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o q� 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 /> ed♦ o- INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 s <br /> �IFOR <br /> P <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> ScopeofWork: Q �j ��� (� . <br /> Project Address: Itu�j Mal TLV�lv AAW <br /> Project Valuation: Contact E-mail: P Ai'1{20;6 -)'O(00 @ITOl -` o)7b <br /> OWNER NAME An ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: n }�al2 Name: YY)� 6�i) <br /> Address: (/41(-" Address: <br /> (/41(-" <br /> State:City: ��/Aq I ` '(� CP( y� p City: := State <br /> ZIP: a�JJ77 Ph ) I v D 3 ZIP: Ph#( ) <br /> d <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Company Name: <br /> Lic. No: r <br /> I. <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: ji i7 Z G <br /> Address: city: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> j <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder' Yes No❑ OFFICIAL USE ONLY <br /> f yes, a completed Owner-Builder Verification rorm 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 CONSTRUCTION PERMIT APPLICANT <br /> By myyssignatureibelow, I certify to one of the following: <br /> amea California licensed contractor or�the property owner or 0 authorized to act on the property owner's <br /> behalf(requires written approval and Owndr/Builder Verification Form signed and submitted). <br /> i. <br /> I have read this construction permit application and certify the information I have provided is correct. I also agree to comply <br /> with all applicable county rdinances and state laws which govern this project. During the course of construction I will also l <br /> takes steps to preserve a survey monuments. In addition, I authorize representatives of this county to enter the above- f <br /> identified property for in ecti pur e . <br /> Applicant's Signature Date �� M1 <br /> �- i <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-list. <br /> i. <br /> plication Forms&HandoulslHANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 <br /> ked.(01-28-15) <br />