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~------------------------------'~4~~OA <br />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 />Scope of Work: <br />OWNER NA~E AND ADDRESS <br />Project Address: <br />Project Valuation: <br />Address:City:St:ZIP: <br />Name:-;;;IYf (/Bk ~() <br />Address:12...'2-IAddress:t Yb {I oO€o.b <br />City:t:»d"State:City: <br />Co.NTRACTOR INFORMATION <br />Lic.No:50G Company Name: <br />Address:2...2.l LV I Je.,.TOw..J t2d <br />DESIGNER INFORMATION <br />Lic.No:--"oG?(z..Company Name: <br />LENDING AGENCY <br />Company Name: <br />Permit will be issued to an "Owner-Builder"Yes D No ~ <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />Identification Number: <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 Signat~-..:::e~V-......-I!'!~~~~~--===""'-..l.__----f~-+Date /2-/,j;6 <br />'IForyourconveniencechecklistsdetailinganyadditionaluittalrequirementsforvariousbuilding permit types <br />are available at the Building Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:lApplication Forms &Handouls\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)