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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 /> gCik'okN�. <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION.MUST'BECOMP..LETELY FILLED;OUTaBY.THE'APPLICANT IN:ORDER TO-APPLY FOR" <br /> BUILDING?ERMITS. / <br /> Scope of Work: :7fU 1 ,(/ {/ /nObi le f <br /> Project Address: U 9,S'336 <br /> Project Valuation: 6ontact E-mail: <br /> OWNERNAME:AN, D ADDRESS ,- ' APPLICANT`NAIVIEAND ADDRESS <br /> Name: e Name: ty <br /> Address: , Address:r � � h/G <br /> City: State: (f f} City: State: <br /> ZIP: QJ 33 Ph#pD ) 597-Z3G ZIP: 95--71a Ph I ) u) 7 <br /> COTRAbTbRNMIPh#(.ON ) <br /> Lic. No: Company Name: g� <br /> Address: City: St: ZIP: <br /> DESIGNEWINFORMATION ' 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 NTNo ❑ OFFICIAL USE;ONLY <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.CONSTRU6T]ON.PERMIT APPLICANT ' <br /> By my signature below, I certify to one of the following: <br /> 1 am ❑ a California licensed contractor or❑the property owner or Zrauthorized 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 ounty to en r the above-identified property for inspection purposes. <br /> Applicant's Signature Date S/,;,/ <br /> For your convenience hecklists detailing any additional submittal requirements for various building permit types <br /> are available at the ilding Division counter. Demolition permit and mobile home on foundation require check- <br /> `.', .list.... <br /> .Wppllcatlon Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 01`2 <br /> "'R' ised(07-08-10) <br />