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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 COMPLETEL Y FILLED OUT BY THE APPLICANT IN ORDER TO APPL Y FOR <br />BUILDING PERMITS. <br />Scope of Work://I5-k./1 11I1,ti~.I£,hl1lY\€'hll1i.t:A'I dif?:;"'<t'-Ctlrv{O-/';,1 tJn fl?J.~L .J.N l-tr <br />y '/•//~rf\lProjectAddress:J(;7<)'1 15 It A AJi)r J20 <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:NAAiL",'~//Sh'Ji jt;..AJ~~/J~hr1 t:;,,1"\Name:/l/iJ.JJL.V I!zi/S~;J ~J;/1/1L'//:1j,'~~J/l <br />Address:J)O /~4)"11'-17 Address:PI!~tI)t Ilq? <br />City:&c/Le r;r 4 State:LA City:[~J4.-{;o-/State:CrA <br />ZIP:CJ5~37 Ph#0(91)J...)-=?t:;'),}.ZIP:Cfs--:-;.-~?Ph#(dCfl)7.J)-J~)rJ. <br />CONTRACTOR INFORMATION Ph#() <br />Lie.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: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes JKJ No 0 OFFICIAL USE ONL Y <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 o~the property owner or D authorized to act on the property owner's <br />behalf (requires written approval and Ow er/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 ~\.\..{').r 1 \'~~LiJ.-.r--..Date J D \.t <Y1 <br />For your convenience checklists det\iling 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:\BUILDING\HANDOUTS\8uilding Permit Application.doc <br />(Revised 1-23-09) <br />Page 1 of2