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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:lJe\J r~~1S'*j~C.t;c.M~Ab Dh.(€ <br />Project Address:IQgo3 E.f/wlf ~L;t1.&,ejl (Jq Q57.)G <br />Project Valuation:Contact E-mail:h D\;d eaJl/1 (i)')OttcoM I H ef <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:M 1 ~Z 0 \e-2c-~Name:r:,~cAPo lit 0)£11 ~""\ru cl/cJlIt <br />Address:,?,0 \(3 0 X '3 <1 Address:-/\0 I 13o )(127 <br />City:L,n ~e r'\State:c»City:L;n d p Yl State:C 14 <br />ZIP:q5Z3~Ph#(20~)Lj g z-()3Y 0,ZIP:052."3 b Ph#({01)4gz-:;62 b <br />CONTRACTOR INFORMATION Ph#(lv<1)If s L-56 z 6 <br />Lic.No:5 254 Lf S Company Name:Gidtvtl UYiS/IurtUJI'1 <br />Address:p,o .~0 y JR7 City:L i (I.rft€Y\St{/1 zlp:qs 2)cO <br />DESIGNER INFORMATION Ph#() <br />Lic.No:Company Name:CP;C c;tee(r3wld;rtCl-.S <br />Address:r.o.f3 6X I Do q City:L.4~flJ.f <br />oJ <br />StC)4 ZIP:qr;3?:>6 <br />LENDING AGENCY Ph#(W~)qR"~-O~(6 <br />Company Name:NIA , <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 following: <br />I am 0 a California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />behalf (requires written approval and OwnerlBuilder 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 or county to enter the above-identified property for inspection purposes. <br />Applicant's Signature TI~SJJ/I a~Date (~/"27/[( <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 />F:\Application Forms &Handouts\HANOOUTS\Building Permit Appiication.docPage 1 of 2 <br />(Revised (07-08-10)