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BUILDING-PERMIT APPLICATION <br /> F � j• ?� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER- (209)468-3165 <br /> LIKOR` <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO,APPLY FOR <br /> BUILDING PERMITS- <br /> Scope of Work: /,c1 pfC3 �p Z <br /> Project Address: 4F: Pe'_L eye -q <br /> Project Valuation: �� ppQ ContactE-mail: <br /> OWNER NAMEAND ADDRESS APP LICANT.NAM E AND ADDRESS <br /> Name:. fi7 �L�6? I Name:- �J`i ddCCdf✓ ��t✓5•d <br /> Address: ,rte fg ,L , A?P Address: <br /> City: r� � <br /> State: City: T � State: <br /> ZIP: �j j a Ph#( ) F,2 ZIP: <br /> CONTRACTOR INFORMATION Ph#( ) _ Vo5 3 <br /> Lic. No: gy Company Name: <br /> Address: `7 s 0-7 +Al D 1e�4 - City: 57Pe., ,_ h.- St: zip: `?5?_6 <br /> DESIGNER-INFORMATION Ph#( <br /> Lia No: 2-g Company Name: & /"/ 5 4e �� ; ,�✓ tlje�S <br /> Address: fL f2� GZ ® City: St: C* ZIP:' ,$ 2 <br /> LENDINGAGENCYPh#( ) g <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit-will be issued to an "Owner-Builder' Yes ❑ No 01 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 signature below, 1 certify to one of the following: <br /> I am California licensed contractor or F1 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 co my to enter-the above identified property for inspection purposes. <br /> Applicant's Signatur Date <br /> For your convenience checklists etailing any additional submittal requirements for vanous buttdrng `$ <br /> are available at the Building Division counter. Demolition permit and mobile home on faundaE <br /> list, - <br /> R\Application Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 �- <br /> (Revised(07-08-10) .�- �" • <br />