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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:NelN ConrtY"l.,)L-+lOYl <br />Project Address:\2-lg S-3 1::...LS \0 s S 0 V"v")\J\evJ c.,\. <br />~PDN ~ <br />Project Valuation:Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:~Q.SoV"\DOVVl Name:~'"-"\e. <br />Address::3~ot{SUYI ~(YY\C-e..~k L.-r-:Address: <br />City:X-Y\odti~D State:C::A City:State: <br />ZIP:c?t;;3S::-Ph#(zo"t)57~3(1 tf ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name:DOY"n &-t--e..."'pyues.W£c,+\V'ot..I ~c.!>oV'>'bovV\ <br />Address:tt-<6\'2--<;T7ZATo So W,*V City:M.o£e..<;+-0 StC:A.ZIP:95:~.stJ <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 ~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 fRlthe property owner or D 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 Signa~~Date 12-(2--0 I 2-D I D <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:lApplication Forms &HandoutslHANDOUTSIBuilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)