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Pa�iN C 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 /> - P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLIGATION'MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> n BUILDING PERMITS.' <br /> _mope of Work: 1\ ILIDb�nn�''rh o �Jc fi'ti S�/� <br /> project Address: a S u IC�t <br /> Contact E-mail: S ham, }( <br /> �rojectValuation C � � ..� � u Ln <br /> OWf SND ADDRESS APPLICANT NAME AND ADDRESS <br /> dame: M o . Name: �� SGG j a- -� <br /> p,ddress <br /> Address: jp� S. ��"1 ✓C— <br /> State: C., City:- 2 ' d^ State: <br /> C,1 Y, <br /> cavC - <br /> Ph#( ) 5 7 36 ZIP: 6 Ph#a-q) 5773-�f'76- <br /> ZIP' <br /> c a QaManory Ph#Q�s <br /> Lic. NoCompany Name: <br /> Address /2 City: I St: ZIP: JG <br /> IN <br /> ER; FORMATION Ph#( <br /> Lic. No: <br /> ) <br /> Company Name: <br /> r <br /> AddressCity: St: ZIP: <br /> . _� � _ <br /> l; LENDING AGENCY Ph#( ) <br /> Company Name:' <br /> Address: City: St: ZIP: <br /> permit will be issued to an "Owner-Builder" Yes E] No ❑ <br /> 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 CONSTRUCTION PERMIT APPLICANT <br /> By my signaturebelow, I certify to one of the following: <br /> I amCalifornia licensed contractor or 0 the property owner or E] 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 ofthiscity or county to enter the above-identified property for inspection purposes. <br /> Applicant's Signature—V Date 10 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- <br /> list. <br /> F.\Application Forms&Handouts\HANDOUTS\Building Permit Application.docPacde 1 of 2 <br /> .;(Revised(07-08-10) <br />