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eAa"`" BUILDING PERMIT APPLICATION a: `a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT �, 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 oq":.�_••tP INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 �lFOR� THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. ScopeofWork: j ,:rc C 41i ' 1c Project Address: Project Valuation: 7, 6 e6 Contact E-mail: OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: �/V,-, J Name: Scan>� r S C c lar d Address: Z Z 5' 4Z 5, L�) /,,y.czr Address: City: f State: C14 City: State: ZIP: S Ph#(Zay ZIP: Ph#( ) CONTRACTOR INFORMATION Ph#( ) Lic. No: Company Name: G°bYh Address: City: St: ZIP: DESIGNER INFORMATION Ph#( ) Lic. No: - / � Company Name: fy � G, , _ ) �y r, Address: . 2 5Zj<. , , ✓ 11'6>r l =t City: i :rs St ZIP: l „ ' LENDING AGENCY Ph#( ) Company Name: 1 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 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 O't6e 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 inspecti R purpeses Applicant's Signature j �f/ / Date_Z I f/Z-0 For your convenience checklists etailing an 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. FAApplication Forms&HandoutslHANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)