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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:-W ~~tA£8 /1/J &'f.ltTlIV1:r /p!(l/5/Lt:../-kJ/J4e.- <br />Project Address:77'S?8"',HW~;L~~7lJ?/::.7VrJ c«.q~2..15 <br />~, <br />Project Valuation:Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:ALr/l6 J.)D CI'IIZO OA.J A Name:/!1lc-lI,f-5L ~~/7H <br />Address:7~'S""?g,tfWY.2~Address:A {).J$.b--/.~~)'-/ <br />City:!;TOUt.70N State:c».City:fl-(~/2..ai?)State:~/1. <br />ZIP:9~:J/5 Ph#(20.,)J{fl3 -8'3 D 5 ZIP:~SS~7'Ph#(;IJ"~2V-()2o.,t. <br />CONTRACTOR INFORMATION 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 :t'S Ph#() <br />t .c»; <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"yes)g No D ••.••J"..OFFICIAL USE ONL Y .c <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 />."r,l~{'.~:~:;',"DECLARATION BY CONSTRUCTION PERMIT ~PPLICAN.T .,_;~<~,~'":<10-·,.: <br />By my signature below,I certify to one of the following: <br />I am D a California licensed contractor or Mthe property owner or D 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 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 at/rdcJ CD~Date 4/l1J8cf1f <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\HANDOUTS\Suilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)