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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 /> ogta "''fl INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: NIVV CCOSTKUCMQnA — 1I-K, fvrnt) e ke <br /> Project Address: Gj s j W, r ew-T C 96Z'-/.7_ <br /> Project Valuation: `5' � ContactE-mail: jcA(,AcCtirisTj C dc.hrr3 Crr, <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: J-lm /FIN 1ZU r7t_*1 Name: ^aMC BUILDERS,ING,. <br /> P n.BOX 1252 <br /> Address: \A/, utrNLfL /Zc1, Address: WOODDRID0E«OA95 <br /> City: State: CA City: State: <br /> ZIP: C�Z5c_Jz Ph#(ZO9) y 83 4t7ry ZIP: Ph#(2cP) 339 qSBy <br /> CONTRACTOR INFORMATION Ph#(Zcx f) 3 3`r Li Re# <br /> Lic. No: 29(6 :310 Company Name: Sf"L bu t)p eve ZtA C. <br /> Address: -PG 13C. /2.52 City: u cicdbrtdce St:CA ZIP:95zsl� <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: CaL¢y_6y0 Company Name: YY11kEsn111rtd 6NG/,vrE(Z/"G <br /> Address: y /V©ev4 /AAA -St City: [,Orli St:CA ZIP: c SZ�/O <br /> LENDING AGENCY Ph#(209) 33'-! 7-332- <br /> Company <br /> 332Company Name: -7,m VL)dv Ruj&V <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes Q No 1Z 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 /> 1 am N a California licensed contractor or❑the property owner or N 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 certify the information I have provided is correct. I also agree to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection purposes. <br /> Applicant's Signature C Date ( } 1 to <br /> For your conveni nce chec lists detailing any additional submittal requirements for various building permit types <br /> are available at the 1 g Division counter. Demolition permit and mobile home on foundation require check-list. <br /> FAApplication Forms&HandoutsWANDOUTSNBuilding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br /> I <br />