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f� . <br /> - SANJOBUiLD[NG PERMIT APPLlG,4TIGN <br /> < AZUfN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 66�U 1810 E. HAZELTON AVENUE STOCKTON CA 95205 <br /> e r+ INSPECTION BUSINESS PHONE: (209)468-3121 <br /> REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT <br /> BUILDING PERil,,,,. APPLICANT IN OE�ERTO APPLY FOR <br /> Scope of Work: A C ITS <br /> Project Address: Z628 dell c�LJ <br /> Project Valuation: <br /> Contact E-mail: <br /> OWNER NAME AND ADDRESS ,COCy� <br /> Name: �(� Gr APPLICANT NAME AND ADDRESS <br /> Address: f�Q Nama; <br /> Addr <br /> City. (��j� C State: ass: <br /> ZIP: City- <br /> GS27�y/ p / <br /> I Ph#(� ) _ ) State: <br /> L ZIP: ) <br /> CONTRACTOR INFORMATION Ph#( <br /> ) <br /> Lic.No: Company Name: �l Ph#( <br /> Address: <br /> City; <br /> DESIGNER INFORMATION St: ZIP: <br /> ) <br /> Lic,No: Company Name: Ph#( <br /> Address: <br /> City; <br /> LENDING AGENCY St: ZIP: <br /> ) <br /> Company Name: Ph#( <br /> Address: <br /> City: <br /> Permit will be issued to an "Owner-Builder" Yes ❑No St ZIP: <br /> If yes, a completed Owner-Builder Verification Form OFFICIAL USE ONLY <br /> be signed and submitted along with copy of,the ownhe o must Identification Number.er'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 F-1a California licensed contractor or{]the property owneror El authorized to act on the property owner's <br /> behalf(requires written approval and Owner(Builder Verification porm signed and submitted). <br /> I have ead 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 inspecfion`purposes- <br /> Applicant's Signature <br /> For your convenience checklists detailing an Date <br /> are available at the Building Division counter. Demtolitio�sub mlttal requirements for various building permit types <br /> list. Permitand mobile home on foundation require check- <br /> F:Wppllmtion Fonns&Handours\HANDOUTS18uilding Peunit Appp�tion.docp <br /> (Revised(07-0&10) age 1 oft - <br />