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BUILD_ING_P-.ERMIT_-AP_P_LICATION-- - <br /> e '• SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> u ` 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> �7 BUSINESS PHONE: (209) 468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209) 468.3165 <br /> </ppR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: , r i I A {if J .1 <br /> Project Address: D (D -Cei - / <br /> Project Valuation: © Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: o 5 ke Name: b 1 t <br /> Address: ' 11/� t�'� . Oiey� dL Ru, Address: <br /> City: 11 C �C GtL State: ^ Clty: State: <br /> ZIP: Ph 7 -�S ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No:N Company Name: <br /> Address: wn ee- tJ� Cit <br /> ' �� Y: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <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�KNo ❑ 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, I certify to one of the following: <br /> I am ❑ a California licensed contractor or❑ 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 r county to enter thea ve-identified property for inspection purposes. <br /> Applicant's Signature Date <br /> For your convenience checklists detailing any additional s bmittal 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 /> FAApplication Fortes&Handouts"ANDOUMBuilding Permit Application.docPage 1 of <br /> (Revised(07-08-10) - <br />