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BUILDING PERMIT APPLICATION zr �" SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT (" $� 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209) 468-3121 INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 ��FOR THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR r BUILDING PERMITS. Scope of Work: gddi"I 1 on --p 1 e51 �I�Y 1CJ�. Project Address: I lDar7 sC)LL:th l and CL CA 1a rj�3(p Project Valuation: Contact E-mail:hi k andcl of l Q n. OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS nEt Name: �Qt F HcrFf Name: 0—he-4^ --I Address: Address: City: aVl �C� State: City: Man+eCOL— State: C ZIP: Q533(o Ph# ) _51 LL51ZIP: SJJ Ph ) CONTRACTOR INFORMATION Lic. No:�B 3, ( 3 Company Name: 1 S s1. � O Address: r7l `L4E.-10DpdL.0o,va Ay4 city: v, I sC(4ziP:Q53317 DESIGNER INFORMATION Ph ) a3 - Col 4 D Lic. No: Company Name: 613LrHo e� _—Dasiqrs Address: `H 31 G City:mcjva—beccL_ S<!14 ZIP: q53 LENDING AGENCY Ph#( Company Name: e__ Address: City: St: ZIP: Permit will be issued to an"Owner-Builder" Yes ❑ No OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my—gnsignature below, I certify to one of the following: I am Ma California licensed contractor or ❑the property owner or❑ authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit application and the information I have provided is correct. I agree to comply with all applicable county ordinances and state laws relating to building construction. I authorize representatives of this city or county to enter the above-identified property for inspection purposes. Applicant's SignatureDate a_ c)- For your convenience checklists tailing any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check- list. F:\Application Forms& Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 (Revised(07-08-10)