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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:NEW c.u s,ID tv'\:51 tJ G LE Ff\('t\\i.'(\-\G\V\E- <br />Project Address: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND.ADDRESS <br />Name:P .liDNtz-.,/D\"\-~M Name:r\-\"....L ~~\'f\t-v•l <br />Address:..6r\C.L Q v v r=R.(l.~(')(")\c:C!...T Address:-State:City:3-r(')t..\(..-r\l>...}State:~City: <br />ZIP:Or (""7_I C1 Ph#(uq)b0/-J_f<X'rI ZIP:Ph#(), <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company~'----=>:City:St:Address:-ZIP: <br />DESIGNER INFORMATION Ph#(&',<t )it 1-'0-6 <6~I <br />~'-'""El\T~rLu()U~'~Lic.No:Company Name:-....-- <br />Address:11'7.':f-~(<.fEN ~\~G iC.."t>Q,City:S~~C.~fel\J se CA ZIP:9~()? <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 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 00 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 ~?\/'20110Date, <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\Building Permit Application.doc <br />(Revised 1-23-09) <br />Page 1 of2