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oPn•u i N..o �4�•ji�oRa BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209) 468-3121 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. Scope of Work: ' Gl C�- Cit-��ct CAD t Project Address: �3�} - y �� (�� „L �f� r Q S Z �C Project Valuation: �-Z� I Contact E-mail: �' �Lo�-�2 a �� C4 Q p L fo OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: <�7 et,\ �Cp�- Name: Address: Address: C_ , C) City: �� t ` State: City: Li State: CA - ZIP: Phgp ')) `{(' l (o°i ZIP: 4S2J Ph#(201�1 CONTRACTOR INFORMATION Lic. No: `- 5- Company Name: & �'A-�at,�i�� n Address: City: C___C Sti3 - ZIP:lqS DESIGNER INFORMATION Ph#( ) Lic. No: Company Name: Ul __ VtR�- Address: City: G `` St: ZIP: �L rZ3 LENDING AGENCY Ph#( ) Company Name: Address: City: St: ZIP: Permit will be issued to an "Own er-Builder" Yes ❑ No If yes, a completed Owner -Builder Verification Form must be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. OFFICIAL USE ONLY Identification Number: DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signat below, I certify to one of the following: m I 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 comply 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 //I/// Date__ For your convenience checklists d tin any additional submiftal requirements for various building permit types are available at the Building Divis n` u ter. Demolition permit and mobile home on foundation require check -list. FAApplication Forms & Hand outsl.4ANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 (Revised (01-28-15)