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ep4U'"= BUILDING PERMIT APPLIT468-3165_ <br /> N <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DT <br /> 1810 E. HAZELTON AVENUE, STOCKT5 <br /> BUSINESS PHONE: (21 <br /> "YiF oo- INSPECTION REQUEST-24 HOUR RECORDER: ( <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THEAPPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> s <br /> Scope of Work: E(�Ie (rot ia�e� � I�, i`IC' t,4 ryL, <br /> V Cf✓f <br /> Project Address: !jcccGje f c rct L:.}ci C ft <br /> Project Valuation: N05,,, o0c) Contact E-mail: IP Y kj<� C 'J �t • <br /> OWNER NAME AND ADD SSS fir,m . APPLICANT NAME AND ADDRESS <br /> Name,'.",,",. C r`t -bnc Ix,I Name: 4MLJ-_AJca*--roc, <br /> Address: �p j Sa -�,If „r,t r Address: �1,J x X S� <br /> City:`0) �C,(.�,� State: eCity: State: C <br /> ZIP: Gt Ph#(2;3q) L4bq--4-)CC3 z 5 Ph#0;F1) (G7tc 7S 7 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No:C-V ?soCompany Name: ' y <br /> 1'�t MCi14�,kei,L-jSG c: c S <br /> Address: taloa N. 6vid,1 ,4e4,z- givec, City:-r"J:-ita Ic St:CA ZIP:��3�C3 <br /> LENDING AGENCY `` Ph#(2Zr1) �.-2 <br /> Company Name: avc C'ct <br /> Address: Ct e_ if City: Z St:)4ZIP: �),) <br /> Permit will be issued to an "Owner-Builder" Yes No El OFFICIAL USE ONLY <br /> If yes, a completed Owner-Builder Verification orm must Identification Number: <br /> be signed and submitted along with copy of the owners <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 ❑ a California licensed contractor or[] the property owner or❑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 Date <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:Wpplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />