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Uk SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT N �y fl 1810 E. HAZELTON ^VENUE, STOCKTON CA 95205 i ;5 , BUSINESS PHONE: (209) 468-3121 .• INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 �Fpn THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BU!LDWG PERMITS. _ Scope of Work: Project Address: Project Valuation: Contact E-mail: /r OWNER NAME AMD RDDRESS APPLICANT-NAME AND ADDRESS Name: w�lztt.�� Name: 7R f --- Address_ Address: -;,:_,> G`c LA-_` <�L' City: t -State: [ ::L Cite: State: i City: } A I I Ph#(�c,-6 2 mac.7• z, � ZIP: �5, f Ph;=(�r� CONTRACTOR INFORMATION l Ph#( Lic. No: ,e,-7 Company Name: �� Address: City St: ZIP: DESIOI'X ll`<FORItI.ATI^I: i Ph#( ) Lie. No- Co spar;, Name: Address: City: ! St: ZIP: i LENDING AGENCY Ph-,( ) Company Name: Address: City: St: 71P- 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 PERMiilT ,APPLICP.NT By my signature below, I certify to one of the following: I am ❑ a California licensed contractor or❑the 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 additio , I authorize.representatives of this county to enter the above- identified property for inspection purposes. Applicant's Signature Date (� For your convenience checklists detang/Zny zdditional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit end mobile home on foundation require check-list. F:V pplicabon Forms&HandouWHANDOUTSSuilding Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)