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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 of Fo P 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: 1p,',,Q 900 Z2 0�fiC (alt 5 l LJ&")rP— Project Address: 2---r).+ F,)t2- ProjectValuation: Contact E-mail: -FWDi9&4,P-r@,rmul u1e1Asso,;&tesc 219, OWNER NAME ffAND ADDRESS APPLICANTNAMEAND ADDRESS A Name: ii r So VI LL Name: G2Y t i CSuO G Address: P. o 12 Address: 1725 50wi tt yyy�,•••1 fl La yt� City: G state: CA, city: �a fine � � state: Com. ZIP: y52 Ph#(71� ) tf54 -22-0 ZIP: J,,� ;Qj Ph#('� CONTRACTOR INFORMATION Ph#(,?0 9 -1' 3 �L $ l Lic. No: &p 9.0 / 9 Company Name: - A ,5 pGt+T-C-$, Address: ) 725- Sou v/L-rr Z44City: 5-F06kn-A,) st:(j} zip: 9S'9,t,,S- DESIGNER INFORMATION Ph#gn 33 y-233 Lic. No: eo #�&70 Company Name: ty(Ke SM(T �711CyiN� �F� Address: 4 /1)(}r-A y44k City: COG//� St: C4 ZIPYT.a ,l 0 LENDING AGENCY Company Name: St-4c6 r- DhwK Address: &o/d 6u cess p city: �� f�r v-yam St: C+ zip: 9S E�rr Permit will be issued to an "Owner-Builder' Yes❑ No X OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify to one of the following: I am [A a California licensed contractor or❑the property owner or❑ 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 permi Iication and the information I have provided is correct. I agree to comply with all applicab co ty ordinances state laws relating to building construction. I authorize representatives of this city or co y to nter the abo%!46tified propqqy for i ecTion purposes. Applicant's Signature Date 7 1 For your convenience checklists detai ' g any additioI s bmittal requirements for various building per/mit types are available at the Building Division counter. Demolit n ermit and mobile home on foundation require check- list. F Wpplication Forms&HandouWHANDOUTS\Building Permit Application.docPage 1 of 2 (Revised(07-08-10)