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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 />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:S\f\l\C\.\\O.L\S \1'\\\'f / <br />v ~ <br />Project Address: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:k:;(>A /J //./1'.r:'z.Name:,~1Yl f2 <br />Address:.9-5/P t2 C i2,~/j /"Iii Address: <br />CitY:~rdJiA"1 State:('#City:State: <br />ZIP:q5'.~:2D Ph#~crt )?~<;<-z;7'7R ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:St ZIP: <br />DESIGNER INFORMATION Ph#V'1J1)~C/0-q 17c; <br />Lic.No(,C?s4 If)Company Name:\\f\C\\f'{'\P)J\fA',\f\€.lX\W'~~,\V'\It\i N\~\,\.J\t. <br />Address:3'6 ('1b.II 'SP J!V\i ve -\k\f P,City:Od.k<:clh.\-e J StW,Z(P:QS?~\ <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:St ZIP: <br />Permit will be issued to an "Owner-Builder"Yes D No D OFFICIAL USE ONL Y <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,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 enter the above-identified property for inspection purposes. <br />Applicant's Signature Date <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:\BUILDING\HANDOUTS\8uilding Permit Application.doc <br />(Revised 1-23-09) <br />Page 1 of2