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BUILDING PERI\._r 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:~66 A.~\)€D 5t\€ET <br />Project Address:6\39<0 S.\"\\0'1 33.\~~c....J <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Address:30\1 ~"1-d·.~t>e..Address:\~O4-'5€I-l€"CA \JL.\ <br />City:tJ\M2.J€UP\State:~tt.City:~o~esl State:t <br />ZIP:C\535 ~Ph#() <br />CONTRACTOR INFORMATION <br />Lic.No:Company Name:U/A. <br />Address:St:ZIP: <br />DESIGNER INFORMATION <br />City: <br />Ph#( <br />Lic.No:Company Name:u/,.. <br />Address:St:ZIP: <br />LENDING AGENCY <br />City: <br />Ph#( <br />Address: <br />I <br />Company Name:~/tt. <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />City:St:ZIP: <br />OFFICIAL USE ONLY <br />Identification Number: <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 rg'the property owner or ~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 If.&AJIl J±1\Date~•...."'_2_0--,\c...:...\_ <br />For your convenience checklists ~etailing ta~ditional submittal requirements for various building permit types <br />are available at the Building Division count .Qlemolition permit and mobile home on foundation require check- <br />list. <br />F:\Application Forms &Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10) <br />\\OOCrZ