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BUILDING PERMIT APPLICATION <br /> 4 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> cqC v••'1y�C INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> +FOR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> ScopeofWork: N(OB)LE Home 6Ec:&/ lJDr3l�!L Pou c <br /> Project Address: 5&P W SN(�Vn O. &( Cli7q <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: CW7_A Ci-) R Name: <br /> Address: 19 _ (p n/. n 7���, d, Address: IAM e5 <br /> City: _Frcv�c. h q,v,? State: CFJ City: State: <br /> ZIP: C5Z 31 Ph#(ZL)?) 6, �1,l'-tp ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: z9 Yfo Company Name: L-�FC W)t-L-iAv, 5 <br /> Address: 1Z3Jr 3907k111l`Z-1At, City: N�av (O?WjI(_ St: CA ZIP: `J_ <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: }� A <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder' Yes ❑ No ❑ <br /> 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 or county to en er he abgve-identified property for inspection purposes. <br /> Applicant's Signature4G6�. / Date <br /> For your convenien checklists detailing any additional submittal requirements for various building permit types <br /> are available at the uilding Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:\Application Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />