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BUILDING PERMIT APPLICATION 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 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work:CONV~/~r c/<..l-5r/"vC;::'/7"~-o~/3G£.10 '8Ior-PIC/35 Project Address:It!~/)/G 'S"r.Rr:?..6 Contact E-mail: OWNER NAME AND ADDRESS ~PLlCANT NAME AND ADDRESS Address::2 0 L,l2'o C.CoPP!E/<OPOu~'Address::2../0 .c:;UN V,q~v Crt City:1..J AlOE...N'State:CA-L..--;';::::t City:RI ;:::OH State:CA-L..I~o ZIP:'1~:i ~A Ph#()ZIP:9-s-a6 6 Ph#~):?99.3;t5"~ CONTRACTOR INFORMATION Ph#(.209 '5~CJ9"3~:>if 'I8~-/75"6 Lic.No:2..:3 4 3/0 Company Name:II£I<"mll-N'Co N5rdZ Address:~J 0 '5 U,II.I V/9LLE y Cr City:l?/po/V'Stell ZIP:9:1J8t66 DESIGNER INFORMATION Ph#(:2.0?47t3 ~~/3 Lic.NO:t:'Z03g4 Company Name:P5AAI -XJ~()IN DE'3/(7A1 Address:/1///AI.Pe~6/YlPI Av~City:g/~£.fJ1 St ZIP:'f5Z07 LENDING AGENCY I Ph#() Company Name: City:St ZIP:Address: OFFICIAL USE ONLYPermitwillbeissuedtoan"Owner-Builder"Yes D No If yes,a completed Owner-Builder Verification Form must be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. Identification Number: DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below,I certify to one of the following: I am D a California licensed contractor or D the property owner or D 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 i~correct. I agree to comply with all applicable county ordinances and state laws relating to building construction. representatives of this city or county to enter the above-identified property for inspection purposes. Applicant's Signature BLv<:JL G /~ I authorize Date -/-:2 tJ-/0~. For your convenience checklists detailing 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:IBUILDINGIHANDOUTSIBuilding Pennit Application.doc (Revised (07-22-09) Page 1 of 2