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°` BUILDING PERMIT APPLICATION <br /> :. <br /> k <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ' : 1 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> i�ba 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: i✓-rx)C t-k <br /> Project Address: 2$cE 4Z TZ-�� CJS 777 <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: C.Lp wLWlf>,�-j Name: <br /> Address: $�� ej �1-�wWt�t tZ� Address: <br /> City:( State: Com- City: State: <br /> ZIP: gj27 Ph#(R2� 3'�i�-2Sg1 ZIP: Ph#( ) <br /> CONTRACTOR INFORMAT_iON Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. 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 eNo❑ 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 ❑ a California licensed contractor-or Hthe property owner or❑ authorized to act on the property owner's <br /> behalf(requires written approval and O-wner/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 purses, <br /> Applicant's Signature 6 '� _ Date -7 - 9-15 <br /> For your convenience checklists detailing 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-list. <br /> F 4Appltcation Forms&HandoutsU3ANDOUMBuilding Permit Application 1-2015.doc Page i of 2 <br /> (ReVisetl(01=28-15) <br />