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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 />". <br />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPL Y FOR <br />BUILDING PERMITS. <br />Scope of Work:Addi -+io •..•+.:.~'f.~CO+-I'I\~OUIC:'"D""~ld ll1, <br />Project Address:2.I 6.0\E.HlqHwAY ('20 <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:B:::troe.\T e;'\auQ.rl-c.r C~':'ttloO ~:r,,~Name:Ch"",,,~'f~"(4nd-4.--,J'o,,-L,I-I'-c •• <br />Address:~I 80\~.HIMY'l"ZO Address:l3~S Vc,,+-..Jrc..L",,,,<. <br />City:e;.;c.a 10'"'State:C.cd_+.City:~TUrloc..k-State:C"'" <br />ZIP:9 ~1-z..::,Ph#()ZIP:'9J3'3~<::>Ph#(Z<1f)"~7-4J<t/ <br />CONTRACTOR INFORMATION Ph#(tof )~<''7 -4.I c(" <br />Lic.No:?8 ~7Zo -(3 I Company Name:An:krs.::w"\-L,l-..f.-c •..•... <br />Address:l?~S Ve('Tiou re..La..1'WL City:T'Ut""'lcx.,..1£.St C~ZIP: <br />DESIGNER INFORMATION Ph#(tv1 )'>7(.-6'Z.ZZ. <br />Lic.No:1)7/1'3 Company Name:L I ot\~k..-,,'4I; <br />Address:IZol 1:'S7r~-+-City:ko.J.-5-1-o St:C"ZIP:9~?Scl.. <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 NO¥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 0 a California licensed contractor or 0 the property owner or)9..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 C4~Date ~--2010 <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:\BUILDING\HANDOUTS\Building Permit Application.doc <br />(Revised 1-23-09) <br />Page 1 of2