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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 c"�t'ikSR`' INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THEAPPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS.! 11�r Scope of Work: Project Address: ��y Q A A /ZJ f7SCA e0A) t-A e� e 6 Project Valuation: Contact E-mail:C9 h , A t,k to Cc rrd OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: .Ii L)Ai ,"v 16 Name: 6Age!E ; Address- 1,31 q Z, C iz4iA3 j�j Address: . T Z L t y City: n l sState: r—g City: L�z„ I State: ZIP: 115120 Ph#(>,O ) Q,.xae, 2,3q,?. , "'dZ. ZIP: { f'�'6)4 Ph#(?p{1) 204 CONTRACTOR INFORMATION Ph#(,� Li c. No: 11 rD,;i-t`'1 Company Name: L��a>2. la'14 A Hcxb /" jeer» - 4C1a.ti Address:. City: �- St3C4 ZIP: t cF z DESIGNER INFORMATION Ph#( ) Lic. No: AJ Company Name: Address: City: St: ZIP: LENDING AGENCY Ph#( ) Company Name: /t i Address: City: St: ZIP: Permit will be issued to an "Owner-Builder' Yes ❑ No ❑ OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owners identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my-signature below, I certify to one of the following: 1 am❑a California licensed contractor or fl the property owner or❑ authorized to act on the property own6r's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction pprmit application and the information 1 have provided is correct. I agree to complywith all applicable county ordinances and state laws relating to building construction. I authorize representatives of this city or count to enter the above-identified property for inspection purposes- 1111 Applicant's Signature cx Zel Date For your convenience checklists detat ing any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check- 11st. F:Wpplimion Forms 2 HandoutslHANDOUTMBuilding Permit Appilcation.docPage 1 of 2 (Revised(07-OB-10)