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~...../"'~'"//~". <br />BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENUE,STOCKTON CAI5205 <br />BUSINESS PHONE:(209)468-3121 <br />INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3185 <br />THE APPLICATION MUST BE COMPLETELY FIUED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Wor1<:NEW ~lst"ro CD\JEl21 ::t:£~C£.+e t .btCJ...DSE..1::>o'>~LK \\4 OOOlE.~ <br />Project Address:~2..~Co3 t""}fu ~T. <br />Project Valuation:20/{)O()O~Contact E-mail:A~C.~b~\~G-ZOCS@.'fA~CO\'t <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:\\t~~~-to'!:>TJ::...Name:\-\t.~R~"TC"SrA <br />Address:.2.0 GG2...8.b-10 -;r05~l2.P.Addra s:ZO(b~2-Sb~--;501;£~• <br />City:t~State:C~City:-nu...c.~State:CA.. <br />ZIP:q5~oLf Ph#{)ZIP:q5~4 Ph#{) <br />CONTRACTOR INFORMATION Ph#() <br />Uc.No:Company Name: <br />Address:City:st:ZIP: <br />DESIGNER INFORMATION Ph#(~f3ll )(92.0 -22oB <br />Uc.No:3S\t"\2...Company Name:t'D\Jp...~O ~l)S 1>--~~t...12.,"P.1Z.. <br />Address:80'0 :E...'R0ti.BLIC..~.City:~()t)~LO St:C~ZIP:q5~COo <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an MOwner-Builder"Yes IDo D OFFICIAL USE ONLY <br />If yes,a completed OWner-Builder Verification Form must Identification Number: <br />be signed and submitted along with copy of tha owner's <br />identification prior to issuance of the building permit. <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below,I cartify to ana of the following: <br />I am D •California licenaed contractor or D the property owner or D authorized to act on the property owner'a <br />behalf (Nqul ••••written approval and OWnerl8ullder Verification Form algned and .aubmltted). <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 anter the above-identified property for inspection purposes. <br />Applicant's Signature Date <br />For your convenience checkliata detailing any additional aubmlttal requirement.for varioua building permit typH <br />ant available at the Building Dlvi8ion counter.Demolition permit and mobile home on foundation ntquint check· <br />li8l <br />F:\Appilcalion Forma &Handou1II\HANDOUTS\Buildlng Permit AppIication.docPage 1 of 2 <br />(Re~aed(07~1Q)