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BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br />BUSINESS PHO~:(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 FiOR <br />BUILDING PERMITS. <br />Scope of Work:~/.l.ldJ~1 .L./.AJ ;1 fl v11/}A~"-i:.e:«: <br />Project Address:f'f-f~r:(uJt2~~~""J.-?~/--../t:frZ {.:$-> <br />Project Valuation:#"~'1ContactE-mal : <br />OWNER NAME AND A~DRESS APPLICANT NAME AND ADDRESS <br />Name:~/~//~/~Q'Name:)1/Lu /~/.S L4A7_/'~ <br />Address:/.0 ~}-oCi 0 Address:-:r1 "fr O'JL--';-0 c::z e: <br />City:c»LI <-~State:(A r City:S~.-LJ~)State:~ <br />ZIP:9?'2-C,7-Ph#(tbq)q1>-3-5r:;;{(ZIP:q,::;.-~?:>;z-Ph#hc.q)li-7CZ .--/-d '!t-':r <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:!50 ?71 Company Name:/~~~ <br />Address:~0,DlAC 7-09 Y City::;S~~St:ZIP:'105 "~6 ;Z <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 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 Owner/Builder Verification Form signed and submitted), <br />- <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 ~~,Date ~I)-,1/ <br />For your convenience checklists detailing any additional submittal requirements for vkUSt:uilding 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 &HandoutslHANDOUTSIBuilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)