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BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 k •. =a`_ INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING // PERMITS.T Scope of Work: �Ci C � f✓ I S-i-O'A aUR-e- Project Address: } Y 'Cita 0 CA 152:a' Project Valuation: Contact E-mail )n` files l(YX! OWNER NA E AND ADDRESS APPLICANT NAME ND ADDRESS Name: e6 and {}' I wri ((r Name: To 1 hlin - r Address: E� , Call Address: Po 601 City: ' "oi State: City: I�UeM 00 1 State: CA Zip: q6 17 o Ph#(G011) .�i. `5 l � ZIP: j."5.� Ph#( ) `j CONTRACTOR INFORMATION Ph#( } Lic. No: Comi pany Name: e e ; e /v �3re�Gt a a_n ty - w Address: 15 to City: -T#sh (1 SOX ZIP: 7&W DESIGNER INFORMATION Ph#( j ) &0 _7256 _ 11S65 Lic. No: Company Name: fl'1 I : -(i t y C a( ^ ) 1 y Address: G 5 ? a :�UJ(, City: i G� SN zip: 11 65f1 LENDING AGENCY Ph#( i ) - )j Company Name: Address: City: St: ZIP: Permit will be issued to an"Owner-Builder Yeses No❑ OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below,I certify to one of the following: I am ❑ a California licensed contractor or( the property owner or❑ authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit application and certify the information I have provided is correct. I also agree to cbmpiy with all applicable county ordinances and state laws which govern this project. During the course of construction I will also takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- identified property for inspection purposes. Applicant's Signature Date ZZ CI For your convenience checklists detailing ny additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. F:1Application Forms&HandoutslHANDOUMBuilding Permit Application 1.2015.doc Page 1 of 2