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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 />INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 <br />TJ!lE APPLIO'A:rIO~~tLlstiaE.,e0MPI..!ET.6L¥:J:'Il:~E[i)~~~t3~~[HEi'A:~~~.eJJ~ft}1N'·~J~]i)ERhJi"~~~~~~r Pr~~i <br />.,.,~",,~,_..'B\i1ILDINGilt?,E .MIiJ'S.'\,-"",'~;.,o,-':'~~""'I!l'i,:,:,,1~c "".~',~;''','d:.i,'be."",,-. <br />Scope of Work: <br />Project Address: <br />Project Valuation:Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:.'65 -c:;;r',~..('/Name:-m.<;VVV\~~-' <br />Address:/9 2'""1 R./:.LJ.L.A-t/<2-Address: <br />City:ST{')if '/;;A/'State:L~City:State: <br />ZIP:7~7e;~Ph#(ZtA1 Zc;-/('6 ~~ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#() <br />" <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lic.No:Company Name:etv&l~B)/~:r <br />Address:City:St:ZIP: <br />LENDING AGENCY .'Ph#() <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 '"..•'OFF-I,QI~l LISE 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 />DEqL~RATIO~B~"C0tJ~:rRl1~~~~~:P'6R~IT A~Pb-ICA~T .~" <br />:>,r':F'.;l,s..:-.-},·~~Mi;;;·,t:·':,; <br />By my signature below,I certify to one of the following: <br />I am 0 a California licensed contractor or 0 the property owner or 0 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 county to ~rdentified property for inspection purposes. <br />Applicant's Signature ~~q~---------Date <::;-/;b /1/ <br />For your conveni~~~~ecklists detailing any additional submittal requirements for variou/buil/n9 permit types <br />are available at th uilding Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\Application Forms &Handouls\HANDOUTS\8uilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)