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°q4U" 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 /> -0t;FORP` INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THEAPPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: V 6 y,(A ✓Y1 e <br /> Project Address: f " I IC,i V Zu N <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: '} 'r�'f to E F n )J�y�' Name: \ IC <br /> Address: I t��n ZAddress: `f�lo � �J 7 <br /> City: 'j-bCaa l� State: `l f} "City: r (py State: e(�} <br /> ZIP_g,5,3491 Ph#(20J) V,7_ 7(DoZIP: r-j aJ c7 Ph#(�k <br /> CONTRACTOR INFORMATION Ph#00(7) G) = qo-7s-� <br /> Lic. No: So23� Company Name: �yq VG I tD T\ <br /> Address: cx City: � y�j Ste <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: (/1 <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder' Yes ❑ No ❑ 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 owners <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❑a California licensed contractor or❑ 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 applica/than and the information I have provided is correct. <br /> I agree to comply with all applicable co nfy ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or county enter th ove-identified property for inspection purposes- <br /> Applicant's Signature Date <br /> L- <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 /> FMpplication Fonns&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />