /> Address: City: St: vl ZIP: FS 2-fc) <br /> LENDING AGENCY Ph#( ) <br /> Company Name: Y <br /> Address: City: St: ZIP: 'r <br /> Permit will be issued to an "Owner-Builder' Yes ❑ No Q 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 a California licensed contractor or❑the property owner or❑ authorized to act on the property owner's <br /> behalf(requires written approval and Owner/BuilderVerification Form signed and submitted). <br /> I have read this construction permit application and certify the information I have provided is correct. I also agAee to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection purposes. <br /> Applicant's Signature - --- Date <br /> For your convenience checklists detail' any a ditional submittal requirements for various building permit types <br /> are available at the Building Division co ter. emolition permit and mobile home on foundation require check-list. <br /> F Vtppltcation Forms&Handouta\HANDOUTS1Building Permit Application 1-2015.doc Page l of 2 <br />