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BUILDING PERMIT APPLICATION <br /> t i 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 /> ��eoR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: !Yd t-' 0 v F 2 �boa )o "vAs f � '�� ' 2 6J A �r <br /> Project Address: i j (.�,g �� y V- <br /> Project Valuation: Z 2 k Contact E-mail: T 0 M �VQ Ab L. oM <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: reName: <br /> Address: _� C.a R Address: . ,�� u <br /> City: Q,` DLk , State: City: e�t_rrK � State: C A <br /> ZIP: $2iS Ph#(1r't4 ) •-(1b ZIP: <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: --------- <br /> - City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: __ _.._____ Company Name: ��tVv, t oc_ aFe< <br /> —22 <br /> Address: "*3v& 6 x . ca bl, /N City: <br /> C pck4_,U -- St: cp- ZIP;q520-,7 <br /> LENDING AGENCY Ph#(Jeq) ij any ft? <br /> Company Name: — > <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder' Yes® No ❑ 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 owners <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[N 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 ordinan es and state laws relating to building construction, I authorize <br /> representatives of this crEy r unt to er>Cer the a ve-identified property for inspection purposes. <br /> �t \ tf <br /> Applicant's Signature -- Date / 3 <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- <br /> list. <br /> HAppllcatlon Fonns&HandouWHANDDUTS\Building Pennit Appllcation.doaPage'I of <br /> (Revised(07-08-10) <br />