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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:c-ie;no 1111 or!v/at-rI--dul slelS <br />Project Address:::J.'/-.~0 0ny'(/fv IsaYJt'- <br />OWNER NAME AND AO£fRESS APPLICANT NAME AND ADDRESS <br />Name:Uev/}JV}/!ellw/r:-j Name:/)~Ie-JdI!Qy <br />Address:~O,&.x 1~?1 Address:,2~/S-S/ntfM h#e <br />City:Sfocl-l~t4 State:CA-City:j a rt('State:r""- <br />)'IJ<J-~3.3C ,)33'-/-139.s-ZIP:Ph#(ZIP:9,)-;'«2...Ph#( <br />CONTRACTOR INFORMATION Ph#() <br />Lie.No:c/a1SS)Company Name:/J,A,jd I/c-/4,4~c- <br />Address:2~(~.(f~(~ht',/h/le.Cit/)ftrf'St{A-ZIP:9s)"VL <br />DESIGNER INFORMATION Ph#() <br />Lie.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 0 No 0 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 fof/owing: <br />I am ~California licensed contractor or 0 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 §~unty to enter the above-identified property for inspection purposes._ <br />Applicant's Signature '::'',~fL}J.)l.by Date 7---'t-f- <br />For your convenience checklists detallVng 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\8uilding Permit Application.doc <br />(Revised 1-23-09)Page 1 of2